Gum Disease Causes and Natural Treatments for Gingivitis
Gingivitis is the name for the early stage of gum disease, where your gums (or gingivae) become swollen, sore or infected.
Gum disease is incredibly common – according to the NHS, most adults in the UK have gum disease to some degree, and most people experience it at least once (i). Thankfully, however, gingivitis isn’t usually serious, and in most people it develops slowly. So if you keep it under control and stop it progressing by practising good oral hygiene, you shouldn’t be affected by any of the symptoms or complications that can come with the later stages of gum disease.
If you have mild gingivitis, however, you may not even realise it, as the symptoms can be hard to spot. Your gums may look a little swollen and more red than they should be, but these are often the only early signs.
Moderate gingivitis is when the symptoms become more noticeable. Your gums may bleed slightly when you brush your teeth, for instance, and they may look more swollen and reddened – but it’s still unlikely you’ll experience any discomfort at this stage.
If you don’t take steps to tackle the symptoms of moderate gingivitis, it can develop into severe gingivitis. The symptoms at this stage are more obvious, and include:
Swollen gums that bleed a lot when you brush your teeth and sometimes also when you’re eating.
Slight discomfort while brushing teeth (though this isn’t usually painful)
Are you at risk?
While most people have gum disease to some extent, certain factors can affect your risk of developing gum disease as well as how quickly the condition may progress, such as:
This has a big impact on the development of gum disease and may also affect how well you respond to treatment for gum disease.
People with poorly controlled diabetes have a greater-than-average risk of developing gum disease.
If you’re under a lot of stress for a prolonged period, it can affect your oral health. One of the reasons this happens is that people who are overwhelmed by stress may not look after their teeth and gums properly, or they may smoke or have a poor diet.
Changes in hormone levels can affect the gums, most notably during pregnancy. This is why good oral hygiene is important for pregnant women.
Some medicines can cause a problem called gingival hyperplasia, which is an overgrowth of gum tissue. These include medicines that suppress the immune system (used in transplant patients), medicines called calcium channel blockers (used to treat high blood pressure and other cardiovascular-related conditions) and medicines that treat seizures. If you have gingival overgrowth, it makes practising good oral hygiene difficult
A very small number of people develop a type of severe gingivitis called acute necrotising ulcerative gingivitis, which causes more serious symptoms such as:
Extremely swollen gums that are painful to touch
Receding gums between the teeth
Excess oral saliva
Those at most risk of developing acute ulcerative gingivitis are smokers with poor oral hygiene, people who have problems with their immune system and people who are under severe stress.
Meanwhile, untreated gingivitis can progress to the later stage of gum disease, called periodontitis, which – according to the World Health Organization – affects 10 - 15 per cent of adults worldwide (ii). This is more serious than gingivitis as it causes inflammation of the periodontal ligament, which attaches the tooth to the bone. Symptoms include bad breath, gum abscesses, loose teeth (and loss of teeth), receding gums and a bad taste in your mouth.
What causes gingivitis?
Gum disease can develop if you have a build-up of dental plaque on your teeth and gums. Dental plaque is a soft, sticky film made from bacteria that form on the surface of your teeth. You can actually feel this film when you haven’t brushed your teeth for a while (it has a fuzzy feeling on the tongue). The bacteria in plaque react with the sugars in the food you eat, which produces acid and other substances that can harm your oral health by irritating gum tissue and destroying tooth enamel.
If plaque isn’t removed regularly through tooth brushing it can become hard and turn into tartar. Also called calculus, this becomes attached much more firmly to your teeth than plaque and can only usually be removed by a dentist or a dental hygienist.
Because the bacteria in plaque and tartar release substances that can damage the gums, the body responds by diverting more blood to the affected area, causing redness and inflammation. In periodontitis, however, the immune system activates more powerful defence mechanisms, which cause more serious damage to periodontal tissues.
Complications of gum disease
Gum disease doesn’t just affect your oral health, it’s been linked with health conditions that affect other parts of your body too. According to the NHS, if you have gum disease you may have an increased risk of conditions such as stroke, diabetes, heart disease, heart attack and rheumatoid arthritis, as well as pregnancy problems and dementia (iii).
According to the Oral Health Foundation, more research is needed to understand how gum disease is linked with these conditions. However, it also says there’s an increasing amount of evidence to suggest having a healthy mouth and gums may help improve your overall health (iv).
If you suspect you have gingivitis the first thing you should do is visit your dentist for a check-up of your teeth and gums. Your dentist may remove any plaque or tartar from your teeth, or they may refer you to a dental hygienist for a scale and polish (a professional clean). You may also be shown how to remove plaque effectively yourself by establishing a good oral care routine at home.
