What Is Gum Disease?
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Medically reviewed by Edmund Khoo, DDS
Gum disease (also called periodontal disease) occurs when the tissues that hold your teeth become infected or inflamed. Poor dental hygiene is the most common cause of this issue, but certain risk factors like smoking can also increase your likelihood of developing gum disease. This condition is extremely common and nearly 50% of adults over 30 develop symptoms.
The symptoms of gum disease depend on the severity of your condition. Gingivitis is a mild form of gum disease and is reversible. But, if your condition is left untreated, it can advance to periodontitis, which is more serious and irreversible. Fortunately, treatments like dental cleaning and medications can help improve symptoms.
Types of Gum Disease
There are two overarching types of gum disease: gingivitis and periodontitis. However, there are specific classifications of periodontitis, ranging from mild to advanced.
Gingivitis: The mildest form of gum disease, which causes inflammation of the gums. Symptoms are limited to the gums and can be reversed with treatment.
Mild periodontitis: This condition is considered stage two gum disease. Mild periodontitis creates "pockets" in your gums, causing your gums to pull away from your teeth slowly. As a result, you may experience symptoms in your gums, nearby tissues, and supporting bone structures.
Moderate periodontitis: If left untreated, periodontitis can advance to moderate periodontitis—or stage three gum disease. In this stage, the ligaments and bones that support the teeth start to erode.
Advanced periodontitis: Stage four gum disease is an advanced form of periodontitis. During this stage, the bone loss in your mouth becomes more pronounced, causing your teeth to fall out or become loose.
Gum Disease Symptoms
Symptoms of gum disease get worse over time, especially if you don't receive proper treatment.
Gingivitis Symptoms
If you develop gingivitis, you may experience the following symptoms:
Red or swollen gums
Bleeding in the gums after brushing, flossing, or eating certain foods
Tender or sore gums
Visible plaque and tartar (crusty deposits) on the teeth
Halitosis (chronic bad breath)
Bad taste in the mouth
Periodontitis Symptoms
As gum disease advances and becomes periodontitis, the symptoms become more severe. Many people experience gum recession that causes the gums to pull back and make the teeth appear larger. Other symptoms may include:
Mouth or tooth pain with severe periodontitis
Tooth sensitivity to heat or cold
Pus-filled pockets between the gums and teeth
Teeth that become loose
Loss of teeth
Changes in your bite
Bone infection
Difficulty chewing food
Causes
A vast majority of gum disease cases occur due to the buildup of plaque—which is a sticky, bacteria-rich film that can develop on your teeth. Plaque is constantly forming on the teeth and it can form into a hardened brown, black, or green crust on the teeth, known as tartar. Tartar, which can’t be removed without dental treatment and can spread below the gum line, causes an inflammatory (immune) reaction in the gums, which causes symptoms of gum disease.
Poor dental hygiene is the primary reason that plaque and tartar build-up on your teeth. Regular brushing and flossing help remove plaque. But if plaque stays on your teeth for longer than two weeks, it can turn into tartar and cause inflammation in your gums.
Risk Factors
Several factors can increase your risk of developing gum disease, such as:
Genetics
Type 2 diabetes
Not flossing or brushing your teeth enough
Crooked teeth
Heart disease
Autoimmune disorders, such as human immunodeficiency virus (HIV/AIDS) or lupus
Defective dental fillings
Poorly fitting dental devices
Taking medications that cause dry mouth
Hormonal changes, such as going through pregnancy or using birth control
Diagnosis
When diagnosing gum disease, dentists, dental hygienists, or periodontists (gum specialists) work to differentiate gingivitis from periodontitis. This involves several steps:
Medical history and evaluation: To assess your risk for gum disease and understand the causes of the issue, your dental provider will ask you about your personal and family medical history, medications you're taking, and dietary habits.
Routine examination: To detect gum disease, your provider will look at your teeth. Usually, an exam is enough to detect signs of gum disease. Alongside a visual examination, your dental provider will also use a periodontal probe—a device that checks the spaces between your gums and teeth.
Imaging: To identify the type of gum disease you have, your provider may also perform a dental X-ray to assess the scope of any bone or tooth damage.
