Gum disease Causes, Symptoms, Diagnosis, Treatment and FAQs

What is gum disease (gingivitis)?

Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. In its early stage, called gingivitis, the gums become swollen, red, and may bleed. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or fall out. Bad breath may also occur.

Periodontal disease is generally due to bacteria in the mouth infecting the tissue around the teeth. Risk factors include smoking, diabetes, HIV/AIDS, family history, and certain medications. Diagnosis is by inspecting the gum tissue around the teeth both visually and with a probe and X-rays looking for bone loss around the teeth.

Treatment involves good oral hygiene and regular professional teeth cleaning. Recommended oral hygiene includes daily brushing and flossing. In certain cases, antibiotics or dental surgery may be recommended. Globally 538 million people were estimated to be affected in 2015. In the United States, nearly half of those over the age of 30 are affected to some degree, and about 70% of those over 65 have the condition. Males are affected more often than females.

What is the difference between gingivitis and periodontitis?

While gingivitis is inflammation of the gums around the teeth, periodontitis occurs when the bone below the gums gets inflamed or infected. Periodontitis derives from the word periodontal, which means “around the tooth” and refers to the structures that surround and support teeth such as gum and bone. Periodontology is the study of the supporting structures of the teeth.

When the underlying bone gets infected, the gums will start to recede away from the teeth and form deep gum pockets. This is called attachment loss. These pockets readily collect plaque and bacteria. Because these pockets are very difficult to keep clean, more bone loss occurs. As periodontal disease progresses into later stages (early, moderate, and advanced) and more bone tissue is lost, the gum pockets are deeper and the teeth may eventually become loose and fall out.

Signs and symptoms of Gum disease

In the early stages, periodontitis has very few symptoms, and in many individuals, the disease has progressed significantly before they seek treatment.

Symptoms may include:

Redness or bleeding of gums while brushing teeth, using dental floss or biting into hard food (e.g., apples) (though this may occur even in gingivitis, where there is no attachment loss)
Gum swelling that recurs
Spitting out blood after brushing teeth
Halitosis, or bad breath, and a persistent metallic taste in the mouth
Gingival recession, resulting in apparent lengthening of teeth. (This may also be caused by heavy-handed brushing or with a stiff toothbrush.)
Deep pockets between the teeth and the gums (pockets are sites where the attachment has been gradually destroyed by collagen-destroying enzymes, known as collagenases)
Loose teeth, in the later stages (though this may occur for other reasons, as well)
Swollen, red gums
Gums that bleed easily
Constant bad breath
Gums that have pulled away (recession) from the teeth
Pus in between the teeth
Changes in bite
Loose permanent teeth

People should realize gingival inflammation and bone destruction are largely painless. Hence, people may wrongly assume painless bleeding after teeth cleaning is insignificant, although this may be a symptom of progressing periodontitis in that person.

What Causes Periodontal Disease?

Improper oral hygiene that allows bacteria in plaque and calculus to remain on the teeth and infect the gums is the primary cause of gum disease. But there are other factors that increase the risk of developing gingivitis. Here are some of the most common risk factors:

Smoking or chewing tobacco prevents gum tissue from being able to heal.
Crooked, rotated, or overlapping teeth create more areas for plaque and calculus to accumulate and are harder to keep clean.
Hormonal changes in puberty, pregnancy, and menopause typically correlate with a rise in gingivitis. The increase in hormones causes the blood vessels in the gums to be more susceptible to bacterial and chemical attack. At puberty, the prevalence of gingivitis ranges between 70%-90%.
Cancer and cancer treatment can make a person more susceptible to infection and increase the risk of gum disease.
Alcohol negatively affects oral defense mechanisms.
Stress impairs the body’s immune response to bacterial invasion.
Mouth breathing can be harsh on the gums when they aren’t protected by the lips, causing chronic irritation and inflammation.
Poor nutrition, such as a diet high in sugar and carbohydrates and low in water intake, will increase the formation of plaque. Also, a deficiency of important nutrients such as vitamin C will impair healing.
Diabetes mellitus impairs circulation and the gum’s ability to heal.
Medications such as antiseizure medications increase the risk of gum disease.
Infrequent or no dental care
Poor saliva production

Does gum disease cause bad breath?

