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Healthy gums and connective tissue keep your teeth healthy and rooted in place. Swelling or bleeding of the gums may be symptoms of gingivitis. If you experience these issues, call a dentist before the condition evolves into a more serious gum disease. Learn more about the symptoms of gingivitis and how to treat it below.
What is gingivitis?
Gingivitis is swelling, redness, irritation, and bleeding of the gums. Called the gingivae, these gums are soft tissues that attach to and cover the necks of the teeth (and crowns of unerupted teeth). Along with deeper connective tissue, the gums help hold the teeth in place. Although symptoms may be mild, gingivitis is the first stage of gum disease (periodontal disease). Left untreated, gingivitis can evolve into more serious conditions and lead to tooth loss.
Gingivitis has many causes, but the most common cause is plaque build-up due to poor oral hygiene. Gingivitis can also be caused by infections, allergic reactions, poor nutrition, pregnancy, and certain types of drugs such as birth control pills, calcium channel blocker blood pressure medications, and the antiepileptic drug phenytoin.
Most gingivitis, however, results from plaque buildup. Dental plaque is a thin film that forms from food particles, saliva, and bacteria on the surface of teeth. Regular brushing of the teeth, flossing, and dental cleaning removes plaque and bacteria from the teeth. Poor dental hygiene, however, causes plaque to build up, harden into tartar, and creep up under the gums. When the immune system attacks bacteria colonies under the gums, this causes the swelling, redness, and irritation of the gums characteristic of gingivitis.
Left untreated, plaque builds up, separates the gums from the tooth, and creates gaps, or “pockets,” between the tooth and the gum tissues. As these pockets increase in size and the infection penetrates deeper tissues, gingivitis evolves into periodontitis, a serious condition that can ultimately lead to tooth and bone loss.
Gingivitis is one of the most common dental conditions in the world. Nearly 50% of adults aged 30 years and older have some form of periodontal disea, but it varies based on age, genetics, and lifestyle. Gingivitis is less common among young children and people with good dental hygiene. It is most common among adolescents and the elderly. While neglect and poor oral health are by far the major risk factors for gum disease, other risk factors include genetics, smoking, diabetes, pregnancy, crowded teeth, and dry mouth.
How is gingivitis diagnosed?
Gingivitis is primarily diagnosed by a visual examination of the gums. While gingivitis is primarily diagnosed and treated by dentists and dental hygienists, more severe cases may be referred to a periodontist, a specialist in gum disease.
Many patients have mild or no symptoms and may not realize they have a problem with their gums. Even if the symptoms are mild, patients should talk to a dental professional if they notice signs of gingivitis such as:
- Bleeding gums when brushing, flossing, or eating
- Bad breath that does not improve with brushing
- Swollen or receding gums
- Red gums
- Tender or sensitive gums
A dental professional diagnoses gingivitis based on the appearance of the gums and X-ray results. Early-stage gingivitis only affects the gingival tissue that lies between the teeth (the interdental papilla) while more severe gingivitis involves most of the gums overlying the crowns.
Lab tests are not necessary unless the dental professional suspects a more serious condition such as periodontitis.
Gingivitis treatment options
Gingivitis treatment focuses on reducing inflammation, removing plaque, and adopting good oral care habits to prevent plaque buildup. Antiseptics and antibiotics may be required to control bacteria growth on the teeth and under the gums.
Lifestyle changes
If medications or poor nutrition are causing gingivitis, the initial treatment involves stopping or changing the medications that are causing gingivitis, changing the diet, or prescribing supplements. Ask your doctor for advice on medications—do not stop or change medications on your own.
Oral hygiene
For all types of gingivitis, improving oral hygiene is a critical component of managing the condition. Teeth must be brushed and flossed regularly. The American Dental Association recommends brushing twice daily and flossing once daily.
Scaling and root planing (SRP)
In most cases, gingivitis is due to plaque buildup, so the first-line treatment is scaling and root planing, or deep cleaning. Scaling removes the plaque below the gum line, and root planing smooths out the root’s surface to allow gum tissues to reattach to the tooth.
