Gingivitis refers to inflammation of the gum of any cause. However, it is most often associated with plaque. Plaque is the soft, sticky bacterial deposit that readily forms on exposed surfaces of teeth. It is easily removed by brushing and flossing. It calcifies over time, forming tartar (calculus) which can only be removed by a dentist or dental hygienist using special instruments. Plaque results in a local inflammatory reaction, gingivitis.

Gingivitis is the mildest form of a spectrum disease and can progress to periodontal disease.

Presentation – in plaque-associated gingivitis, the gums become red, swell and bleed easily. There is usually little or no discomfort. The most important risk factors for this disease are:

• Ineffective oral hygiene
• Cigarette smoking
• Diabetes mellitus

Older individuals as well as immunocompromised patients are also at risk. It is extremely common, with some degree of the disease occurring in up to 90% of the adult population in the UK. It is estimated to affect a little over 40% of UK teenagers too.

Other causes of bleeding gums:

• Platelet disorders
• Vitamin C deficiency
• Vascular conditions
• Leukaemia
• HIV infection

Management – this condition should be managed by a dentist. However, in the interim, advise good oral hygiene (see ‘Oral healthcare’, below) and use of antiseptic mouthwashes (eg, chlorhexidine or hexetidine). This is also an opportunity to address the issue of smoking cessation, as this also contributes to periodontal disease.