Bad breath, or halitosis, is most frequently associated with gum disease. The oral bacteria that are present in the mouth release chemical gases called volatile sulfur compounds that have a strong odor. Bad breath can also come from the bacterial plaque that builds upon the tongue. When the plaque and tartar are removed from the teeth and tongue with regular brushing, flossing, and professional dental cleanings, the halitosis can be eliminated. This is the easiest way to reverse bad breath, but it can take a while for the mouth odor to completely disappear. A person needs to be consistent and persistent with oral hygiene to reverse the condition.

Other causes of bad breath include partially erupted wisdom teeth, dry mouth, mouth breathing, postnasal drip, infections in the throat or lungs, tonsil stones, smoking, digestive problems, and systemic diseases like diabetes.

How do health care professionals diagnose gum disease?

The following methods and symptoms and signs are very useful in the diagnosis of gum disease during routine checkups:

Measuring the gums: A dentist or dental hygienist will use a periodontal probe to measure the depths of the pockets around all of the teeth in the mouth generally once per the calendar year. Healthy gums will have pockets 1 mm-3 mm deep. Beyond that, the deeper the pockets, the more severe the disease.
Taking X-rays: Dental X-rays, particularly bitewing X-rays, will help show the level of the underlying bone and whether any bone has been lost to periodontal disease.
Examining sensitive teeth: Teeth that have become sensitive around the gum line may indicate areas of receding gums.
Check for loose teeth: Teeth may become loose due to bone loss or an incorrect bite.
Checking the gums: A dentist or hygienist will look for red, swollen, or bleeding gums.

Diagnosis of Gum disease

At a dental visit, a dentist or dental hygienist will:

Examine your gums and note any signs of inflammation.
Use a tiny ruler called a “probe” to check for and measure any pockets around the teeth. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.
Ask about your medical history to identify conditions or risk factors (such as smoking or diabetes) that may contribute to gum disease.

The dental professional may also:

Take an x-ray to see whether there is any bone loss.
Refer you to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist.

Treatment of Gum disease

The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The dentist may also suggest changing certain behaviors, such as quitting smoking, as a way to improve your treatment results.

Helpful Tips for Gum disease

You can keep your gums and teeth healthy by:

Brushing your teeth twice a day with a fluoride toothpaste.
Flossing regularly to remove plaque from between teeth. Or, you can use a device such as a special brush, wooden or plastic pick, or a “water flosser” recommended by a dental professional.
Visiting the dentist routinely for a check-up and professional cleaning.
Quitting smoking.

Additional Resources of Gum disease

Periodontal Disease
Information from the Centers for Disease Control and Prevention about the causes of periodontal disease, its warning signs, risk factors, and prevention and treatment.
MedlinePlus: Gum Disease
The NIH National Library of Medicine’s collection of links to government, professional, and non-profit/voluntary organizations with information on periodontal disease and gingivitis.

I’m Ready to Quit! Information from the Centers for Disease Control and Prevention (CDC) on quitting smoking.

Risks and Prevention of Gum disease

The bacteria in plaque are the main cause of periodontal disease. But several other factors also can contribute. They include other diseases, medicines, and oral habits. These factors can increase your risk of gum disease or make it worse once the infection has set in.

