Gingivitis in Adults: Causes, Signs & Treatment

Evidence Based
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What is Gingivitis?

Gingivitis, also referred to as mild gum disease, is characterized as the inflammation of the gingiva (gums). In gingivitis, the damage is reversible and the supporting structures of teeth, such as bones, are not permanently lost.

Gingivitis is the earliest stage of periodontal disease (PD), which is a severe form of gum disease that develops from untreated gingivitis due to long-term plaque buildup. PD seriously damages the gums and bones, and surgery is typically the only treatment option for this disease.

teeth with plaque and red gums from gingivitis

The earlier your dentist catches gingivitis, the less likely periodontal disease will form or tooth loss will occur.

More than half of American adults are affected by gingivitis and the prevalence is even higher as people age. Children and teens are also at risk of developing gingivitis, especially during puberty.

Many people do not find out they had gingivitis until periodontal disease forms. This is because mild gum disease typically does not cause pain, show clear warning signs, or affect everyday life.

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“About 50 percent of adults aged 30 or older (65 million people) have signs of gum disease.”

How Gingivitis Forms

Stage 1 — As excess plaque builds up in the mouth, foreign bacteria and proteins are released. This causes an immediate response that results in the migration of inflammatory cells to the gingiva. These cells produce cytokines, which are small proteins that signal to other cells.

Stage 2 — Some of the activated cytokines cause dilated blood vessels, which means they become porous and leaky in the infected area (gingiva). Cytokines also tell other cells to create destructive proteins to help destroy bacterial cells. When these cells kill bacteria, they also damage healthy cells, which causes the tissues to break down.

Stage 3 — Blood cell leakage occurs in the gingiva, which causes redness and swelling. As a result, gingivitis forms.

Causes and Risk Factors

Gingivitis is the earliest stage of periodontal disease, also referred to as periodontitis. Many of the risk factors associated with both diseases are similar and preventable with lifestyle changes.

The primary causes of gingivitis include:

Smoking and Tobacco Use

Tobacco doesn't actually "cause" gum disease. However, it can contribute to it by causing dry mouth, which leads to more plaque buildup.

Smokers are seven times more likely to develop gum disease than non-smokers. Those who have never smoked tobacco have the lowest risk of developing gum disease.

Poor Oral Hygiene

Inconsistent brushing and flossing habits can cause gingivitis. Everyone should brush and floss twice a day to help prevent gum disease, cavities, and other oral health conditions.

Plaque Buildup

Gingivitis forms due to the long-term buildup of plaque, which is a sticky film that coats teeth and contains decay-causing bacteria. When plaque is not completely removed, the gums become inflamed and irritated over time.


Constant stress weakens the immune system and increases inflammation. High-stress levels, in combination with poor oral hygiene, are also linked to gum disease.

Hormonal Changes

Hormonal changes are linked to gum disease. Pregnant women are most at risk because extreme hormonal changes occur during pregnancy. Puberty, menopause, and menstruation also cause gum sensitivity and inflammation.

Roughly 60 to 75 percent of pregnant women develop gingivitis. Gum disease can also be transferred from mother to baby, which may lead to low birth weight or preterm birth.

Nutritional Deficiencies

Poor nutrition makes it difficult for the body to fight infection, which puts people at a higher risk of developing gum disease. The buildup of dental plaque is also more likely, especially when consuming sugary or processed foods long-term.

Medications and Diseases

Cancer, diabetes, and HIV make it difficult to fight off infections, including gum disease. Some prescription medications can also increase your risk of gum disease. These medications include blood pressure medications, heart disease medications, and immunosuppressants.

Dry Mouth

Dry mouth occurs when the salivary glands in the mouth do not produce enough saliva to keep the mouth wet. This condition is often a side effect of aging. Medications, radiation therapy, and mouth breathing can also lead to dry mouth, and eventually gum disease.

6 Warning Signs and Symptoms

Regular brushing, flossing, and professional teeth cleanings help prevent gingivitis, but there is still a possibility of formation even with proper oral care.

Common warning signs and symptoms of gingivitis formation include:

  1. Dark red or dusky red gums
  2. Puffy and tender gums
  3. Swollen gums
  4. Receding gums or a “gummy smile”
  5. Bleeding gums when brushing or flossing
  6. Bad breath throughout the day, even after brushing

Prevention and Treatment

The best way to prevent gingivitis and more severe gum diseases is by brushing and flossing regularly, using mouthwash, and visiting the dentist for professional teeth cleanings.

Since gingivitis is reversible, good oral hygiene is the best way to prevent the disease. There are three different outcomes for someone with gingivitis:

  1. If an individual’s oral health is restored during the early stages of gingivitis, including brushing, nutrition, flossing, and professional plaque removal, the disease can be reversed.
  2. Without changes to your oral care habits, gingivitis will become persistent.
  3. If left untreated, the disease results in periodontitis, a severe gum disease that is irreversible without surgery or invasive treatment.

Professional Teeth Cleanings

The reversal of early gingivitis is relatively simple and focuses on the removal of plaque during professional teeth cleanings. During treatment, a dentist or dental hygienist examines the patient’s teeth and cleans them with small instruments. These instruments remove plaque and tartar that a normal toothbrush cannot reach.

If the gingivitis hasn’t gotten worse, no further treatment is needed. Although, if periodontitis has formed, further treatment is necessary. This may include scaling and root planing, flap surgery, bone grafting, or gum grafting.

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“Gingivitis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 4 Aug. 2017,

National Institutes of Health (NIH). Periodontal (Gum) Disease: Causes, Symptoms, and Treatments. NIH Publication, 2013.

Kachlany, Scott C. Infectious Diseases of the Mouth. Chelsea House, 2007.

Updated on: September 1, 2020
Alyssa Hill
Medically Reviewed: September 11, 2019
Photo of Lara Coseo
Lara Coseo