Gingivitis: Causes, symptoms and how to treat it

A small amount of blood in the sink after brushing your teeth. This is the sign that most people ignore for months, sometimes even years, before realising there is a problem. Gingivitis is the most common form of gum disease and probably one of the most underestimated. It is also the only stage of gum disease that can still be completely reversed, which makes early recognition particularly important.

What Is Gingivitis?

Gingivitis is inflammation of the gums caused by the accumulation of bacterial plaque along the gumline. It affects only the superficial tissues, without yet involving the bone or periodontal ligament that support the tooth. This is why it is reversible: once the cause is removed and good oral hygiene is restored, the gums can return to a healthy state.

This distinction determines everything that follows. As long as the inflammation remains superficial, there is no loss of support. Once it reaches the bone, complete recovery is no longer possible.

Most Common Causes

Bacterial Plaque

Bacterial plaque is a film that continuously forms on the teeth from bacteria naturally present in the mouth. When it is not removed every day, it accumulates along the gumline and triggers an inflammatory response in the tissues.

It does not take long. After just a few days of inadequate brushing in a particular area, signs of inflammation may already become visible.

Tartar

When plaque remains on the teeth, it mineralises and turns into tartar, a hard, rough deposit that can no longer be removed with a toothbrush.

Tartar acts as a surface on which further plaque can accumulate, making daily oral hygiene progressively less effective. At this stage, brushing alone is no longer enough and professional scaling is required.

We have already explained in another article on the blog what causes tartar to build up on the teeth and how it can be prevented.

Insufficient or Ineffective Brushing

Brushing twice a day does not, on its own, guarantee healthy gums. What matters is whether the toothbrush is actually reaching the right areas.

The areas most often missed are the inner surfaces of the lower teeth, the areas around the molars and, above all, the spaces between the teeth, which a toothbrush cannot reach.

This is where gingivitis begins in many cases, and it is also why dental floss or interdental brushes should not be regarded as optional extras.

Hormonal Changes

Pregnancy, puberty and the use of oral contraceptives can alter the way the gum tissues respond to bacterial plaque.

The same amount of plaque that might not cause noticeable symptoms at another stage of life can, during these periods, trigger clear inflammation. Pregnancy gingivitis is particularly common, especially from the second trimester onwards.

Smoking

Smoking can have a misleading effect in this context. It reduces the blood supply to the gums, meaning that they may bleed less even when inflammation is present and active.

As a result, many smokers only become aware of the problem once it has reached a more advanced stage, precisely because the most obvious warning sign has been suppressed.

Crowding and Poorly Positioned Teeth

Overlapping teeth create areas that are difficult to reach with a toothbrush and dental floss. Plaque accumulates in these spaces and inflammation develops much more easily than it would in a well-aligned dental arch.

This is one of the reasons why dental crowding can have consequences that go far beyond appearance, as we explained in our dedicated article on the subject.

Symptoms: How to Recognise Gingivitis

Bleeding When Brushing or Flossing

This is the most common symptom and also the one most frequently dismissed.

There is a common belief that gums bleed because the teeth have been brushed too forcefully. As a result, many people respond by brushing the affected area more gently or even avoiding it altogether.

This only makes the problem worse. Healthy gums do not bleed during normal brushing.

Red, Swollen or Shiny Gums

Healthy gums are pale pink, firm to the touch and fit closely around the teeth.

With gingivitis, they become redder, increase in volume and develop a smooth, shiny appearance, losing the characteristic stippled texture of healthy gum tissue.

Sensitivity and Discomfort

Pain is not always present. When it does occur, it tends to feel like a general discomfort when brushing or chewing harder foods rather than a sharp, localised pain.

In fact, the absence of pain is one of the reasons why gingivitis can go unnoticed for so long.

Persistent Bad Breath

The bacteria responsible for gum inflammation produce compounds with an unpleasant odour.

When bad breath persists despite careful oral hygiene, the source is often the gums rather than the stomach, as is commonly assumed.

Gingivitis or Periodontitis: What Is the Difference?

Gingivitis affects only the gums and is reversible. Periodontitis also involves the periodontal ligament and alveolar bone, and the resulting loss of support is largely permanent.

