Improper oral hygiene that allows bacteria in plaque and calculus to remain on the teeth and infect the gums is the primary cause of gum disease. But there are other factors that increase the risk of developing gingivitis. Here are some of the most common risk factors:

• Smoking or chewing tobacco prevents the gum tissue from being able to heal.
• Crooked, rotated, or overlapping teeth create more areas for plaque and calculus to accumulate and are harder to keep clean.
• Hormonal changes in puberty, pregnancy, and menopause typically correlate with a rise in gingivitis. The increase in hormones causes the blood vessels in the gums to be more susceptible to bacterial and chemical attack. At puberty, the prevalence of gingivitis ranges between 70%-90%.
• Cancer and cancer treatment can make a person more susceptible to infection and increase the risk of gum disease.
• Alcohol negatively affects oral defense mechanisms.
• Stress impairs the body’s immune response to bacterial invasion.
• Mouth breathing can be harsh on the gums when they aren’t protected by the lips, causing chronic irritation and inflammation.
• Poor nutrition, such as a diet high in sugar and carbohydrates and low in water intake, will increase the formation of plaque. Also, a deficiency of important nutrients such as vitamin C will impair healing.
• Diabetes mellitus impairs circulation and the gums ability to heal.
• Medications such as antiseizure medications increase the risk for gum disease.
• Infrequent or no dental care
• Poor saliva production

The treatment goals for gingivitis are to identify and eliminate the factors that make the person more susceptible to gum disease. Most factors can be eliminated by establishing more consistent and thorough oral hygiene habits and professional dental cleanings. If there are certain risk factors such as smoking or uncontrolled diabetes that are contributing to the gum disease, they need to be addressed or eliminated to have success in reversing gingivitis. After the plaque and tartar are removed by a dentist or dental hygienist, the patient can usually eliminate gingivitis by brushing and flossing after every meal. Under the supervision of a dentist, a patient can use a prescription mouth rinse that specifically targets oral bacteria that cause gum disease. This is especially helpful in patients where conventional oral hygiene practices like brushing and flossing are impaired due to age or special needs.

In individuals where gingivitis has led to periodontal disease and there are deep pockets that are difficult to clean, the patient may require deep scaling and root planing to clean teeth that are surrounded by deep pockets. They may need surgical treatment to gain access to all the tooth surfaces for a more thorough cleaning. This surgical procedure is called flap surgery and can be combined with a pocket-reduction surgery to make the areas around the teeth easier for the patient to clean with brushing and flossing. This procedure consists of numbing the gums and then lifting them back to expose and clean the teeth and sometimes reshape the bone. The gums are then repositioned back around the teeth so there aren’t the deep pockets that existed before treatment.

Soft-tissue grafts cover up root surfaces exposed by receding gums. This can help eliminate sensitive teeth and protect the root surfaces that are softer and more difficult to clean.

Laser therapy is another treatment to help increase gum health. The gum pocket is treated with a soft-tissue laser to eliminate the harmful bacteria deep in the periodontal pockets, remove unhealthy tissue, and help stimulate healing.