Stages of Gum Disease
Dental providers will stage your condition to help guide your treatment plan. Everyone's treatment plan depends on the stage of gum disease they're in and the symptoms they're experiencing. The stages include:
Stage 1 (gingivitis): Pockets around teeth are between 1 to 2 millimeters (mm), with bone loss being minor and only seen above the gum line
Stage 2 (mild periodontitis): Pockets between the gums and teeth are 3 to 4 mm large, and the bone loss is more extensive and affects the upper part of the teeth
Stage 3 (moderate periodontitis): Pockets are 5 mm or deeper and bone loss extends to lower parts of the teeth, sometimes causing tooth loss
Stage 4 (advanced periodontitis): Pockets are 5 mm or more, there’s a loss of five or more teeth, signs of significant bone loss, and symptoms such as difficulty with chewing
Gum Disease Treatment
The goals of treatment for gum disease are to stop inflammation and remove plaque and tartar from your teeth. Your exact treatment plan will depend on the severity of your condition and symptoms.
Dental Cleaning
Dentists, dental hygienists, or periodontists can all treat gingivitis. The first line of treatment for stage one gum disease is dental cleaning. They'll also recommend regular toothbrushing and flossing. Your dental provider may also schedule more frequent cleaning appointments to remove tartar and help the gums heal.
Scaling and Root Planing
Scaling and root planing are procedures that dental providers use to scrape tartar and plaque. Scaling involves using specialized tools to scrape tartar off your teeth above and below the gum line. With root planing, dental providers remove plaque and tartar from the root of the tooth.
Medications
Your dental provider will likely also prescribe medications, especially if you're receiving a dental procedure like root planing. Some common medications for gum disease include:
Paroex Oral Rinse (chlorhexidine): A prescription, antimicrobial mouthwash
PerioChip (gelatin with chlorhexidine): An antiseptic chip that you can insert into a pocket in your gums
Atridox (doxycycline): A type of antibiotic gel
Arestine (minocycline): An antibiotic microsphere that you can place in the pockets between teeth and gums
Vibramycin (doxycycline): An oral medication to help reduce infection and inflammation
Surgery
Surgeries may be necessary in very advanced or difficult-to-manage gum disease cases. Flap surgery involves removing portions of the gums to allow better access to removing tartar buildup on parts of the teeth at the root and below the gum line. The tissue is then sutured (or sewn) back into place.
Bone and tissue graft surgeries improve lost bone structure and help your gums grow back. For a bone graft, a dental surgeon will use either an artificial bone or bone harvested from other parts of the body to restore the loss of bone in your mouth. To treat lost tissue, they can also place a small mesh-like material between tooth and gum to guide regrowth. They can also harvest gum tissue from other parts of the mouth and suture it to the affected areas in your mouth.
How to Prevent Gum Disease
The main way to prevent gum disease is to keep your teeth and mouth clean to prevent plaque and tartar from forming. Preventative measures you can take include:
Brushing your teeth thoroughly for at least two minutes twice a day
Flossing daily via a plastic pick or a water flosser to remove food and bacteria between teeth
Quitting smoking or avoiding chewing tobacco
Using antibacterial mouthwash
Having regular dental examinations and cleanings with your dentist or dental hygienist
Complications
Tooth loss is the most common complication of untreated gum disease. This occurs as the inflamed gums recede and underlying bone and tooth structures become destroyed. Gum infections can also spread and worsen your oral health, and cause the following complications:
Abscesses, painful and infected pockets of pus that form due to infection
Teeth that migrate or move
Tooth roots becoming exposed
Researchers have also linked gum disease to several other conditions:
High blood pressure
Stroke
Pregnancy complications, such as a low birth weight
A Quick Review
Gum disease causes inflammation, bleeding, swelling, and tenderness in the gums. This condition is most often the result of poor hygiene. There are two overarching types of gum disease: gingivitis (stage one gum disease) and periodontitis (stage two to four gum disease). Getting treatment early for gum disease can reduce your risk of complications like tooth loss. Dental providers recommend preventing this condition via brushing and flossing twice a day and going in for regular dental cleanings.
Frequently Asked Questions
Can you stop gum disease from getting worse?
Improving your oral hygiene and getting regular dental cleaning stops gum disease from worsening. This means brushing for at least two minutes, flossing daily, and quitting smoking.
When is it too late to reverse gum disease?
Stage 1 gum disease is completely reversible with good oral hygiene and regular dental cleanings. But if the condition advances to periodontitis, which can be mild (stage 2), moderate (stage 3), or advanced (stage 4), the infection has spread to the bone surrounding the teeth. Though treatments help, by this point, there’s irreversible damage.
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