Gum disease

Gum disease is common and ranges from mild to severe. If not treated, it can lead to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost.

Key points:

  1. There are a number of gum diseases, with the most common being gingivitis
  2. People usually don’t show signs of gum disease until they are in their 30s or 40s. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. 
  3. Men are more likely to have gum disease than women.
  4. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.
  5. The key to preventing or stopping gum disease getting bad is caring for your teeth and gums every day.

Causes of gum disease

Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colourless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only professional cleaning by a dentist or dental hygienist can remove tartar.

Gingivitis

The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called gingivitis. In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.

Periodontitis

When gingivitis is not treated, it can advance to periodontitis (which means inflammation around the tooth”). In periodontitis, gums pull away from the teeth and form spaces, called pockets, that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.

Risk factors for gum disease

  • Smoking – this is one of the biggest risk factors associated with the development of gum disease. If you smoke, it also lowers your change of treatment working to improve your gum disease. 
  • Hormonal changes in girls/women  these changes can make gums more sensitive and make it easier for gingivitis to develop.
  • Diabetes – people with diabetes are at higher risk for developing infections, including gum disease.
  • Other illnesses and their treatments – diseases such as AIDS and its treatments can also negatively affect the health of gums, as can treatments for cancer.
  • Medications – there are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medicines can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth and gums clean.
  • Our genes  some people are more prone to severe gum disease than others and this can run in families. 

Symptoms of gum disease

  • bad breath that won’t go away
  • red or swollen gums
  • tender or bleeding gums
  • painful chewing
  • loose teeth
  • sensitive teeth
  • receding gums or longer appearing teeth.

Treatment of gum disease

Any of these symptoms may be a sign of a serious problem, which should be checked by a dentist. 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 “probe” to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.

The 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.

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 doctor may also suggest changing certain behaviours, such as quitting smoking, as a way to improve treatment outcome.

Non-surgical treatments

Deep cleaning: scaling and root planing

The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. In some cases a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.

Medications

Medications may be used with treatment that includes scaling and root planning, 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 mouth washes, antibiotics or other medication would help in your case. 

Surgical treatments

Flap surgery

Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.

Bone and tissue grafts

In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration. In this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow. Growth factors – proteins that can help your body naturally regrow bone – may also be used. In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots.

Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with oral care at home, and certain risk factors, such as smoking, which may lower the chances of success. Ask your periodontist what the level of success might be in your particular case.

Self care for gum disease

  • Brush your teeth two times a day (first thing in the morning and before bed) with a fluoride toothpaste.
  • Floss regularly to remove plaque from between teeth. Or use a device such as a special brush or wooden or plastic pick recommended by a dental professional.
  • Visit the dentist routinely for a check-up and professional cleaning.
  • Don’t smoke.

Complications

Can gum disease cause health problems beyond the mouth?

In some studies, researchers have observed that people with gum disease, when compared to people without gum disease, were more likely to develop heart disease or have difficulty controlling blood sugar. Other studies showed that women with gum disease were more likely than those with healthy gums to deliver preterm, low birth weight babies. But so far, it has not been determined whether gum disease is the cause of these conditions.

There may be other reasons people with gum disease sometimes develop additional health problems.

For example, something else may be causing both the gum disease and the other condition, or it could be a coincidence that gum disease and other health problems are present together.

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

Learn more

Gum disease Healthy Smiles website from the NZ Dental Association
Periodontal disease National Institute of Dental and Craniofacial Research
Gum disease Medline Plus

Credits: Adapted from a non-copyright article on periodontal disease from the National Institute of Dental and Craniofacial Research. Last reviewed: 02 Apr 2015