Here are some tips to help you look after your teeth and gums yourself:
Brush your teeth twice a day for at least two minutes each time (this should happen last thing at night before bed and at one other time but not within an hour of eating).
Use either a manual or electric toothbrush – though according to the Dental Health Foundation, test show electric toothbrushes are more effective at removing plaque (v). If using a manual toothbrush, look for one with a small to medium-sized brush head with soft to medium multi-tufted, round-ended nylon bristles (it should be small enough to reach all parts of your mouth, including the back).
Replace your toothbrush every two or three months, or sooner if the bristles look worn or splayed.
Use a toothpaste that contains the right amount of fluoride, as it helps protect against tooth decay: adults and children over the age of three should use a toothpaste containing 1,340 - 1,500 parts per million (ppm) fluoride) and younger children should use a toothpaste with a fluoride level of 1,000ppm.
After brushing, spit out the toothpaste in your mouth rather than rinsing your mouth with water. This helps to keep some of the fluoride on your teeth, which means your teeth are protected for longer.
Clean between your teeth every day using dental floss, dental tape or interdental brushes. Your dentist or hygienist can show you how to use floss or interdental brushes, as well as recommend the best type for you (interdental brushes come in different sizes, so you need to know which size – or combination of sizes – is suitable). According to the National Institute for Health and Care Excellence (NICE), interdental brushes are more effective than dental floss or tape for most people with gum disease (vi).
Consider using a fluoride mouthwash too, as it can help prevent tooth decay. You may want to use it in the middle of the day rather than straight after brushing and flossing in the morning, as this can help remove any plaque that has built up since then – plus it gives you another ‘hit’ of fluoride. If you need help with controlling plaque or reducing gingivitis, you may need an antibacterial mouthwash – ask your dentist or dental hygienist for advice.
See your dentist for check-ups regularly, as often as they advise (at least once every one or two years).
If you need additional treatment for gum disease your dentist may recommend a procedure called root planing. This helps get rid of bacteria from under the gums and around the roots of your teeth. This can cause discomfort for up to 48 hours after having the treatment, and you may also need a local anaesthetic beforehand.
For more severe gum disease, you may be advised to have periodontal surgery. This can involve having plaque and tartar removed from the roots of your teeth after the edge of your gum has been cut and lifted away. You’ll have a local anaesthetic injection to numb the gum beforehand, and once the cleaning is finished you may have a few stitches in your gum to hold it back in place. Sometimes some of the gum is removed and reshaped, which can make it easier for you to clean your teeth and gums yourself.
After surgery you may need more appointments for cleaning with your dentist or hygienist, or if your gum disease is severe you may need to have one or more teeth taken out and a denture or bridge put in their place.
If you don’t treat gingivitis, however, and it progresses to periodontitis, your symptoms may become worse, your teeth may become painful and one or more may even fall out.
Can diet help?
Since the acids produced by plaque bacteria when they react with sugars in food are destructive to your gums as well as your teeth, there’s a strong relationship between diet and oral health. Indeed, your dentist may recommend that you cut down how much sugar you eat as well as how often you have sugary foods and drinks.
Here are some sugar-reducing tips you may find useful:
Try switching to a lower-sugar breakfast cereal – swapping a bowl of sugary breakfast cereal for plain cereal could reduce the sugar in your diet over a week by 70g. Try weaning yourself off sugary cereals gradually by mixing sugary and non-sugary cereal in the same bowl or add some chopped fresh fruit for sweetness.
Take care with condiments and sauces such as ketchup, as they can contain as much as half a teaspoon per serving (choose low-sugar versions or try to have them less often).
Stir-in sauces and ready meals can contain lots of sugar too – a third of an average-sized jar of pasta sauce can have more than 13g of sugar. Try to get into the habit of checking food labels before you buy and choose a sauce or meal with the least amount of sugar. Making your own meals and sauces from fresh ingredients – and no sugar – is preferable, if you have the time.
Give in to your chocolate cravings by having a lower-calorie instant chocolate drink, and swap biscuits for oatcakes, oat biscuits or unsalted rice cakes.
Substitute a slice of cake for a plain currant bun, a fruit scone or slice of malt loaf. And instead of ice cream, serve low-fat lower-sugar yoghurt.
Fruit juice may sound like a healthy alternative to sugary fizzy drinks, but juice can be high in sugar too. Restrict your juice intake to 150ml a day or less. Still water and milk are good choices if you’re thirsty, or you could try diluting fruit juice or sugar-free fruit drinks with water.
Also try to get into the habit of checking food labels for ‘hidden’ sugars – these are often ingredients that end in ‘ose’, such as sucrose, fructose and glucose. And remember that natural sweeteners – such as honey and agave syrup – are also forms of sugar, so aim to have these too in smaller amounts and less often.