Genes — Some people are more likely than others to get the periodontal disease because of their genes. But your genes do not make gum disease inevitable. Even people who are highly prone to periodontal disease can prevent or control the disease with good oral care.
Smoking and tobacco use — Smoking increases the risk of periodontal disease. The longer you smoke, and the more you smoke, the higher the risk. If you have periodontal disease, smoking makes it more severe. Smoking is a major reason that some cases of periodontal disease are resistant to treatment. Smokers tend to collect more tartar on their teeth. They often develop deeper periodontal pockets once they have gum disease. They also are likely to lose more bone as the disease gets worse. Unlike many other factors that affect the health of your gums, the decision to smoke or not is under your control. Quitting smoking can play a major role in bringing the periodontal disease under control.
Misaligned or crowded teeth, braces or bridgework — Anything that makes it more difficult to brush or floss your teeth is likely to enhance plaque and tartar formation. The more plaque and tartar you have, the greater your chance of developing gum disease. Dentists and periodontists can show you the best ways to clean your teeth, even if they are hard to clean. For example, you can use special tools and ways of threading floss to clean around bridgework or slide under braces. If overcrowded or crooked teeth are a problem, your dentist might recommend orthodontics. This could straighten out your smile and give you a better chance of preventing disease.
Grinding, gritting or clenching of teeth — These habits won’t cause periodontal disease. However, they can lead to more severe disease if your gums are already inflamed. These habits exert excess force on the teeth. This pressure appears to speed up the breakdown of the periodontal ligament and bone. In many cases, people can learn to stop this habit simply by recognizing when it is happening and then relaxing. If these efforts don’t work, your dentist or periodontist can create a custom guard appliance to help reduce the pressure of clenching or grinding on the teeth. This device is sometimes called an occlusal guard, night guard, mouth guard or bite guard.
Stress — Stress can make periodontal disease worse and harder to treat. Stress weakens your body’s immune system. This makes it harder for your body to fight off infection, including periodontal disease.
Fluctuating hormones — Whenever hormone levels go up and down in the body, changes can occur in the mouth. Puberty and pregnancy can temporarily increase the risk and severity of gum disease. So can menopause.
Medicines — Several types of medicines can cause dry mouth or xerostomia. Examples include certain drugs for depression and high blood pressure. If you don’t have enough saliva, plaque is more likely to form. This may lead to tooth decay (cavities). Other medicines may cause the gums to enlarge. This makes them more likely to trap plaque. These medicines include:
- Phenytoin (Dilantin and other brand names), used to control seizures
- Cyclosporine (Neoral, Sandimmune), used to suppress the immune system in people who have had organ transplants
- Nifedipine (Adalat, Cardizem, and others) and other calcium channel blockers, used to treat high blood pressure, chest pain (angina) or heart arrhythmias.
Diseases — People with certain diseases have a higher risk of developing periodontal disease. For example, people with diabetes are more likely to get periodontitis than people without diabetes. Their gum disease is also likely to be more severe. Other diseases that increase periodontal disease risk include inflammatory conditions such as rheumatoid arthritis and HIV infection. Having one of these diseases can make control of your periodontal disease more difficult. But a good periodontist or dentist who is aware of these problems can give you guidance on how to maintain your periodontal health.
Poor nutrition — Nutrition is important for overall good health, including a working immune system and healthy gums and mouth. Severe vitamin C deficiency (scurvy) can cause bleeding gums.

What is the treatment for gum disease?

The treatment goals for gingivitis are to identify and eliminate the factors that make the person more susceptible to gum disease. Most factors can be eliminated by establishing more consistent and thorough oral hygiene habits and professional dental cleanings. If there are certain risk factors such as smoking or uncontrolled diabetes that are contributing to gum disease, they need to be addressed or eliminated to have success in reversing gingivitis. After the plaque and tartar are removed by a dentist or dental hygienist, the patient can usually eliminate gingivitis by brushing and flossing after every meal. Under the supervision of a dentist, a patient can use a prescription mouth rinse that specifically targets oral bacteria that cause gum disease. This is especially helpful in patients where conventional oral hygiene practices like brushing and flossing are impaired due to age or special needs.

In individuals where gingivitis has led to periodontal disease and there are deep pockets that are difficult to clean, the patient may require deep scaling and root planing to clean teeth that are surrounded by deep pockets. They may need surgical treatment to gain access to all the tooth surfaces for a more thorough cleaning. This surgical procedure is called flap surgery and can be combined with a pocket-reduction surgery to make the areas around the teeth easier for the patient to clean with brushing and flossing. This procedure consists of numbing the gums and then lifting them back to expose and clean the teeth and sometimes reshape the bone. The gums are then repositioned back around the teeth so there aren’t the deep pockets that existed before treatment.

Soft-tissue grafts cover uproot surfaces exposed by receding gums. This can help eliminate sensitive teeth and protect the root surfaces that are softer and more difficult to clean.

Laser therapy is another treatment to help increase gum health. The gum pocket is treated with a soft-tissue laser to eliminate the harmful bacteria deep in the periodontal pockets, remove unhealthy tissue, and help stimulate healing.

What types of specialists treat gum disease?

Periodontists are dentists who have completed additional training in periodontology after dental school. They are focused entirely on the evaluation, diagnosis, and treatment of disease of the gum and bone surrounding the teeth. In advanced cases of gingivitis or periodontitis, a general dentist may recommend a gross debridement of superficial plaque and tartar and will then refer the affected patient to a periodontist for evaluation. Periodontists may recommend a variety of nonsurgical or surgical procedures to help stabilize the gum condition. Periodontists are also very skilled at performing treatments of other conditions of the gums and bone including gum and bone grafts, functional and esthetic gingivectomy, gingivoplasty, implants, and crown lengthening. Because gum disease in its advanced stages is the primary cause of tooth loss today, periodontists are especially important in working to treat a difficult disease.

