OBJECTIVE: This study sought to determine the influence of sense of coherence (SOC), a personal stress-coping resource, and smoking on the self-reported gingival health of a cohort of rural black South African adolescents. METHODS: This 18-month study involved a three-wave survey of a representative sample of eighth graders from 11 randomly selected high schools in the Limpopo province, South Africa (n=970). Using a generalized estimating equation model, we examined the correlates of recent gingivitis, defined as self-reporting frequent gingival bleeding (GB). Explanatory variables included baseline socio-economic status, age, gender, plaque levels, toothbrushing frequency, tobacco use status and SOC levels. RESULTS: Among our sample, 74.6% reported experiencing gingivitis at some point during follow-up, while 41.9% reported frequent GB at the last survey. Factors that were positively associated with recent gingivitis include living in poor households [odds ratio (OR)=1.49; p<0.01], having higher plaque levels (OR=1.18; p=0.04) and smoking regularly (OR=1.57; p=0.04). Self-reporting gingivitis was negatively associated with being female (OR=0.76; p=0.02) and having a higher SOC (OR=0.96; p<0.001). CONCLUSIONS: Adolescent smoking and SOC levels are independent predictors of self-reported gingivitis. Therefore, in addition to plaque control, smoking prevention and the teaching of stress-coping skills may be important interventions for promoting adolescents' gingival health.