The transition from one condition to the other is not automatic and does not occur in everyone. Not every case of gingivitis progresses to periodontitis, but virtually all periodontitis begins as untreated gingivitis.

Individual susceptibility, genetics, smoking and conditions such as diabetes all influence this progression. We have written a dedicated article on periodontitis, where we explain in detail the signs that distinguish the more advanced stage from the initial one.

The key point is when treatment begins. Treating the condition at the gingivitis stage means restoring healthy tissue. Treating it once periodontitis has developed means trying to stop further loss after damage has already occurred.

Gingivitis During Pregnancy

Pregnancy gingivitis affects a significant proportion of pregnant women and results from the hormonal changes characteristic of this period, which amplify the inflammatory response to bacterial plaque. It is usually most noticeable between the second and eighth months of pregnancy.

This is not a reason to postpone dental care. On the contrary, oral hygiene appointments during pregnancy are safe and recommended, and controlling gum inflammation during this period has been associated with better maternal health outcomes.

Pregnant women should inform their dentist how far along they are so that the treatment plan can be adapted accordingly.

Gingivitis in Children and Teenagers

Gingivitis is more common than many people realise, particularly during adolescence, when hormonal changes often coincide with a period of less consistent oral hygiene.

In teenagers with fixed braces, the risk is higher because brackets and wires create multiple surfaces where plaque can accumulate.

In these cases, brushing technique needs to be adapted. We have already covered in detail in another article on the blog how to brush your teeth properly while wearing braces, including the use of interdental and orthodontic brushes.

How Is Gingivitis Treated?

Scaling

Treatment begins with the professional removal of plaque and tartar from above and around the gumline.

This procedure is carried out in the dental practice and, in cases of gingivitis, one appointment is often sufficient. For a few days afterwards, it is normal for the gums to continue bleeding slightly or to feel sensitive while the inflammation subsides.

Improving Your Oral Hygiene Technique at Home

Scaling removes the deposits that are already present. It does not prevent them from returning.

What determines the long-term result is what happens at home every day: brushing twice a day with a soft-bristled toothbrush using gentle movements from the gum towards the tooth, together with daily interdental cleaning using dental floss or an interdental brush, depending on the space available between the teeth.

Interdental brushes are often more effective than floss in wider spaces between the teeth, and the correct size should be selected with guidance from a dentist or dental hygienist.

Treating the Underlying Cause

When gingivitis keeps returning, it is worth looking for the underlying cause.

Significant crowding, restorations with excess material close to the gumline, mouth breathing or chronic dry mouth are all factors that can keep inflammation active despite good oral hygiene.

In these situations, addressing the underlying cause is what helps prevent the problem from recurring.

How Long Does Gingivitis Take to Clear Up?

Once plaque and tartar have been removed and good daily oral hygiene has been established, signs of inflammation usually improve visibly within around one to two weeks.

Complete resolution may take several weeks, depending on the initial extent of the inflammation and the individual response.

If bleeding remains unchanged after two to three weeks, further assessment is advisable. This may indicate that subgingival tartar remains, that the oral hygiene technique is not reaching the affected areas, or that the disease has progressed beyond the gums.

How to Prevent Gingivitis

Preventing gingivitis is relatively straightforward, but consistency matters more than intensity.

Brushing twice a day with fluoride toothpaste, cleaning between the teeth every day and attending professional oral hygiene appointments as frequently as recommended by the dentist are the main measures. For people with no history of gum disease, these appointments are usually recommended once or twice a year.

Diet also plays a role. A diet containing adequate amounts of vitamin C and low in rapidly absorbed sugars can help maintain healthier gum tissues.

In another article on the blog, we have brought together the foods that can help keep your gums healthy.

When to Book an Appointment

If your gums regularly bleed when you brush, appear swollen or have changed colour, it is advisable to arrange an assessment.

When gingivitis is treated early, it can resolve without lasting damage. The difference between taking action now and waiting another two years can be the difference between a straightforward scaling appointment and prolonged periodontal treatment.

During an assessment, it is possible to determine the stage of the inflammation, whether any loss of supporting tissue has already occurred and which changes to your oral hygiene routine may be appropriate for your particular situation.