Medications
After deep cleaning, the dentist may prescribe an antiseptic mouthwas, topical antibiotics or antiseptics. For more severe infections or periodontitis, a dentist may prescribe a short course of oral antibiotics.
Gingivitis medications
Prevention and treatment of gingivitis are founded on good oral hygiene with daily tooth brushing twice a day, mouth rinsing, and flossing to prevent or reduce plaque formation and bacteria. Severe cases may be treated with a short course of antibiotics.
Toothpastes and mouth rinses
The mainstays of gingivitis treatment are over-the-counter or prescription toothpastes or rinses containing antibacterial or anti-plaque agents. The fundamental role of brushing the teeth is to mechanically remove food particles, plaque, and bacteria from the tooth surface. Certain mouth rinses include ingredients that are effective at killing bacteria or preventing plaque buildup. For any mouth rinse to work effectively against bacteria, do not eat, drink, or brush the teeth 30 minutes after use.
Toothpastes and mouth rinses will contain one or more plaque- or bacteria-fighting ingredients including:
- Essential oils. Several essential oils including methyl salicylate (wintergreen), menthol, eucalyptol, and thymol are mildly effective at fighting bacteria or relieving swollen gums. One or more of these ingredients are often included in over-the-counter toothpastes (Listerine Essential Care) or mouth rinses (Listerine) They may be effective at preventing gingivitis or treating early-stage gingivitis in patients with good dental health and excellent daily oral hygiene habits.
- Stannous fluoride. Added to toothpastes (Parodontax, Crest Pro-Health, and Crest Gum Detoxify) and mouth rinses (3M ESPE PerioMed) to help prevent tooth decay, the tin (stannous) in stannous fluoride is also a potent antibacterial agent that significantly prevents or reduces gingivitis. Prescription toothpastes and mouth rinses deliver a higher concentration of stannous fluoride than over-the-counter formulations.
- Chlorhexidine. A potent antibacterial agent, chlorhexidine is used by surgeons to disinfect their skin before operations. Chlorhexidine mouth rinses (Colgate Periogard, 3M Peridex, and GUM Paroex) are considered the most effective bacteria-killing mouth rinse. Brushing removes chlorhexidine from the teeth, so tooth brushing should be avoided for at least 30 minutes after rinsing.
- Cetylpyridinium chloride. Found in toothpastes (Colgate TotalCare) and mouth rinses (Crest Pro-Health Mouthwash), cetylpyridinium chloride (CPC) effectively kills bacteria that form on plaques. It is considered less effective than chlorhexidine.
- Hydrogen peroxide. Another potent antiseptic, hydrogen peroxide is frequently added to toothpaste (Arm & Hammer PeroxiCare) as a tooth whitener and to mouth rinses (Colgate Peroxyl and Orajel For Mouth Sores) to treat mouth sores. Hydrogen peroxide helps prevent or treat gingivitis, so some dentists recommend hydrogen peroxide products as part of daily gum treatment.
- Delmopinol. Classified as a medical device rather than a drug, delmopinol mouth rinse (GUM PerioShield) inhibits plaque formation and prevents bacteria from attaching to and congregating on plaque surfaces.
Topical antibiotics
After scaling and root planing, dentists may apply topical antibiotics—gels, chips, strips, or mini-capsules—to the teeth, gums, or under the gums. Containing minocycline, doxycycline, tetracycline, or metronidazole, these topical drugs slowly release antibiotics over time to the tooth and gum tissues to control bacteria growth and reduce pocket depth.
Oral antibiotics
A dentist may prescribe oral antibiotics for severe periodontitis, but only very rarely for gingivitis. Unlike topical antibiotics, oral (systemic) antibiotics have potentially hazardous side effects and risk producing drug-resistant bacteria. The one exception is acute necrotizing ulcerative gingivitis (ANUG), a severe form of gingivitis that requires a regimen of one or more oral antibiotics.
What is the best medication for gingivitis?
