Gum Disease

Gum disease, also known as periodontal disease, is an infection of the tissues that support and surround your teeth. It ranges from simple gum inflammation (gingivitis) to serious disease resulting in major damage to the soft tissue and bone supporting teeth.

Overview

Gum disease is one of the most common oral health problems worldwide, affecting millions of adults. It's a progressive condition that begins with bacterial growth in your mouth and may end with tooth loss due to destruction of the tissue that surrounds your teeth. The disease occurs when bacteria in plaque build up between the gums and teeth.

There are two main stages of gum disease: gingivitis and periodontitis. Gingivitis is the milder and reversible form, characterized by red, swollen gums that bleed easily. When gingivitis is left untreated, it can advance to periodontitis, where the inner layer of the gum and bone pull away from the teeth and form pockets that can become infected.

The good news is that gum disease is largely preventable through good oral hygiene practices. Regular brushing, flossing, and professional dental cleanings can help prevent, stop, or reverse gum disease in its early stages. Understanding the signs, symptoms, and risk factors is crucial for maintaining healthy gums and teeth throughout life.

Symptoms

The symptoms of gum disease can vary depending on the stage and severity of the condition. In the early stages, symptoms may be subtle or even absent, which is why regular dental check-ups are essential for early detection. As the disease progresses, symptoms become more noticeable and potentially painful.

Common Symptoms

  • Bleeding gums - Especially during brushing or flossing, often the first sign of gum disease
  • Gum pain or pain in gums - Tenderness or discomfort when touching or applying pressure
  • Toothache - Pain in teeth, especially when chewing or biting
  • Facial pain - Discomfort that can radiate from infected gums
  • Mouth ulcer - Sores that may develop in advanced cases
  • Jaw swelling - Inflammation that extends beyond the gums
  • Lip swelling - May occur with severe infections

Less Common Symptoms

  • Ear pain - Referred pain from jaw and dental infections
  • Fever - May indicate a severe infection or abscess
  • Peripheral edema - Swelling in face and neck area
  • Bad breath (halitosis) that doesn't go away
  • Receding gums making teeth appear longer
  • Formation of deep pockets between teeth and gums
  • Loose or shifting teeth
  • Changes in bite or the way teeth fit together
  • Pus between teeth and gums

It's important to note that gum disease can progress painlessly, producing few obvious signs even in late stages. This makes regular dental examinations crucial for early detection and treatment. Some people may have gum disease only around certain teeth, such as the molars, rather than throughout the mouth.

Causes

Gum disease is primarily caused by the bacteria in plaque, a sticky, colorless film that constantly forms on your teeth. However, several factors and conditions can contribute to the development and progression of periodontal disease.

Primary Causes

  • Bacterial plaque: The main cause of gum disease, containing bacteria that produce toxins irritating the gums
  • Poor oral hygiene: Inadequate brushing and flossing allows plaque to build up and harden into tartar
  • Tartar formation: Hardened plaque that can only be removed by professional cleaning
  • Bacterial infection: Specific bacteria like Porphyromonas gingivalis and Treponema denticola

Contributing Factors

  • Smoking or tobacco use: One of the most significant risk factors for gum disease development and treatment failure
  • Hormonal changes: During pregnancy, puberty, menopause, and monthly menstruation
  • Diabetes: Increases risk of infections including gum disease; see diabetes
  • Medications: Some drugs reduce saliva flow, which protects teeth and gums
  • Genetic susceptibility: Some people are more prone to severe gum disease
  • Poor nutrition: Especially vitamin C deficiency
  • Age: Incidence increases with age, with 70% of people 65 and older having periodontitis

Other Medical Conditions

  • HIV/AIDS and other conditions affecting the immune system
  • Cancer and cancer treatments that weaken the immune system
  • Stress, which makes it harder for the body to fight infection
  • Grinding or clenching teeth, which puts excess force on supporting tissues
  • Rheumatoid arthritis and other inflammatory conditions

Risk Factors

Understanding the risk factors for gum disease can help you take preventive measures and seek early treatment. Some risk factors are modifiable, while others are not.

  • Age: Risk increases with age; over 70% of Americans 65 and older have periodontitis
  • Smoking/Tobacco use: Smokers are up to seven times more likely to develop gum disease
  • Genetics: Up to 30% of the population may be genetically susceptible
  • Stress: Can weaken the immune system's ability to fight infection
  • Medications: Including antidepressants, heart medications, and oral contraceptives
  • Teeth grinding: Can accelerate tissue destruction
  • Poor nutrition: Especially deficiencies in important nutrients like vitamin C
  • Obesity: May increase risk of periodontal disease
  • Systemic diseases: Including diabetes, cardiovascular disease, and rheumatoid arthritis
  • Gender: Men are more likely to develop gum disease than women
  • Substance abuse: Including alcohol and illicit drugs

Diagnosis

Diagnosing gum disease involves a comprehensive dental examination and assessment of your medical history. Early detection is crucial for successful treatment and preventing tooth loss.

Clinical Examination

  • Visual inspection: Checking for red, swollen, or bleeding gums
  • Periodontal probing: Measuring pocket depths around teeth (healthy pockets are 1-3mm deep)
  • Tooth mobility assessment: Checking for loose teeth
  • Bite evaluation: Assessing how teeth come together
  • Gum recession measurement: Documenting exposed tooth roots

Diagnostic Tools

  • Dental X-rays: To check for bone loss around teeth
  • Periodontal charting: Recording pocket depths, bleeding points, and recession
  • Bacterial testing: Identifying specific bacteria causing infection
  • Genetic testing: For susceptibility to aggressive periodontitis
  • Salivary diagnostics: Newer tests that can detect disease markers

Classification

Gum disease is classified based on severity:

  • Gingivitis: Inflammation limited to gums, reversible with treatment
  • Mild periodontitis: Early bone loss, pockets 4-5mm
  • Moderate periodontitis: Moderate bone loss, pockets 6-7mm
  • Severe periodontitis: Advanced bone loss, pockets >7mm, tooth mobility
  • Aggressive periodontitis: Rapid progression, often in younger patients

Treatment Options

Treatment for gum disease depends on the stage and severity of the condition. The goal is to control infection, stop disease progression, and restore supportive tissues when possible. Treatment success requires good daily care at home combined with professional therapy.

