Gum Symptoms

Gum inflammation (gingivitis): why does it happen, and how does it reverse?

The only stage of gum disease that can be reversed

Gingivitis is the earliest stage of gum disease, and one that can be fully reversed. It shows itself through redness, swelling and bleeding when you brush, and usually causes no pain. We explain when it is called gingivitis, which of the tools you use at home really work, the limits of mouthwash, and which signs are no longer gingivitis.

Short answer

Gingivitis is inflammation caused by bacterial plaque building up at the gum margin: the gum goes red, swells and bleeds when you brush, but the bone holding the tooth has not yet been affected. That is why it reverses. When plaque is cleaned off properly every day and hardened tartar is removed at the dentist, the gum returns to its former health. If it is not treated, it can stay the same for years or, in some people, progress to periodontitis, which destroys bone. A picture that is very painful, has open sores or comes with loose teeth is not simple gingivitis; see a dentist straight away.

Cause: Bacterial plaque building up at the gum margin
Main sign: Bleeding when you brush or floss
Does it reverse?: Yes, before bone loss begins
Most effective tool at home: Brush + interdental brush or floss

What gingivitis is, and where it ends

The medical name for gum inflammation is gingivitis. Healthy gums are pale pink and firm and fill the triangular space between the teeth; when pressed, no blood or pus comes out. In gingivitis, a red band forms along the gum margin, the triangles of gum between the teeth swell, and the slightest touch causes bleeding. According to MSD Manuals, there is usually no pain. The fact that the sign is silent is why most people think bleeding is normal.

The cause of almost all gingivitis is plaque: the soft layer of bacteria that sticks to the tooth surface anew every day. As long as plaque stays at the gum margin, the tissue reacts. Once it hardens with the minerals in saliva and turns into tartar, it no longer comes off with a brush and constantly feeds the inflammation. Crowded teeth, a filling or crown with an overhanging edge, food getting trapped between the teeth and a dry mouth all make it easier for plaque to build up.

There are also conditions that magnify the inflammation caused by plaque. Puberty, periods, pregnancy, the menopause and hormonal contraception can make the gum react more strongly to the same plaque. Diabetes, some blood disorders and some medicines also change the picture. These usually act not on their own but by making existing plaque inflammation more noticeable.

How gingivitis is defined matters too. In the international classification work carried out in 2017, a person is counted as a 'gingivitis case' if 10 per cent or more of the points measured with a probe bleed. If this proportion is between 10 and 30 per cent it is called localised gingivitis, and above 30 per cent generalised gingivitis. Bleeding at one or two points is not a diagnosis of disease in itself; the dentist decides by measuring this across the whole mouth.

What separates gingivitis from periodontitis is whether the tissue attaching the tooth to the bone, and the bone itself, have been lost. In gingivitis this attachment is in place. In periodontitis the inflammation goes deeper, the gum comes away from the root, a pocket forms and the bone is destroyed. MSD Manuals writes that gingivitis can clear up on its own, can stay superficial for years, or can sometimes progress to periodontitis. It is not possible to know in advance in whom it will progress; that is why gingivitis is not something to wait on but something to put right.

Gingivitis can also occur in a mouth that has had periodontitis before and been treated. In that case the bone loss belongs to the past, but the current inflammation is again only in the gum. The distinction is made with pocket measurements and X-rays.

Gingivitis is not contagious, but it cannot be considered separately from the balance of bacteria in the mouth. A lasting solution is less about getting over the inflammation once and more about setting up a routine in which plaque is removed again every day. The inflammation goes within weeks; keeping up that routine is a lifelong habit.

Does this picture point to simple gingivitis or something more serious?

The definite distinction is made by examination, pocket measurements and, if needed, X-rays. The signs below help you understand which way to look.

When it fits

Bleeding when you brush and floss, no painIf the bleeding happens only on contact, the gums are staying in place and the teeth are firm, the picture is most likely gingivitis.
The gum margin is red and puffyThe triangles between the teeth in particular are swollen, and the margin looks shiny and red. The thin, firm edge of healthy gum has gone.
It is concentrated where tartar can be seenThe inner surface of the lower front teeth and the cheek side of the upper molars are where tartar builds up most. The inflammation is usually most noticeable in these areas too.
It started in pregnancy or pubertyHormonal changes increase the gum's reaction to plaque. When plaque control is tightened, the picture improves; in pregnancy, dental check-ups should not be put off.

