This is the earliest stage of periodontal disease. Inflammation is limited to the gingiva (gums) surrounding the teeth. This condition is very easily treated and controlled. It can actually be reversed. Most people have gingivitis at some time in their lives. However, it can be prevented with good oral hygiene.

What happens: As dental plaque builds up at the gumline, bacteria in the plaque release toxins. This causes irritation and inflammation of the gums.

Symptoms: Your gums become red and puffy around the teeth. They may bleed easily when brushed or probed. These symptoms can easily be missed because there is usually no pain. If you see blood in the foam when you spit out your toothpaste, or if you get minor bleeding if you use a toothpick or floss, chances are you have gingivitis. You should see your dentist. If you ignore these early signs, the condition may worsen.

Variations: The cause of gingivitis is bacteria in dental plaque. However, many factors can affect the disease process. For example, severe gingivitis can occur as children go through puberty. In part, this is because of hormones. The surge of extra hormones during puberty can help certain types of harmful plaque bacteria to grow.

Smoking also affects the periodontal disease process. People who smoke are four to seven times more likely than nonsmokers to get periodontitis. They also don't respond as well to treatment. It is not clear why smoking appears to contribute to periodontal disease. It may be because chemicals in tobacco interfere with blood flow to the gums. Reduced blood flow seems to speed the destruction of gum tissue. It also can slow the healing process after periodontal treatment.

People with diabetes also are more likely to develop periodontal disease. They tend to suffer greater tooth loss than people without diabetes. One reason may be diabetics' weakened immune system. This makes them more likely to get infections. They also have a greater risk of poor blood flow. This is believed to contribute to the development of periodontitis. On the other hand, periodontal treatment may allow diabetes to be controlled more easily and with less medicine.

Another form of gingivitis is more severe. It is seen most often between the ages of 16 and 30. Necrotizing ulcerative gingivitis (NUG) is associated with high levels of stress and poor oral hygiene. Smoking increases the risk of NUG, commonly called trench mouth. NUG appears suddenly. Symptoms include painful gums, bleeding gums, a metallic taste, bad breath and poor appetite. Unlike ordinary gingivitis, NUG rapidly destroys the triangles of gum tissue between the teeth. These are called interdental papillae.

Teenagers, smokers and people with diabetes need to be particularly careful about their dental care. It's also important to eat a healthy diet and get enough Vitamin C.

What can be done: The best remedy for gingivitis is very careful attention to brushing and flossing. Your dentist might want to do a careful and complete cleaning of the teeth, but the rest is up to you. Brush at least twice a day. Floss daily. Your dentist may give you special instructions about the proper way to brush and floss. This may feel like going back to dental kindergarten, but brushing and flossing the right way is a bit trickier than it seems. Just swiping back and forth with your toothbrush won't do the trick. It could even harm your gums. Regular dental visits will help ensure that the disease is caught as soon as it appears. That's when it is most easily treated.