Non-Surgical Treatments

  • Professional dental cleaning: Removal of plaque and tartar above and below the gum line
  • Scaling and root planing: Deep cleaning under local anesthesia to remove bacteria and smooth root surfaces
  • Antibiotic therapy:
    • Topical antibiotics (gels, mouth rinses, or chips placed in pockets)
    • Oral antibiotics for more severe infections
    • Combination antibiotic therapy for aggressive cases
  • Laser therapy: To remove inflamed tissue and bacteria
  • Host modulation therapy: Medications to control destructive immune response

Surgical Treatments

  • Flap surgery (pocket reduction): Lifting gums to remove tartar and reducing pockets
  • Bone grafts: Using natural or synthetic bone to promote regrowth
  • Soft tissue grafts: Reinforcing thin gums or filling in receded areas
  • Guided tissue regeneration: Stimulating bone and gum tissue growth
  • Bone surgery: Smoothing shallow craters in bone due to bone loss
  • Tissue-stimulating proteins: Gel applied to diseased tooth root to stimulate growth

Maintenance Therapy

  • Regular professional cleanings: Every 3-4 months for periodontal patients
  • Home care instruction: Proper brushing and flossing techniques
  • Antimicrobial mouth rinses: To control bacteria
  • Prescription toothpaste: With higher fluoride content
  • Lifestyle modifications: Smoking cessation, stress reduction, improved nutrition

Adjunctive Treatments

  • Orthodontic treatment: To correct crowded teeth that are hard to clean
  • Occlusal adjustment: Reshaping biting surfaces to reduce trauma
  • Night guards: For patients who grind their teeth
  • Treatment of underlying conditions: Such as diabetes control

Prevention

Preventing gum disease is far easier and less expensive than treating it. With proper oral hygiene and regular professional care, most cases of gum disease can be prevented entirely.

  • Brush properly: At least twice daily for two minutes using fluoride toothpaste
  • Floss daily: To remove plaque and food particles between teeth
  • Use antimicrobial mouthwash: To reduce bacteria and freshen breath
  • Regular dental visits: Professional cleanings and check-ups every six months
  • Quit smoking: One of the best things you can do for your gum health
  • Eat a balanced diet: Rich in vitamins C and A, calcium, and omega-3 fatty acids
  • Manage stress: Through exercise, meditation, or other stress-reduction techniques
  • Stay hydrated: Drinking water helps wash away bacteria and food particles
  • Replace toothbrush regularly: Every 3-4 months or when bristles fray
  • Consider electric toothbrush: More effective at removing plaque than manual brushing
  • Chew sugar-free gum: Stimulates saliva production which helps neutralize acids
  • Avoid teeth grinding: Use a night guard if necessary

When to See a Doctor

Don't wait for pain to see a dentist, as gum disease can progress painlessly. Seek professional dental care if you experience:

  • Persistent bleeding gums when brushing or flossing
  • Red, swollen, or tender gums
  • Gums that have pulled away from your teeth
  • Persistent bad breath or bad taste in mouth
  • Loose or separating teeth
  • Any change in the way your teeth fit together when biting
  • Pus between your teeth and gums
  • Facial pain or jaw swelling
  • Fever accompanying dental symptoms

Immediate dental care is needed for severe symptoms such as facial swelling, difficulty swallowing, high fever, or severe pain, as these may indicate a serious infection requiring emergency treatment.

Frequently Asked Questions

Is gum disease reversible?

Gingivitis, the early stage of gum disease, is reversible with proper treatment and good oral hygiene. However, periodontitis causes permanent damage to bone and tissues, though its progression can be stopped with treatment.

Can gum disease affect overall health?

Yes, research shows links between gum disease and systemic conditions including heart disease, diabetes, respiratory disease, and pregnancy complications. The bacteria and inflammation can affect other parts of the body.

How long does gum disease treatment take?

Treatment duration varies by severity. Gingivitis may improve within days to weeks with proper care. Periodontitis treatment can take several months, with maintenance therapy continuing indefinitely.

Can children get gum disease?

Yes, though less common than in adults. Chronic gingivitis is common in children, while aggressive periodontitis can affect otherwise healthy adolescents and young adults.

Is gum disease contagious?

The bacteria that cause gum disease can be transmitted through saliva, but developing the disease depends on individual susceptibility, oral hygiene, and other risk factors.

References

  1. Eke PI, et al. Periodontitis in US Adults: National Health and Nutrition Examination Survey 2009-2014. J Am Dent Assoc. 2018;149(7):576-588.
  2. Papapanou PN, et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop. J Periodontol. 2018;89 Suppl 1:S173-S182.
  3. American Academy of Periodontology. Comprehensive Periodontal Therapy: A Statement by the American Academy of Periodontology. J Periodontol. 2011;82(7):943-949.
  4. Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: Framework and proposal of a new classification. J Periodontol. 2018;89 Suppl 1:S159-S172.
  5. Kinane DF, Stathopoulou PG, Papapanou PN. Periodontal diseases. Nat Rev Dis Primers. 2017;3:17038.