When it doesn't

The gums are very painful, the tips look like sores, and bad breath is noticeableA grey or yellow sore at the tips of the triangles between the teeth, marked pain and a smell suggest necrotising gum disease. This is not simple gingivitis. The NHS advises getting an urgent dental appointment if you have severely painful, swollen gums, sores in the mouth or red patches.
Teeth are loose or gaps are opening between themThis is a sign that the inflammation has reached the bone holding the tooth; it is no longer gingivitis, and periodontitis is considered.
Pus is coming from the gum, or there is swellingDischarge and localised swelling show there may be an abscess in a pocket or at the root of a tooth. It needs assessing the same day. If there is swelling spreading quickly in the face, difficulty swallowing or breathing, or swelling with a fever, call 112 or go to the nearest A&E.
The bleeding starts on its own, and there are bruises on the bodyBleeding that starts without brushing, bruising easily on the skin, tiredness and fever can point to blood disorders. MSD Manuals writes that gum symptoms can be the first finding in leukaemia. A doctor's examination and a blood count are needed without waiting, within the same week at the latest; tell your dentist too.

How gingivitis is treated

Treating gingivitis has two parts: the cleaning the dentist does and the cleaning you do every day. Without one, the other does not give a lasting result.

1
Examination and measurement
The dentist examines your gums, measures pocket depth if needed and looks at X-rays. The aim is to establish whether the inflammation has stayed in the gum or has reached the bone. This distinction changes the scope of treatment.
2
Tartar and plaque cleaning
Hardened tartar is cleaned off with hand instruments or an ultrasonic tip. MSD Manuals states that simple gingivitis is brought under control with proper oral care and professional cleaning. Bleeding during the clean is normal.
3
Correcting what holds plaque
If there is a filling with an overhanging edge, a crown that does not fit the tooth or a contact point where food gets trapped, it is corrected. If these stay, the inflammation comes back in the same area.
4
Being shown the right cleaning method for you
How to place the brush against the gum margin, and which interdental brush fits which gap, should be shown to you at the appointment. An interdental brush of the wrong size either does nothing or injures the gum.
5
Check-up
A few weeks later, the gums are assessed again. If the bleeding is still continuing, either there is an area that is not being reached or the problem has gone beyond gingivitis. In that case, deeper cleaning is discussed.

How well each tool at home works

Most of the comparisons below come from Cochrane reviews; the strength of the evidence varies from tool to tool.

Brushing twice a day with fluoride toothpaste

The basic step. The NHS recommends brushing at least twice a day with fluoride toothpaste and, after brushing, just spitting rather than rinsing your mouth with water. Hold the brush at an angle towards the gum margin and clean with small movements.

Rechargeable or electric toothbrush

A Cochrane review of 56 studies found that rechargeable brushes reduced plaque and gingivitis more than manual brushing in the short and long term. In the long term, the extra improvement in gingivitis is about 11 per cent. The review finds the clinical importance of this difference uncertain; a manual brush used properly also does the job.

Interdental brushes and floss

A toothbrush does not reach between the teeth. According to a Cochrane review, floss or interdental brushes may reduce gingivitis or plaque more than brushing alone; interdental brushes may be more effective than floss. The certainty of the evidence is low, but there is no other way to keep the spaces between the teeth healthy.

Water flossers and toothpicks

In the same review, water flossers showed an improvement in gingivitis at one month, but not at three and six months. For wooden toothpicks and rubber-tipped sticks, the evidence is limited and inconsistent.

Antiseptic mouthwash

Chlorhexidine markedly reduces plaque, its effect on gingivitis is small, and it causes staining. The NHS advises not using mouthwash straight after brushing. Leave the decision on long-term use to your dentist.

Common mistakes

The reason gingivitis does not reverse is usually the wrong tool or the wrong expectation.

Avoiding brushing the place that bleeds

The bleeding comes not from the brush but from the inflammation there. Leaving the bleeding area alone lets plaque build up there and makes the inflammation worse. Keep going with a soft brush, taking more care in that area.

Using mouthwash instead of brushing

In a Cochrane review, chlorhexidine mouthwash markedly reduced plaque, but the average improvement in gingivitis was small (0.21 points on a 0 to 3 scale) and staining of the teeth increased markedly. Changes in taste and a burning feeling in the mouth were also reported. Mouthwash is an aid, for as long as your dentist tells you.

Trying to treat it with home mixtures

Mixtures made with salt, turmeric or herbal oils do not lift plaque stuck to the tooth and do not remove hardened tartar at all. Even if they give a feeling of relief for a while, the cause of the inflammation stays in place.

