Gingivitis is a widespread oral health condition defined by inflammation of the gingival tissue. This inflammation, which often presents as redness, swelling, and bleeding during brushing, is primarily a response to the accumulation of bacterial biofilm, or plaque, along the gumline. Many people become frustrated when they believe they are taking appropriate measures, yet the persistent irritation does not resolve. Understanding why this inflammatory process continues requires looking beyond basic brushing to examine the mechanics of plaque removal, underlying health factors, and the possibility of disease progression.
Inadequate Oral Hygiene Practices
The most immediate cause of persistent gum inflammation is the mechanical failure to remove plaque. Many individuals rush through their routine, failing to meet the recommended two-minute duration for brushing, which allows bacterial colonies to remain undisturbed in certain areas. The technique itself is often flawed, with many using a vigorous, back-and-forth “sawing” motion that can irritate gums and miss the plaque lodged near the gumline.
The correct method involves aiming the soft-bristled toothbrush at a 45-degree angle toward the gums and using gentle, circular motions to disrupt the biofilm. Neglecting to floss daily means that up to 40% of the tooth surface is never cleaned, creating a constant source of bacterial toxins. To effectively scrape away plaque below the gum margin, the floss must be gently guided and curved into a “C” shape around the base of each tooth.
Using a worn-out toothbrush is another factor, as frayed or flattened bristles cannot effectively reach and clean the contours of the teeth and gums. Failures in technique or duration allow the plaque to mature and harden into calculus, or tartar, which home care tools cannot remove. This hardened deposit provides a rough surface that accelerates further plaque accumulation, sustaining the inflammatory cycle despite ongoing efforts.
Systemic Factors Impeding Healing
Even with diligent home care, systemic factors can prevent the gums from achieving a healed state. Chronic conditions like diabetes impair the body’s ability to fight infection and heal tissues, making individuals more susceptible to persistent gingival inflammation. Poorly controlled blood sugar levels can compromise the small blood vessels in the gums, reducing circulation and the delivery of immune cells necessary for resolving the infection.
Hormonal fluctuations influence gum response, which is why gingivitis can be more pronounced during pregnancy or menopause. The elevated hormone levels increase blood flow and sensitivity in the gums. Certain medications used to manage systemic conditions can also contribute to the problem, such as calcium channel blockers or anti-seizure drugs like phenytoin, which may cause overgrowth of the gum tissue, physically complicating plaque removal.
Other medications can reduce saliva flow, leading to dry mouth, which removes the natural washing and buffering mechanisms of saliva, allowing plaque to flourish more easily. Deficiencies of Vitamin C can compromise tissue integrity and impede the necessary repair processes in the gums. These systemic influences often require collaboration with a healthcare provider to manage the underlying condition alongside focused oral care.
When Gingivitis Has Progressed
The persistent inflammation may signal that the condition is no longer gingivitis but has progressed to a more destructive state. Gingivitis is reversible because the inflammation is contained to the soft gum tissue without damage to the underlying bone. However, if the bacterial infection remains unchecked, it can breach the barrier, leading to periodontitis.
Periodontitis is characterized by irreversible damage, including the loss of the ligament and alveolar bone that support the teeth. As the disease advances, the gums detach from the tooth surface, forming deep pockets that exceed the healthy depth of one to three millimeters. These pockets create an environment where home brushing and flossing cannot reach the bacteria and calculus, allowing the infection to perpetuate itself.
In some cases, the persistent symptoms may not be plaque-induced gingivitis, but rather a different type of infection or inflammatory condition. Specific fungal infections, such as oral thrush, or certain non-plaque-induced lesions can mimic the redness and swelling of gingivitis. A professional dental examination is necessary to differentiate between reversible inflammation, irreversible structural damage, or a distinct diagnosis that requires a specialized treatment approach.
Necessary Professional Interventions
When gingivitis fails to resolve despite improved home practices, professional intervention is required to remove the persistent irritants. The primary treatment is scaling, which involves a thorough cleaning to remove hardened calculus and bacterial toxins from both the tooth surfaces and beneath the gum line. If periodontitis is suspected, a deeper procedure called scaling and root planing is performed, which smooths the root surfaces to eliminate bacterial products and encourage the gums to reattach.
The dental professional may also prescribe antimicrobial agents to reduce the bacterial load that home care cannot manage. This can include antimicrobial mouth rinses, such as those containing chlorhexidine, used for short-term control of plaque and bacteria. For localized areas of persistent infection or deeper pockets, the hygienist or dentist may apply antibiotic gels or chips directly into the gum pocket. These professional treatments are designed to reset the oral environment, eliminating bacterial deposits that sustain the inflammation and creating a foundation for renewed home care efforts.