The best treatment for gingivitis is deep cleaning and correct daily dental hygiene. Toothpastes and mouth rinses sometimes contain agents that effectively fight off bacteria, inhibit plaque formation, and relieve pain and swelling of the gums. However, many have side effects, such as tooth staining, so the “best” medication is the agent or drug that helps restore gum health with a minimum of unwanted side effects.
| Best medications for gingivitis | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Listerine | Mouth rinse with antibacterial agents | Topical | Gargle and rinse with 20 ml for 30 seconds in the morning and night | Dry mouth, bad taste, bad breath |
| Parodontax (stannous fluoride) | Toothpaste with a prophylactic agent | Topical | Brush teeth thoroughly after each meal at least twice per day (no more than 3 times daily) | Tooth staining, upset stomach, vomiting (rare and usually due to overdose) |
| Periogard (chlorhexidine) | Mouth rinse with an antiseptic agent | Topical | Rinse the mouth with 15 ml of undiluted Periogard for 30 seconds twice daily; no eating, drinking, or tooth brushing for 30 minutes after rinsing | Tooth staining, calculus formation, unusual taste sensations |
| Crest Pro-Health (cetylpyridinium chloride) | Mouth rinse with an antiseptic agent | Topical | Rinse with 20 ml for 30 seconds after brushing and flossing; use twice daily | Tooth staining, calculus formation, temporary taste alteration |
| Peroxyl (hydrogen peroxide) | Mouth rinse with an antiseptic agent | Topical | Rinse up to four times a day with one-half capful for one minute and then spit out | Irritation, redness, pain |
| Perioshield (delmopinol) | Mouth rinse with an antiplaque agent | Topical | Rinse the mouth with 10 ml for 30 seconds and then spit out; use twice daily; no eating, drinking, or tooth brushing for 30 minutes after rinsing | Tingling, numbness, gum irritation |
| Arestin (minocycline) | Antibiotic | Topical | Inserted below the gums into a gingival pocket using a cartridge injector | Periodontitis, tooth problems, pain |
| Atridox (doxycycline) | Antibiotic | Topical | Dose depends on the size of the pocket. Administered via syringe directly into the pocket and then covered with periodontal dressing | Gum discomfort, toothache, periodontal abscess |
The standard dosages above are from the U.S. Food and Drug Administration (FDA) and the National Institute of Health (NIH). Dosage is determined by your doctor based on your medical condition, response to treatment, age, weight and individual formulations may vary; check label before use. Other possible side effects exist. This is not a complete list.
What are the common side effects of gingivitis medication?
All medications may produce side effects, and side effects will vary depending on the type of medication. Fortunately, most medications that treat gingivitis have minor and rarely-experienced side effects. However, this is not a complete list of possible side effects, so consult with a dental professional about any concerns or questions you may have regarding side effects or possible drug interactions.
Over-the-counter medicated toothpastes, mouth rinses, and mouth sprays are very safe provided they are used as directed. Remember: toothpastes and mouth rinses are never meant to be ingested.
The most common side effects of anti-gingivitis agents are mouth irritation, inflammation, dry mouth, and unusual tastes. Some agents, such as cetylpyridinium chloride and stannous fluoride stain the teeth. Some, such as chlorhexidine and hydrogen peroxide, can cause chemical burns if overused. Serious side effects are possible if these substances are swallowed in large quantities.
As of early 2019, triclosan-containing toothpaste is no longer commercially available in the United States due to its association with causing osteoporosis in women.
Topical antibiotics used to treat gingivitis rarely cause side effects. The most common are headache, flu symptoms, infection, and mouth sores. Allergic reactions are possible and can be severe. Ask your dentist about possible side effects.
Oral antibiotics are only very rarely used for gingivitis and only for very serious cases involving sores and tissue death. The most common side effects involve the digestive tract: diarrhea, nausea, vomiting, abdominal pain, and constipation. The most serious side effects are potentially life-threatening allergic reactions.
What is the best home remedy for gingivitis?
In its earliest stages, gingivitis can be effectively treated at home with tooth brushing, flossing, and any number of over-the-counter or home mouth rinses. However, when bacteria have penetrated more than a few millimeters below the gums, professional dental care is required. However, home remedies are essential for guaranteeing the long-term success of any gingivitis treatment.