What types of medications are used to treat gum disease?

Chlorhexidine gluconate (Peridex) is an antiseptic mouthwash that can be used under the direction of a dentist to help reduce the bacteria that cause gum disease. Additionally, antibiotic therapy can be combined in various ways to help treat periodontitis. Pellets or gels like PerioChip that contain chlorhexidine or doxycycline can be placed in deep gum pockets after deep scaling and root planing to kill stubborn bacteria and reduce the size of periodontal pockets. These modes of delivering medications are very effective because the agent is released slowly over the course of about seven days. Additional medications such as Xylocaine and NSAIDs may be needed for pain control during and after treatment.

Are home remedies or natural treatments effective for gum disease?

There has been evidence to suggest the effectiveness of the following over-the-counter and natural treatments for gum disease:

Green tea has antioxidants that reduce inflammation in the body.
Hydrogen peroxide helps kill bacteria when used as a mouthwash or as a gel in a custom-fitted tray, but it cannot be swallowed.
Warm salt water rinses can help to soothe sore mouth tissue.
Baking soda diluted in water can be used to rinse and brush the teeth and gumline to help neutralize the acids that irritate the gum tissue.
Oil pulling (swishing or rinsing): There has been little evidence to prove that sesame oil or coconut oil can help reduce bacteria that cause gum disease, but has been become a recent trend. On a case by case basis, people have noticed improvement with this treatment.
In addition, see the section on the prevention of gum disease and on toothpaste.

Is it possible to reverse gum disease?

As long as the causes of early-stage gum disease (gingivitis) are correctly identified and the patient is persistent in improving their oral hygiene and seeking necessary treatment, gum disease can be reversible. The prognosis is best when treatment is obtained in the early stages of gingivitis. At this stage, the affected person usually just needs a professional dental cleaning and more thorough brushing and flossing to reverse the disease. Once the bacteria spread to the bones in periodontitis, irreversible changes can start to take place with the loss of attachment of the gums and bone loss. Therefore, it is very important to catch and treat gum disease as early as possible.

Is gum disease associated with other health problems?

There have been many attempts to understand the link between gum disease and other systemic health problems such as heart disease, stroke, and Alzheimer’s disease. Comparing the bacteria that cause dental plaque with the bacteria involved in heart disease suggests a correlation between gum disease and heart disease, but researchers have been unable to establish a cause and effect relationship. According to the American Academy of Periodontology, recent studies have shown that periodontal disease bacteria may play a role in the pathology of Alzheimer’s disease. These types of relationships are difficult to prove or disprove, so it is fair to assume that aiming for a life free of gum disease will only help in leading a generally healthier life.

While it may be hard to prove what health problems are directly caused by gum disease, it is known that certain health problems can cause gum disease. If there are any sudden changes to a person’s medical condition, they should ask their primary care provider or dentist if there might be any effects on oral health. Healthy gums can quickly become threatened when the body’s overall health diminishes or changes for any reason.

How is gum disease managed in children?

A child should start having his or her teeth brushed with a pea-sized amount of toothpaste beginning at 12 months of age. Emphasis should be placed on brushing all surfaces of the teeth including the gum line. As soon as the gaps between the teeth start to close, it is important to start flossing. At the beginning, the parents should establish a routine to brush the teeth so the child can get used to it. As soon as the child is able, the brushing and flossing should be passed over to him or her and monitored by the parent to ensure good thorough technique and consistency. According to the American Dental Association, a child should get regular dental visits starting at about one year of age. Abiding by these guidelines will help prevent and treat gum disease in most children.

It is common for there to be an increase in gingivitis during puberty due to the hormonal changes that occur throughout the body. Adolescents should be monitored for good oral hygiene habits and taken to the dentist regularly to treat gum disease with professional dental cleanings.

How is gum disease managed in pregnancy?

Many women who become pregnant think that they should avoid the dentist to keep their pregnancy safe, but they shouldn’t miss their professional cleanings as long as they feel strong and comfortable enough. During pregnancy, women are at risk of developing pregnancy gingivitis. Because of the increase in hormones that occurs with pregnancy, the gum tissues are more susceptible to attack from bacteria and other pathogens. Pregnant women will often notice an increase in swollen, bleeding gums even if their oral hygiene has remained consistent. It may be necessary to get dental cleanings more often than usual during pregnancy to help combat this increased risk.

Is it possible to prevent gum disease?

