Gum disease

Also known as periodontal disease or periodontitis

Periodontitis or gum disease is caused by an infection that destroys the bone surrounding and supporting your teeth. It is a serious condition and if you have the symptoms you should see your dentist.

Key points 

  1. Periodontitis is caused by an infection that destroys the bone surrounding and supporting your teeth.
  2. Symptoms include loose teeth, bad breath, gum tenderness, receding gums, pus in your gums and gaps opening up in your teeth.
  3. Periodontitis usually builds up slowly over many years but some people may have a very active form of the disease that causes rapid loosening and loss of the teeth.
  4. It is a serious condition and if you have the symptoms you should see your dentist.
  5. You can’t treat periodontitis at home, but a dental professional can treat it with scaling, root planing and other treatments.

What are the causes of periodontitis?

Your mouth is full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky ‘plaque’ on your teeth. If you don’t brush and floss regularly, the plaque can harden and form ‘tartar’ (also known as ‘calculus’). Calculus increases the rate at which plaque forms, as it provides a base for the bacteria.

While your body's immune system is working to get rid of the toxins created by bacteria, it can accidentally damage your gum tissues. This leads to your gums pulling away from your teeth and forming spaces, called pockets, that become infected. These pockets are filled with bacteria and can be hard to clean.

If not treated, this can lead to the bone and connective tissue that hold your teeth in place breaking down. The bones, gums and tissue that support your teeth can be destroyed. Your teeth may eventually become loose and have to be removed.

What is the difference between periodontitis and gingivitis? 

Gingivitis is a milder inflammation of your gums. It is also caused by the bacteria in your mouth forming plaque on your teeth. However, if you improve your oral hygiene habits, you can usually get rid of gingivitis at home. If you don’t, gingivitis may turn into periodontitis, but not always. 

Periodontitis is more severe inflammation and infection leading to loss of tooth support, including loss of bone and gum tissue. You may have gingivitis before developing periodontitis, but not always. You are more likely to get periodontitis if you smoke and have poor oral hygiene.

Periodontitis may develop without the symptoms of gingivitis. If you are a smoker or have a suppressed immune system, the normal response of bleeding gums may never occur.

What are the symptoms of periodontitis?

Signs of periodontal/gum disease include:

  • teeth getting loose by themselves
  • bad breath (halitosis)
  • tenderness in your gums
  • gum recession – seeing more of the root or neck of the tooth
  • pus between your teeth
  • gaps opening up between your teeth. 

Who is at risk of getting periodontitis?

You are more likely to develop periodontitis if you have one or more of the following risk factors.

Smoking

Smoking is one of the biggest risk factors associated with the development of gum disease. This is because when bacteria attack your gums, the lower immune response and poor blood supply as a result of smoking mean your gums don’t fight back against the bacterial infection. If you smoke, it also lowers your chance of treatment working to improve your gum disease.  If you stop smoking, your gums will start to attack the plaque caused by the bacteria, which means you will get the symptoms that have been suppressed by smoking, such as bleeding gums.

Diabetes

People with diabetes are at higher risk for developing infections, including gum disease. This is because diabetes causes your blood vessels to thicken.

Pregnancy

The hormonal changes that occur during pregnancy can make your gums more sensitive. This makes it easier for inflammation to develop.

Medication

Prescription and over-the-counter medications can reduce the flow of saliva. Saliva helps protect your gums from bacteria. If your mouth is dry, it becomes more vulnerable to infections such as gum disease.

Some medicines can also cause abnormal overgrowth of your gum tissue, making it difficult to keep teeth and gums clean.

Existing oral conditions

Having calculus/tartar, large fillings or partial dentures increases your risks of gum disease developing. This is because they provide sites for bacteria to build up undisturbed, which then form more plaque.

Other health conditions

Treatments for HIV/AIDS and cancer can affect your immune system and therefore can negatively affect the health of your gums.

Genes

Some people are more prone to severe gum disease than others and this can run in families.

How is periodontitis diagnosed?

If you have any symptoms of periodontitis, see your dentist or dental hygienist. At your dental visit the dentist or hygienist is likely to:

  • ask about your medical history to identify underlying conditions or risk factors (such as smoking) that may contribute to gum disease
  • examine your gums and note any signs of inflammation
  • use a tiny ruler called a ‘periodontal probe’ to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually less than 3mls. This test for pocket depth is usually painless, but not always.

Your dentist or hygienist 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.

What are the types of periodontitis?

The diagnosis will include what type of periodontitis you have. There are three types of periodontitis:

  • necrotizing periodontitis
  • periodontitis as a manifestation of systemic diseases
  • periodontitis. 

Necrotizing periodontitis

This type of periodontitis usually occurs in people with compromised immunity. The main symptom in addition to the other periodontitis symptoms is ulcers on your gums. 