Brush your teeth
The simplest, most effective, and mandatory treatment for gingivitis is to brush your teeth for two minutes twice per day. Your dentist can show you the proper type of toothbrush to use and how to correctly brush your teeth. Many dentists recommend an electric toothbrush for better results.
Floss daily
You should only floss the teeth you want to keep. If you want to keep every one of your teeth, then floss between every tooth daily. Again, your dentist can show you the correct way to floss your teeth.
Use antibacterial toothpastes
Most over-the-counter toothpastes are formulated to prevent cavities and whiten teeth. Choose a toothpaste with antibacterial ingredients. Be careful. Some of these ingredients, such as stannous fluoride, can stain the teeth. Some, like chlorhexidine, are not effective in toothpastes. Others may have concentrations too low to do anything. Talk to your dentist for the antibacterial toothpaste that’s right for your situation.
Visit a dentist
Bi-annual checkups and professional cleaning go a long way in preventing gingivitis and other gum problems.
Avoid risk factors
There are habits such as smoking, a bad diet, a high sugar diet, and medications that may contribute to gingivitis. A few lifestyle changes may make the condition easier to avoid. Ask your doctor if any of your medications could be contributing to gum problems.
Frequently asked questions about gingivitis
Is gingivitis curable?
Gingivitis is usually curable. Early-stage gingivitis can be cured by improving daily oral hygiene habits. Later-stage gingivitis is often reversed with periodontic (gum) deep cleaning by a dentist or dental hygienist.
Can you reverse gingivitis?
Gingivitis is reversible through good oral hygiene, lifestyle changes, and, in more advanced cases, with periodontal therapy involving the removal of plaque below the gum lines.
Can you get rid of gingivitis on your own?
Early-stage gingivitis can be reversed by correctly brushing and flossing one’s teeth daily. Later-stage gingivitis will require professional dental care to remove plaque and bacteria deep below the gum’s tissues.
How can I get rid of gingivitis fast?
The most effective treatment for gingivitis is a dental professional removing plaque buildup below the gum line, called periodontal treatment. Swelling, redness, and gum tenderness caused by gingivitis typically resolves in 10 to 14 days after treatment.
How do dentists treat gingivitis?
Dentists treat gingivitis by removing plaque deep within the gum tissues. Scaling is a process by which they remove the plaque on the tooth below the gum line using a pick-like instrument. Scaling is followed by root planing. The dentist or a dental hygienist smooths the surface of the tooth under the gum line to make it easier for the gum tissue to re-attach to the tooth. The dentist may place slow-release topical antibiotics under the gums or between the teeth to control bacteria while the gum tissue heals.
How long does it take to get rid of gingivitis?
Early-stage gingivitis typically clears up in two weeks with proper oral hygiene. Later-stage gingivitis will require deep cleaning to remove plaque under the gums. Most patients will be symptom-free within 10 to 14 days after a deep cleaning, provided you keep up with oral hygiene at home.
What is the best treatment for gingivitis?
The most universal treatment for gingivitis is correct daily oral hygiene: brushing the teeth for two minutes twice a day and flossing the teeth once per day. Late-stage gingivitis, however, can only be treated by a dentist removing plaque from below the gum line.
What medications can cause dental problems?
Gingivitis can be caused by hormones (birth control and menopause medications), calcium channel blockers (for heart problems and high blood pressure), anticoagulants, some types of antiviral drugs, and the antiepileptic drug phenytoin.
What is the best antibiotic for a gum infection?
The most common antibiotics used for gum infections are tetracyclines (like minocycline or doxycycline), amoxicillin, clindamycin, metronidazole, ciprofloxacin, and azithromycin. Because of side effects and the risk of producing drug-resistant bacteria, most are only used for severe gum infections. When antibiotics are used for gingivitis, they are used topically following a deep cleaning procedure.
Related resources for gingivitis
- A wash worth its while? Harvard Health Letter
- Gingivitis. StatPearls
- Oral Health Conditions. Centers for Disease Control and Prevention (CDC)
- Peroxide Use in Dentistry: Is It Safe for Oral Care? Today’s RDH
- Scaling and Root Planing. MouthHealthy (American Dental Association).