It’s also worth noting that when a food label says ‘no added sugars’, it doesn’t mean there isn’t any sugar found naturally in the food in question, just that no sugar has been added to it.
So what should you eat?
Having healthy teeth and gums doesn’t mean you can never eat sugar again. The trick is to eat it at the right time. That means having sweet foods at mealtimes, rather than in snacking between meals, as snacking puts your teeth under constant attack by plaque acids.
If you need a snack, try to choose something savoury, such as cheese, raw vegetables or nuts. Cheese may be particularly beneficial, as it neutralises the acids in your mouth after eating (this is why dentists often recommend finishing a meal with a small cube of cheese). Still wanting something sweet, there are ways to quench that thirst for a sweet treat without a spoonful of sugar in sight. why not check out our recipes.
Another way to keep your teeth and gums healthy after eating or drinking is to chew sugar-free gum, as it can help your mouth produce more saliva to neutralise the acid in your mouth. Chewing gum that contains xylitol may be an even better option, as xylitol is thought to help reduce tooth decay.
Natural supplements for oral health
There are lots of ways you can prevent or slow down gingivitis, from having a good oral care routine to eating less sugar. But you may also be able to support your oral health by taking the following supplements:
High-strength multivitamin and mineral Eating a healthy balanced diet that provides a wide range of nutrients is important for all parts of your body, including your teeth and gums. So if you’re not eating as healthily as you should for any reason, it may be a good idea to make sure you’re not missing out on any essential nutrients by taking a good-quality multivitamin and mineral supplements. If you already have gum disease, look for a supplement that includes vitamin D and calcium, as researchers have found they may improve periodontitis (vii).
It may be best known for its immune system support, but vitamin C is thought to be important for your oral health too. For instance, researchers have found people with periodontitis have lower levels of vitamin C in their blood than those without gum disease (viii). Another study also found that vitamin C is found in lower-than-normal levels in people with periodontitis, particularly in those who smoke (ix).
You can get vitamin C in supplement form or by eating more vitamin C-rich foods such as citrus fruit, kiwifruit, tomatoes, berries, pineapple, broccoli, cabbage, spinach and potatoes. Vitamin C is also found in multivitamin and mineral supplements.
Researchers have discovered that acidophilus and other types of live bacteria may help boost oral health and reduce the symptoms of gum disease. In one study, for instance, school children given live bacteria daily were found to have significantly lower levels of plaque than others who weren’t given any live bacteria, with researchers suggesting live bacteria would help improve the oral health of children if included in their regular diet (x).
Scientists writing in the Swedish Dental Journal, meanwhile, have found a particular type of live bacteria called Lactobacillus reuteri may help reduce plaque as well as gum bleeding in people with moderate to severe gingivitis (xi).
Food sources of live bacteria include yoghurt, kefir, sauerkraut, miso and tempeh, but nutritional supplements that contain live bacteria are also popular.
Gingivitis may not be serious but if it isn’t controlled it can lead to more severe gum disease. This guide should help you start making the most of your oral health. For more information on a number of common health conditions, feel free to visit our health library.
Available online: https://www.nhs.uk/conditions/gum-disease
Available online: https://www.who.int/oral_health/publications/j_periodontol_76/ene
Available online: https://www.nhs.uk/live-well/healthy-body/health-risks-of-gum-disease
Available online: hhttps://www.dentalhealth.org/gum-disease
Available online: https://www.dentalhealth.org/caring-for-my-teeth
Available online: https://cks.nice.org.uk/gingivitis-and-periodontitis#!scenario
Perayil. I., et al. Influence of Vitamin D & Calcium Supplementation in the Management of Periodontitis. J Clin Diagn Res. (2015 Jun). ;9(6):ZC35-8. Available online: https://www.ncbi.nlm.nih.gov/pubmed/?term=.+Influence+of+Vitamin+D+%26+Calcium+Supplementation+in+the+Management+of+Periodontitis
Pussinen. P.J., et al. Periodontitis Is Associated with a Low Concentration of Vitamin C in Plasma. Clin Diagn Lab Immunol. (2003 Sep). 10(5): 897–902. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC193894
Borutta. A. Vitamin C intake and periodontal disease. British Dental Journal volume 199, page 210. (27 August 2005). Available online: https://www.nature.com/articles/4812616
Karuppaiah. R.M., et al. Evaluation of the efficacy of probiotics in plaque reduction and gingival health maintenance among school children – A Randomized Control Trial. J Int Oral Health. (2013 Oct). 5(5): 33–37. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3845282
Krasse. P., et al. Decreased gum bleeding and reduced gingivitis by the probiotic Lactobacillus reuteri. Swed Dent J. (2006). 30(2):55-60. Available online: https://www.ncbi.nlm.nih.gov/pubmed/16878680
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.