Periodontitis as a manifestation of systemic disease

This occurs when an immune disorder that is affecting your whole system also affects your gums, leading to disease.

Periodontitis

This diagnosis is used when the other two factors are not present. Your dentist will determine the stage and grade of your periodontitis to help work out what treatment plan to follow.

How is periodontitis treated?

Any of the symptoms may be a sign of a serious problem, which should be checked by a dentist. The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the disease. With any treatment, you will need to keep up good daily oral care at home. Your dentist may also suggest you quit smoking, if you do, to improve the outcome of the treatment.

Scaling and root planing

As gum disease progresses, plaque forms below your gum line. This is impossible for you to clean off by yourself. Instead, a dentist, periodontist, or dental hygienist can remove the plaque through a deep-cleaning method called scaling and root planing.

Scaling means scraping off the plaque from above and below your gum line. It is a deep clean of all the hard and soft deposits on your teeth. Root planing gets rid of rough spots on the tooth root where bacteria gather and helps remove bacteria that contribute to the disease.

Laser treatment

In some cases, a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling and discomfort.

Medication

Medication may be used with treatment that includes scaling and root planing, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time.

Talk with your dentist or periodontist about whether any mouthwashes, antibiotics or other medication would help in your case.

Flap surgery

Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications.

This common surgery involves lifting back your gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. This makes it easier to keep the area clean. After surgery, the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.

How can I care for myself with periodontitis?

  • Follow good oral hygiene practices. Read about taking care of your teeth.
  • Follow any special instructions from your dentist.
  • If you smoke, quit, as this will improve your treatment outcomes and help prevent future gum disease developing.
  • If you have gum recession, make sure you aren’t over-brushing (brushing too much or too hard), and that you are using a soft toothbrush. Read about tooth wear.

How can I prevent periodontitis?

The same good oral hygiene practices that protect your teeth also protect your gums from the bacteria build-up that leads to inflammation and infection.

This includes:

  • brushing your teeth twice a day (first thing in the morning and before bed) with a fluoride toothpaste
  • using a soft or ultra-soft toothbrush – medium and hard toothbrushes can damage your gums and can be less effective at removing plaque
  • flossing once a day to remove plaque from between your teeth – if you have larger gaps between your teeth a dental professional might recommend you use an interdental brush
  • visiting your dentist and dental hygienist regularly for a check-up and professional cleaning
  • using an electric toothbrush rather than a manual one. 

You should also:

  • visit your dentist routinely for a check-up and professional cleaning
  • be smokefree and limit alcohol intake
  • avoid cannabis use as this is associated with severe gingivitis and periodontitis
  • avoid eating sugary foods between meals.

Read more about taking care of your teeth

How does smoking affect my gums?

Avoiding smoking is a key step in keeping your gums healthy. People who smoke have a higher risk of gum problems (and oral cancer), such as complications after tooth extractions and surgery in your mouth. You have lower resistance to infections and your healing is impaired. 

Gum conditions in smokers are also often not noticed as smokers typically do not have bleeding gums as they have poor blood supply to the gums. If you are a smoker and you stop smoking, your gums are likely to start to bleed. This is because the blood supply is returning to your gums and they are starting to fight the plaque. 

Can gum disease cause health problems beyond your mouth?

Some researchers have observed that people with gum disease were more likely to develop heart disease or have difficulty controlling blood sugar than people without gum disease. Other studies showed that women with gum disease were more likely than those with healthy gums to deliver preterm, low birthweight babies. However, it is not been proven that gum disease is the cause of these conditions. It may be that another risk factor, such as smoking, is causing both the gum disease and the other condition.

More research is needed to clarify whether gum disease actually causes health problems beyond your mouth, and whether treating gum disease can keep other health conditions from developing.

Learn more

The following links provide further information about periodontitis or gum disease. Be aware that websites from other countries may have information that differs from New Zealand recommendations.  

Dental plaque and gum disease Patient Info, UK, 2017
Gum disease NHS Choices, UK, 2016
Gingivitis and periodontal disease WebMD, 2017 

References

  1. Smoking and oral health Better Health, Australia, 2017
  2. EL Morelli, JM Broadbent, JW Leichter, WM Thomson. Pregnancy, parity and periodontal disease Australian Dental Journal. 2018; 0: 1–9.
  3. Papapanou PN, Sanz M, et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions Clin Periodontol. 2018;45(Suppl 20):S162–S170.
  4. Robinson P, Deacon S A, Deery C et al. Manual versus powered toothbrushing for oral health. Cochrane Database Syst Rev 2005; CD002281.

Reviewed by

Associate Professor Jonathan Broadbent is an Associate Professor in Dental Public Health, Department of Oral Sciences, University of Otago. He is a dental public health specialist.
Credits: Health Navigator Editorial Team. Reviewed By: Associate Professor Jonathan Broadbent, Department of Oral Sciences, University of Otago