Gum Disease (Gingivitis and Periodontitis)

How gum disease develops

Plaque is a sticky film of bacteria that forms on teeth constantly. If it is not removed by brushing and flossing, it irritates the gums within days. Plaque left for longer hardens into tartar (calculus), which only a dental professional can remove.

The body's immune response to these bacteria causes inflammation. In periodontitis, this inflammation spreads below the gumline and breaks down the ligament and bone that anchor teeth. Gaps called periodontal pockets form between teeth and gums, trapping more bacteria in a self-sustaining cycle.

Stages of gum disease

Periodontitis is staged (I to IV) by severity and graded (A to C) by how fast it is progressing, under the 2017 international classification.

Symptoms

Gum disease is often painless, so many people do not notice it until it is advanced.

• Bleeding gums when brushing, flossing or eating
• Swollen gums that are red, puffy or tender
• Bad breath or a bad taste that persists
• Receding gums, making teeth look longer
• Pus between teeth and gums
• Loose or shifting teeth, gaps appearing between teeth
• Changes in bite or how dentures fit
• Gum abscesses

Causes and risk factors

• Poor oral hygiene, the main cause
• Smoking or vaping: the strongest modifiable risk factor. Smoking also reduces gum bleeding, hiding the disease
• Diabetes: poorly controlled diabetes increases risk and severity
• Genetics: some families are more susceptible
• Hormonal changes: puberty, pregnancy, menopause
• Medicines that reduce saliva or cause gum overgrowth
• Weakened immunity: HIV, chemotherapy
• Stress and poor nutrition, including vitamin C deficiency
• Crowded teeth, rough fillings and poorly fitting dental work that trap plaque

Gum disease and general health

Periodontitis is linked with several health conditions, though not all links are proven to be causal:

• Diabetes: a two-way relationship. Gum disease makes blood sugar harder to control, and treating it can modestly improve HbA1c
• Heart disease and stroke: associated with higher risk
• Rheumatoid arthritis: shared inflammatory pathways
• Pregnancy: associated with preterm birth and low birth weight
• Respiratory infections in older adults

Diagnosis

A dentist or periodontist will:

1. Examine the gums for redness, swelling and bleeding.
2. Measure pocket depths around each tooth with a small probe. Healthy pockets are 1 to 3 mm.
3. Check for gum recession and loose teeth.
4. Take X-rays to assess bone loss.
5. Ask about smoking, diabetes and medicines.

Treatment

Gingivitis

• Professional cleaning to remove plaque and tartar
• Improved home care: brushing twice daily for 2 minutes with fluoride toothpaste, and cleaning between teeth daily with floss or interdental brushes
• Antiseptic mouthwash for a short time if recommended

Gums typically heal within 1 to 2 weeks of good care.

Periodontitis

• Scaling and root planing (deep cleaning): removes tartar and bacteria from below the gumline and smooths root surfaces so gums can reattach. Usually done with local anesthetic over one or more visits.
• Antimicrobials: local antibiotic gels or chips placed in pockets, antiseptic rinses, and occasionally oral antibiotics.
• Periodontal maintenance: professional cleaning every 3 to 4 months to keep the disease stable.
• Surgery for deep pockets or advanced disease: flap surgery to clean deep areas, bone or tissue grafts, and guided tissue regeneration.
• Replacing lost teeth with implants, bridges or dentures once the disease is controlled.

Addressing risk factors

• Stop smoking
• Control blood sugar in diabetes
• Treat dry mouth and review medicines

Prevention

• Brush twice daily with a soft toothbrush and fluoride toothpaste
• Clean between teeth every day
• See a dentist for checkups and cleanings, typically every 6 to 12 months, or more often if you have had periodontitis
• Don't smoke or vape
• Eat a balanced diet with enough vitamin C
• Manage diabetes

Frequently asked questions

What are the first signs of gum disease?

The earliest sign is usually gums that bleed when you brush or floss. Gums may also look red or swollen and feel tender, and you may notice bad breath. These are signs of gingivitis, which is reversible with good cleaning.

What is the difference between gingivitis and periodontitis?

Gingivitis is inflammation of the gums only, without bone loss, and is fully reversible. Periodontitis is a more advanced stage in which the infection destroys the bone and tissue holding teeth, causing pockets, recession and loose teeth. The damage is permanent but can be stopped.

Can gum disease be cured?

Gingivitis can be cured with professional cleaning and good home care. Periodontitis cannot be fully reversed, but it can be controlled with deep cleaning, regular maintenance and good oral hygiene, preventing further damage and tooth loss.

Is gum disease linked to heart disease?

Studies show that people with periodontitis have a higher risk of heart disease and stroke, possibly due to body-wide inflammation. It has not been proven that gum disease directly causes heart disease, but keeping gums healthy is part of overall health.

How is gum disease treated?

Treatment depends on the stage: professional cleaning and better brushing and flossing for gingivitis, and scaling and root planing (deep cleaning), antimicrobials, regular maintenance and sometimes surgery for periodontitis. Stopping smoking and controlling diabetes improve results.