What Is the Gingival Index?

L. Baran

The gingival index is used in dental care to evaluate the extent of gum disease. A dental professional uses visual analysis to rate the gingival tissue surrounding each tooth on a scale of one to four, with four representing significant periodontal disease. This index can help dentists create a care plan for patients and explain the extent of gingival disease in an understandable manner. It can also be used to track the progress of dental treatment over time.

A one rating in the gingival index indicates normal gums.
A one rating in the gingival index indicates normal gums.

The gum tissue is probed with dental instruments to determine the extent of gingival bleeding. While some bleeding is typical during dental exams, significant bleeding can be indicative of gum disease. The dentist also takes into account the color and firmness of the gums. Red or purple gums indicate periodontal disease. Tender, soft gums can also be a sign of gingivitis.

Gum diseases, such as gingivitis, may cause bad breath.
Gum diseases, such as gingivitis, may cause bad breath.

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While the gingival index uses a scale from one to four, the difference between a rating of one and two and three and four is not the same. This makes the index somewhat subjective, and given values may vary slightly from professional to professional. The same dentist should perform the analysis during subsequent dental visits to ensure reliability.

The gingival index is used in dental care to evaluate the extent of gum disease.
The gingival index is used in dental care to evaluate the extent of gum disease.

The numbers from each gingival pocket can be averaged together to give an overall representation of gingival health. Many dentists use the gingival index at the beginning of a patient's first visit to get a concrete overview of that person's dental health and to provide a baseline for comparison during future visits. Analysis typically lasts approximately five minutes.

Hormonal changes experienced during pregnancy can worsen mild gingivitis.
Hormonal changes experienced during pregnancy can worsen mild gingivitis.

Each rating in the gingival index describes a particular state of gum health. A rating of one represents normal gums without any bleeding after probing or discoloration, while two indicates minor change in gum color and minor inflammation, but the absence of bleeding. Three represents moderate redness, swelling, and bleeding during probing. Four indicates moderate to severe inflammation and bleeding without pressure, significant color change to deep red or purple, severe inflammation, and possible ulceration.

Gingivitis, or gum disease, is a very common dental problem and has many causes. Signs of gingival disease include bleeding gums with daily brushing, red or purple gingiva, gum swelling, tenderness, and sores in the mouth. Known causes of gingivitis include diabetes, poor oral hygiene practices, illness, and pregnancy. It is possible to reverse or reduce the severity of periodontal disease. Regular, thorough dental cleanings, at-home flossing, mouthwash use and the realignment of teeth can all help to treat gingivitis.

Untreated gingivitis may cause the lymph nodes to swell.
Untreated gingivitis may cause the lymph nodes to swell.

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Discussion Comments


I am very concerned with my teeth as they have ended up costing me quite a bit (even with dental insurance) secondary to large fillings that I had put in when I was younger (I actually had one crown break apart and fall into my gum - it was the most slow and constant pain I have ever felt - I wanted to actually itch my gum).

Anyway, because of this over-concern I have for my teeth, I was uncomfortable when the dental hygienist started calling out numbers as she checked my teeth? my gums? to the other hygienist during my first visit to my new dentist.

So I had to ask what all the numbering was about. Luckily my numbers for what I now know is the gingival index and I think possibly a gingival index with a proper name such as the Loe and Silness gingival index came out well.

Thank you Loe and Silness for coming up with a way for me to further monitor my expensive teeth so they do not become any more expensive.


First I am going to sound like a typing advertisement for the vibrating toothbrushes but I have to say - they have changed my dental care and I have not had a cavity since and my gums feel better when I floss.

Just as @allenJo commented, maybe the vibration massages the gums making them healthy as well.

But really this is very lazy of me, but the reason the vibrating toothbrush works for me is that mine has a timer that beeps after ever thirty seconds and then the toothbrush turns off after the recommended two minutes of brushing!

My teeth have just never felt cleaner! Now if I could just get that flossing every day down.


@allenJo - I had some gingivitis too but I don’t think it had anything to do with poor dental hygiene. In my case, it had to do with some medication that I was taking.

It caused a condition called hyperplasia, which makes the gums inflamed and easily susceptible to bleeding. It went on for quite some time to the point where it was difficult to brush or floss because of the extreme sensitivity of my gums.

Finally I went to the doctor and had him switch my medication. The new drug causes dry mouth (like the old drug did) but it doesn’t produce any hyperplasia. It is so relieving to be able to brush and floss without pain and almost no bleeding.

Like you, I don’t know what my gingivitis index is, but I do know that the dentist was surprised at the difference in the health of my gums.


@SarahSon - Well, I regret to say that I developed gingivitis over the years. This was the result of poor brushing and flossing habits when I was younger.

I have since corrected those habits but still some bleeding remains. I don’t exactly know what my gingival bleeding index is, but I can hear the dentist calling out various numbers to his assistant when he prods and probes my teeth and gums. I guess that’s what he’s referring to.

One thing that I found which reduces bleeding is to massage your gums. Massaging the gums makes them more healthy and pink, and it also makes it easier to floss your teeth as well. The dentist recommends a pick to stimulate the gums as well.


My son went for about four years without seeing the dentist after he was out of high school. My dentist said this was quite common and they saw this often with this age of kids.

When he made that first appointment after that long, they did a thorough exam and took x-rays to get at good idea of what his periodontal status was.

He had to have the regular cleaning done, but surprisingly, his gingival index was not that bad. Other than a couple small cavities that had been there for a few years, he was able to get things back in shape with a couple of appointments.


When I was between jobs, I went for a few years without dental insurance. Since I was not having any problems, I just figured I would wait until I had insurance to see the dentist.

When I finally went to have my teeth cleaned, they could tell right away that I had not been there for awhile. I had to have two sessions to get all the plaque removed.

When they poked the gum tissue all around my mouth, I knew that my gingival index score would be very poor. I had quite a bit of bleeding with all that poking and realized that putting off that cleaning visit hadn't been such a good idea after all.

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