Giving up care because the bleeding has decreased

Plaque forms again every day. If care slackens after the bleeding stops, the inflammation soon comes back.

No bleeding in people who smoke

Smoking narrows the blood vessels in the gums and can suppress bleeding. In these people, the absence of bleeding is not a sign of health; regular check-ups matter even more.

What healing looks like

The sequence below is a general framework. How long the inflammation takes to go depends on the amount of tartar and how regular your care at home is.

The first few days after cleaning
There may be tenderness in the gums and sensitivity to cold. Where tartar has been removed, it may feel as though gaps have opened between the teeth; that space is where the tartar used to be.
The first weeks
With regular brushing and cleaning between the teeth, the bleeding gradually decreases, the swelling goes down and the colour changes from dark red to pink. Bleeding in the first days of cleaning between the teeth shows the inflammation in that area, and it decreases as you keep going.
Check-up appointment
The dentist reassesses the bleeding points. If the bleeding continues, areas that are not being reached or a deep pocket are looked for.
In the long term
MSD Manuals recommends professional cleaning every six months to once a year for healthy people; for those with a general illness that makes them prone to gingivitis, this interval may be shorter. Your dentist sets the interval.

Don't wait if

The gums are very painful and there are sores at the tips. This suggests necrotising gum disease; an urgent dental appointment is needed.
There is swelling or discharge in the gum, or a fever. There may be an abscess, and you need to be seen the same day. If there is swelling spreading quickly in the face and neck, or difficulty breathing or swallowing, call 112.
Bleeding has gone on for weeks despite regular care. This means the problem has gone beyond gingivitis or there is a build-up of tartar that is not being reached. Ask for pocket measurements and X-rays.
Your teeth have started to move. This shows bone loss. The NHS advises an urgent dental appointment for loose teeth; an assessment for periodontitis is needed.

What determines the scope of treatment

Treatment for gingivitis is usually a limited procedure; the scope changes with these factors.

The amount of tartar: A small build-up of tartar is removed in one session; tartar that has built up over years may need more than one session.
Gingivitis or periodontitis: If pocket measurements show bone loss, treatment extends to cleaning inside the pockets; this is a different and more extensive procedure.
Fillings or crowns that need correcting: If there are overhanging edges that hold plaque, replacing them is a separate item.
Check-up interval: More frequent maintenance is planned for people who are prone to it.

Frequently asked questions

Does gingivitis clear up on its own?

It can, but not if there is hardened tartar. Tartar does not come off with a brush and constantly feeds the inflammation. Unless plaque control improves, the inflammation can go on for years or, in some people, progress to periodontitis.

Is gingivitis contagious?

No, gingivitis does not pass to someone else through kissing or drinking from the same glass. The inflammation is the person's reaction to the plaque in their own mouth.

Floss or interdental brushes?

According to a Cochrane review, interdental brushes may be more effective than floss. But if the gaps between the teeth are very narrow, a brush will not go in; floss is used in those gaps. Ask your dentist which size fits which gap.

Should I use mouthwash?

Mouthwash does not replace brushing and cleaning between the teeth. Chlorhexidine mouthwash reduces plaque but stains the teeth, and long-term use is the dentist's decision. Do not use mouthwash straight after brushing; it washes away the fluoride in the toothpaste.

Do salt water or herbal mixtures work?

They can be soothing, but they do not remove plaque and tartar. Because the cause of the inflammation stays in place, they do not provide a lasting solution.

Is gingivitis dangerous in pregnancy?

In pregnancy, hormonal changes increase the gum's reaction to plaque and bleeding becomes more frequent. The NHS particularly recommends regular dental check-ups in pregnancy; check-ups and cleaning are not put off. Your dentist plans which procedure is done at which stage.

How long does gingivitis take to clear up?

The time depends on the amount of tartar and how regular your care is. In Cochrane studies, the effect of the tools was usually measured over one to six months. If the bleeding does not decrease despite a few weeks of regular care, book a check-up appointment.

Can gingivitis also happen around my implants?

Around an implant, the same picture is called peri-implant mucositis: the gum becomes inflamed, but the bone is not yet affected. According to the 2017 international classification, the risk of bone loss around implants increases in people without regular plaque control and maintenance. If you are considering full-mouth or multiple implant treatment, bringing gum inflammation under control before treatment is part of the plan.

Sources

Send your X-ray and we will tell you which option is realistic for your tooth.

Get an assessment

Next step

Send your X-ray and we will talk through the options.

Share your CBCT or panoramic X-ray. We will write back within 24 hours on which option is realistic for your tooth.

Get an assessment