Periodontal Disease (Gum Disease)

How periodontal disease develops

Plaque is a sticky film of bacteria that forms on teeth every day. If it is not removed, it irritates the gums, causing gingivitis. Plaque that stays on teeth hardens into tartar (calculus), which only a dental professional can remove.

In some people, the inflammation spreads below the gumline. The gums pull away from the teeth to form pockets that collect more bacteria. The body's immune response, along with bacterial toxins, breaks down the ligament and bone that support the teeth. This is periodontitis. Bone loss is permanent, though it can be stopped.

Stages

Dentists now classify periodontitis by stage (severity, I to IV) and grade (rate of progression, A to C), considering factors like smoking and diabetes.

Symptoms

• Bleeding gums, especially when brushing or flossing
• Red, swollen or tender gums
• Gums receding from the teeth
• Persistent bad breath (halitosis) or a bad taste
• Pus between gums and teeth
• Loose or shifting teeth, or gaps opening between teeth
• Changes in your bite or the fit of partial dentures
• Sensitive teeth from exposed roots

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

Causes and risk factors

• Plaque buildup from inadequate brushing and flossing
• Smoking and tobacco use: one of the strongest risk factors. Smoking also masks bleeding, hiding the disease
• Diabetes: poorly controlled diabetes increases risk and severity. Gum disease can also make blood sugar harder to control
• Hormonal changes: pregnancy, puberty and menopause
• Dry mouth from medicines or medical conditions
• Medicines that cause gum overgrowth, such as phenytoin, some calcium channel blockers and cyclosporine
• Genetics
• Stress, poor nutrition and weakened immunity
• Crooked teeth, poorly fitting fillings or dental appliances that trap plaque

Links to general health

Periodontitis has been linked to diabetes, heart disease, stroke, rheumatoid arthritis and pregnancy complications. The strength and direction of these links are still being studied, but treating gum disease is known to modestly improve blood sugar control in people with diabetes.

Diagnosis

A dentist or periodontist:

• examines the gums for redness, swelling and bleeding
• measures pocket depth around each tooth with a small probe. Healthy pockets are usually 1 to 3 mm. Deeper pockets suggest periodontitis
• checks for tooth movement and recession
• takes dental X-rays to assess bone loss

Treatment

Gingivitis

• Professional cleaning to remove plaque and tartar
• Better home care: brushing twice a day for 2 minutes with fluoride toothpaste, and cleaning between teeth daily with floss or interdental brushes
• An antibacterial mouthwash if recommended

Periodontitis

• Scaling and root planing ("deep cleaning"): removing plaque and tartar from below the gumline and smoothing the roots so gums can reattach. It is usually done with local anesthetic.
• Antibiotics: sometimes as gels or chips placed in pockets, or as tablets.
• Periodontal maintenance: cleanings every 3 to 4 months to keep the disease under control.
• Surgery: flap surgery to clean deep pockets, bone or tissue grafts to regenerate support, and gum grafts for recession.
• Treating risk factors: stopping smoking and controlling diabetes.
• Replacing lost teeth with bridges, dentures or implants.

Prevention

• Brush twice daily with a fluoride toothpaste and a soft brush.
• Clean between your teeth once a day.
• Do not smoke or use tobacco.
• See a dentist regularly for checkups and cleanings.
• Manage diabetes and other health conditions.
• Eat a balanced diet low in sugary snacks.

Frequently asked questions

What is the difference between gingivitis and periodontitis?

Gingivitis is inflammation of the gums only, causing redness, swelling and bleeding, and it is fully reversible with good cleaning. Periodontitis is more advanced: pockets form, bone and supporting tissue are lost, and teeth can loosen. Bone loss from periodontitis is usually permanent.

Can periodontal disease be cured?

Gingivitis can be completely reversed. Periodontitis cannot be fully reversed because lost bone usually does not regrow, but it can be controlled with deep cleaning, good home care, regular maintenance visits and, in some cases, surgery. This can save teeth for life.

What are the early signs of gum disease?

Early signs include gums that bleed when you brush or floss, red or swollen gums, tender gums and persistent bad breath. Gum disease is often painless in its early stages, so regular dental checkups are important even if you have no pain.

Is periodontal disease contagious?

The bacteria involved can be passed through saliva, for example by sharing utensils or kissing, but whether someone develops gum disease depends mainly on their own oral hygiene, smoking, genetics and health conditions. It is not considered contagious in the usual sense.

What is a deep cleaning at the dentist?

A deep cleaning, or scaling and root planing, removes plaque and tartar from below the gumline and smooths the tooth roots so the gums can heal and reattach. It is the main treatment for periodontitis and is usually done over one or two visits with local anesthetic.