Common causes and risk factors of gingivitis

Gingivitis is the mildest form of gum disease that most commonly occurs when bacteria in plaque (a sticky, colorless film that forms constantly in the mouth) builds up for a sustained period of time along and below the gumline. Accumulated plaque bacteria secrete toxins that irritate and inflame the gum tissue above where it attaches to the tooth. If plaque is left long enough, it can cause gum deterioration and more serious complications, like bone loss from around the tooth (periodontitis) and eventual tooth loss.

Gingivitis can occur at any age and throughout one’s lifetime.¹ Discovered early it may be minor problem  i.e. “incipient gingivitis”, or, if ignored, it may become more extensive and severe. Gingivitis can occur at localized sites around a single tooth or involve many or all teeth.

Gingivitis is reversible. It can be controlled and treated with good oral hygiene and regular professional cleaning. Your dentist or hygienist can identify gingivitis early on and provide you with the knowledge you need to efficiently remove plaque on an ongoing basis and prevent any further problem.

You can prevent gingivitis by staying on top of your oral hygiene and being aware of the common causes and risk factors of this mild form of gum disease.

Gingivitis causes and risk factors

Certain local and systemic factors can increase your risk for gingivitis and affect the severity and extent of the problem, should it occur. If any of these factors apply to you, we recommend speaking with your dentist about the extra measures you can take to protect your mouth and keep it healthy²:

• Poor oral hygiene – Inconsistent or irregular brushing or flossing or consistently missing the same areas of the mouth allow plaque to accumulate. Factors like crooked teeth, rough or defective fillings, or extensive dental work can make it more difficult to effectively maintain good oral hygiene.
• Formation of tartar/calculus – The minerals in your saliva can eventually harden accumulated plaque into tartar (also called calculus), a rough-surfaced substance that brushing alone cannot remove.³ Tartar allows more plaque build-up, further irritating the gums.
• Dry mouth – A consistent lack of saliva can lead to an increased build-up of plaque.
• Smoking/tobacco use – Smoking has profound effects on gingival tissues. Research shows that smokers have twice the risk for gum disease when compared to a nonsmoker.^4,5,6
• Systemic diseases and conditions – Certain diseases like diabetes, leukemia, cancer, and HIV hinder your body’s ability to battle infection, including gum disease. Let your dentist know if you have any preexisting medical conditions.
• Hormonal shifts – Puberty, menstruation, pregnancy, menopause, oral contraceptives and other hormonal changes can cause increased sensitivity in your gums. During these periods, it’s extra important to take care of your teeth.
• Stress – High levels of stress can weaken the immune system and impair your ability to fight off infection, including gum disease.
• Poor nutrition – An unbalanced diet deprives your body of vital nutrients and makes it more difficult for your body to ward off infections like gum disease. Be sure to consume the foods and nutrients your body needs to stay healthy.
• Medications – Certain medications and drugs, such as steroids and oral contraceptives, could make you more prone to gum disease. It’s important to be transparent with your dentist or hygienist about any prescription and over the counter medications, or recreational drugs you take.
• Age –Older people have higher rates of periodontal disease. The Centers for Disease Control and Prevention reports that more than 70% of Americans over age 70 have some level of periodontal disease. To keep your teeth for a lifetime, you must maintain a high level of at-home care and continue to see your dentist regularly for exams and cleanings.
• Genetics – Studies show some people are more susceptible to developing gum disease.  If, despite your best efforts at home, you still are having gum problems, make sure that you see your dentist regularly, perhaps two or more times per year, and take action to reduce other risk factors.
• Gum lesions– Though less common than the factors listed above, gum lesions may be made worse by the existence of plaque even though they are not directly caused by dental bacterial plaque.
  • These lesions usually don’t get better even after plaque is removed.
  • These types of lesions can be caused by trauma, genetic or systemic conditions, viruses, fungi or non-typical plaque bacteria, allergic or autoimmune conditions, nutritional deficiencies, and other conditions.⁶

Final thoughts

It’s natural to have some level of plaque on your teeth. However, when this plaque remains undisturbed for days or weeks at a time, signs and symptoms of gingivitis may occur. Gingivitis is often a warning that more serious periodontitis may occur unless you take action to improve your gum health. If you are worried that you may have gingivitis, know that it can easily be treated, reversed, and prevented on your own or with the help of your dentist or hygienist.  

Early diagnosis and care are key in successfully keeping your teeth and gums healthy for a lifetime. To prevent gingivitis and periodontitis, regularly brush and floss your teeth; if you smoke -stop; eat a healthy, balanced diet; and check in with your dentist and hygienist for regular exams, cleanings and oral care advice. Know your risk factors for gum diseases and be sure to reach out to your dentist if you have any concerns.

Additional resources

Looking for more information? Learn more about general oral health:

• Preventing gum disease for overall health
• Gingivitis diagnosis and treatment
• Gingivitis signs and symptoms

Sources

Pari A, Llango P, Subbareddy V. et.al. Gingival Diseases in Childhood – A Review. J Clin Diagn Res. 2014 Oct; 8(10): ZE01–ZE04.

Murakami S, Mealey BL, Marioti A, Chapple ILC. Dental plaque–induced gingival conditions. JPeriodontol. 2018;89(Suppl 1):S17–S27. https://aap.onlinelibrary.wiley.com/doi/full/10.1002/JPER.17-0095

NIH. “Periodontal (Gum) Disease - Causes, Symptoms, and Treatments.” National Institute of Dental and Craniofacial Research, 2013, www.nidcr.nih.gov/sites/default/files/2017-09/periodontal-disease_0.pdf.

Eke PI, Dye BA, Wei L, et al. Prevalence of Periodontitis in Adults in the United States: 2009 and 2010. Journal of Dental Research 2012; 91(10):914–20

CDC. “Smoking, Gum Disease, and Tooth Loss.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 23 Mar. 2020, www.cdc.gov/tobacco/campaign/tips/diseases/periodontal-gum-disease.html#one.

Chapple ILC, Mealey BL, Van Dyke TE. Et.al. Periodontal health and gingival diseases and conditions on an intact and reduced periodontium: Consensus report of Workshop 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions. Periodontal. 2018;89(Suppl 1):S74–S84.