Prevention of gingivitis and periodontitis is very simple in most cases. Gum disease is best prevented through proper plaque control. This involves brushing to remove plaque from the outer surfaces of the teeth and flossing to remove food particles and plaque from in between the teeth. Electronic toothbrushes tend to make it easier to remove plaque from some of the harder to reach areas of the mouth. Using a mouthwash after brushing and flossing can also help by reducing the bacteria that cause gingivitis.

Besides these basic oral hygiene practices, there are other things that can be done to eliminate the factors that lead to an increase in gum disease:

Sleep/Stress: The immune system is very important in controlling disease, and getting adequate sleep and reducing stress will help the body fight gum disease, too.
Stop smoking: Smokers are much more likely to develop gingivitis and periodontitis. Avoiding tobacco should be a primary goal to achieve healthy gums.
Orthodontic therapy or braces: It is much easier to remove plaque from straight teeth than crowded, overlapped, and crooked teeth. Braces can make a big difference in having healthier gums.
Diet: Limiting the frequency of plaque-causing sugars and carbohydrates will help limit plaque. Eating a well-balanced diet will help keep the body’s immune system healthy and ready to fight infection.

What is the best toothpaste to use to prevent gum disease?

The goal of toothbrushing is to remove plaque on the teeth that will harbor bacteria and cause gum disease and tooth decay. Just about any toothpaste when used with consistent thorough brushing habits will accomplish this goal. Fluoride in toothpaste, particularly stannous fluoride, helps to kill mouth bacteria. There are other ingredients in toothpaste that help remove plaque more effectively and help keep plaque off the teeth after they have been brushed. The abrasive agents in toothpaste such as silicates and calcium carbonates help remove sticky plaque. Sodium lauryl sulfate (SLS) is a detergent in toothpaste that causes the foaming effect of toothpaste. Toothpaste varies in the amount of SLS they contain; a high concentration of SLS can cause problems for patients who have dry mouth or low saliva flow. Some toothpaste includes plaque-control agents such as pyrophosphates and zinc citrate that prevent plaque from sticking to the teeth after they’ve been brushed. Using a toothpaste that contains any combination of these ingredients will increase the effectiveness of oral hygiene.

Is gum disease contagious?

While most of the factors that lead to gingivitis and periodontal disease are dependent on the individual, there has been some limited scientific evidence to affirm that gingivitis and periodontitis-causing bacteria can be passed down from parents to children and between couples.

Frequently Asked Questions About Gum disease

What Are the Symptoms of Gingivitis?

Gingivitis, or early gum disease, often produces symptoms such as red, tender gums and bleeding while flossing. You also might notice bleeding while eating hard or crunchy foods. Your dental hygienist might tell you that you have some pockets in your gums where they attach to your teeth.

What Are the Symptoms of Periodontitis?

As gum disease progresses, it can turn to periodontitis. Symptoms are more severe than those found with gingivitis. Pockets will get larger and you might notice pus seeping out between your gums and your teeth. Your teeth might get loose. You might get sores in your mouth or struggle with a foul taste or smell coming from your mouth.

What Are the Dangers of Gum Disease?

Periodontitis can cause tooth loss and serious infections. In rare cases, the infection can spread. There are also indications that dental infections can cause heart problems or exacerbate the symptoms of diabetes. It’s important to have your gum disease treated promptly by a San Diego periodontist.

What Causes Gum Disease?

Causes include smoking and poor dental hygiene. There are also risk factors you might not be able to control, such as genetics, age and underlying diseases like diabetes or heart disease.

What Is a Periodontist?

A periodontist is a gum specialist. They help prevent, diagnose and treat gum disease. They also place dental implants.

How Does a Periodontist Treat Gum Disease?

Your periodontist will first instruct you in good oral hygiene. In cases of mild gingivitis, improving your dental hygiene can actually reverse the condition and improve the health of your gums. If the disease has progressed to periodontitis, treatments might include scaling and root planing, laser treatment, and various surgical treatments. San Diego Periodontics & Implant Dentistry will talk to you about the options that are best for your gums.

How Can Someone Prevent Gum Disease?

Having excellent oral hygiene and seeing your dentist regularly can help prevent gum disease. Quit smoking if you currently smoke. Let your dentist know what medications you are on because some drugs can cause gum inflammation. Finally, follow your dentist’s recommendations when it comes to keeping your gums and teeth healthy. Do you have any other question(s) we may not have addressed here? Give us a call at (619) 543-0905, we’d be more than happy to talk to you.