Gingivitis is an inflammatory process limited to the mucosal epithelial tissue surrounding the cervical portion of the teeth and the alveolar processes. Gingivitis has been classified by clinical appearance (e.g., ulcerative, hemorrhagic, necrotizing, purulent), etiology (eg, drug-induced, hormonal, nutritional, infectious, plaque-induced), and duration (acute, chronic). The most common type of gingivitis is a chronic form induced by plaque.

Acute necrotizing ulcerative gingivitis (ANUG, i.e., trench mouth) is an acute infectious gingivitis. The term trench mouth was coined in World War I when ANUG was common among trench-bound soldiers.

Signs and symptoms
Because early-stage gum disease is seldom painful, you can have gingivitis without even knowing it. Often, though, you're likely to have warning signs such as:

• Swollen, soft, red gums.

• Gums that bleed easily, even if they're not sore. Many people first detect a change in their gums when they notice that the bristles of their toothbrush are pink - a sign that gums are bleeding with just slight pressure.

• A change in the color of your gums from a healthy pink to dusky red.

Sex:

• Gingivitis is slightly more prevalent in males than in females because females tend to have better oral hygiene.

Age:

• Adults are most commonly affected.

• Children from sub-Saharan regions of Africa may be at risk for ANUG because of poor living conditions.

Causes
Gingivitis begins with plaque. This invisible, sticky film, composed primarily of bacteria, forms on your teeth when starches and sugars in food interact with bacteria normally found in your mouth. Brushing your teeth removes plaque, but it re-forms quickly, usually within 24 hours.

Plaque that stays on your teeth longer than two or three days can harden under your gumline into tartar (calculus), a white substance that makes plaque more difficult to remove and that acts as a reservoir for bacteria. What's more, you usually can't get rid of tartar by brushing and flossing - you'll need a professional cleaning to remove it.

The longer plaque and tartar remain on your teeth, the more they irritate the gingiva, the part of your gum around the base of your teeth. In time, your gums become swollen and bleed easily.

Risk factors
Although anyone can develop gingivitis, many people first experience gum problems during puberty and then in varying degrees throughout life. The most common contributing factor is lack of proper oral hygiene, but other factors also can increase your risk, including:

• Diabetes: If you have diabetes, elevated blood sugar levels can damage many parts of your body - and your mouth is no exception. Diabetes increases your risk of cavities, gingivitis, tooth loss and a variety of infections. It also makes it more likely that you'll have a dry mouth, which further increases your risk of gum disease.

• Decreased immunity: If you have a weakened immune system, you're more susceptible to infections of all kinds, including gum infections.

Complications
Untreated gingivitis can progress to periodontitis, a much more serious form of gum disease. Periodontitis can cause tooth loss and may even increase your risk of heart attack and stroke.

Treatment
The first step is to thoroughly clean your teeth, removing all traces of plaque and tartar - a procedure known as scaling. The cleaning may be uncomfortable, especially if your gums are already sensitive or you have extensive plaque and tartar buildup.

Meticulous oral hygiene is necessary after professional tooth cleaning. The dentist or hygienist will demonstrate brushing and flossing techniques. Professional tooth cleaning in addition to brushing and flossing may be recommended twice per year or more frequently for severe cases. Antibacterial mouth rinses or other aids may be recommended in addition to frequent, careful, tooth brushing and flossing.

Prevention
The best way to prevent gingivitis is a program of good dental hygiene, one that you begin early and practice consistently throughout life. That means brushing your teeth at least twice daily - in the morning and before going to bed - and flossing at least once a day. Better yet, brush after every meal or snack or as your dentist recommends. Antiplaque or antitartar toothpastes or mouth rinses may be recommended by the dentist or dental hygienist.

Regular professional tooth cleaning is important to remove plaque that may develop even with careful brushing and flossing. Many dentists recommend having the teeth professionally cleaned at least every 6 months.