In this, the earliest stage of periodontal disease, inflammation is limited to the gingiva (gums) surrounding the teeth. This condition is very easily treated and controlled. Most people, at some time in their lives, will have gingivitis even though it can be prevented with good oral hygiene.

What happens: As dental plaque accumulates 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, and may bleed easily when brushed or probed. These symptoms can easily be missed because there is usually no pain associated with them. 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 and should see your dentist. If you ignore these early signs, the condition may worsen.

Variations: Although the cause of gingivitis is bacteria in dental plaque, numerous factors can affect the disease process. For example, severe gingivitis can occur in adolescents as they go through puberty. In part, this is because certain types of harmful plaque bacteria grow very well in the presence of the extra hormones that surge through a young person's body at that time.

Smoking also affects the periodontal disease process. People who smoke are four to seven times more likely than nonsmokers to get periodontitis, and they 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 and slow the healing process after periodontal treatment.

People with diabetes also are more likely to develop periodontal disease and tend to suffer greater tooth loss than people without diabetes. Reasons for this enhanced risk may include diabetics' weakened immune system, which makes them more susceptible to infections, and their greater risk of poor circulation, which also is believed to contribute to the development of periodontitis. On the other hand, successfully treating periodontal disease may allow diabetes to be controlled more easily and with less medication.

Another, more serious form of gingivitis 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 causes rapid destruction of the triangles of gum tissue between the teeth (interdental papillae).

Adolescents, smokers and people with diabetes need to be particularly careful about their dental care. Other preventative measures include eating a healthy diet and making sure to get enough Vitamin C.

What can be done: The best remedy for gingivitis is meticulous attention to oral hygiene. Your dentist might want to do a careful and complete cleaning of the teeth, but the rest is up to you — brush regularly and 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 and could harm your gums. Regular dental visits will help ensure that the disease is caught at its earliest appearance, when it is most easily treated.