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Healthy gums typically exhibit no visible signs of inflammation and do not bleed when probed. They can range from pale pink to brown or even dark brown, depending on their natural pigmentation.
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Gum Disease: The Facts
Gum disease, also referred to as periodontal disease is the 6th most common disease in the world. It’s triggered by bacteria in plaque and can lead to tooth loss. Good oral hygiene can help reverse and prevent it.
This page is here to tell you everything you need to know about it – the signs & symptoms, how you can treat it as well as the best way to prevent it!
What Is Gum Disease?
Gum disease is a collective name for a group of inflammatory conditions that affect the structures that support and hold the teeth in place. In the early stages of the disease is characterised by red, swollen gums that bleed. This stage of the disease is called gingivitis, only the gum tissue is affected and is reversible.
When left untreated the disease progresses to periodontitis, a more severe form where the gums pull away from your teeth, creating periodontal pockets where plaque and food debris can get trapped. The body’s immune response to bacteria and the bacteria itself causes bone loss which can lead to gum recession and teeth which become loose.
How Common Is It?
Gum diseases are a very common problem around the world.
According to the Centers for Disease Control and Prevention (CDC), 47.2% of adults aged 30 and over in the United States have some form of gum disease. The prevalence increases with age, with 70.1% of adults aged 65 and over having some degree of the disease.
The British Society of Periodontology, estimate that gingivitis affects 55% of adults. Other sources suggest the figure rises to 80% worldwide.
The World Health Organisation estimates that severe periodontitis affects around 19% of the global adult population, representing more than 1 billion cases worldwide.
It is slightly more common in men than women.
Signs and Symptoms
The early signs and symptoms of gum disease include
- Red, swollen gums
- Gums may bleed when brushing and flossing
- Bad breath
- A metallic taste in the mouth
As the disease progresses the following symptoms may also develop:
- Periodontal pockets
- Bone loss
- Gum recession which exposes the tooth roots causing sensitivity
- Abscesses/Pus
- Changes in bite
- Loose, wobbly teeth
- Tooth loss
When to see a dentist
Regular dental check-ups are essential in maintaining oral health, but it’s particularly crucial to schedule an appointment if you notice bleeding gums or any symptoms listed above. Early detection and professional treatment can help prevent the disease from progressing to more severe stages, ultimately safeguarding your overall dental and overall well-being. If your dentist thinks your symptoms are advanced or not improving they may refer you to see a specialist called a periodontist.
The Stages & Types of Gum Disease
In 2018 the AAP and EAP updated and amended how gum diseases are classified. So this may be different to what you see elsewhere online if they haven’t updated their content.
Gingivitis
This is the earliest stage of the disease, which when treated quickly can prevent irreversible damage that occurs in the later stages. The gums are red (although this depends on the natural skin tone), inflamed and they bleed easily when brushing and flossing.
This stage is often caused by poor oral hygiene but can also be influenced by your general health, pregnancy, hormones, smoking, diabetes and medication.
Periodontitis
If left untreated, gingivitis will often lead to periodontitis where there is progressive loss of bone and structures that hold the teeth in place.
In most cases, this is a result of the accumulation of dental plaque and tartar on the teeth and beneath the gumline. The body’s immune response to this bacterial buildup leads to inflammation and tissue damage.
There are several other forms of periodontitis including necrotising (ANUG) and that which is a manifestation of systemic disease.
As part of your diagnosis, your dentist will stage and grade your disease – this enables them to give individualized diagnoses and create tailor-made treatment plans for every patient.
The stages range from Stage I to Stage IV, with the lowest number representing the least severe form of the disease. The stage is determined by various factors including the
- amount of bone loss
- number of teeth lost
- depth of periodontal pockets
- and how complex the treatment needs to be.
The grade evaluates how likely it is that your gum disease will progress and how quickly it will happen. it takes into account whether you smoke, have diabetes and how your body responds to plaque.
How do dentists diagnose periodontal disease?
If a dentist suspects you have some degree of gum disease during a routine examination they will formally diagnose the condition by:
- Measuring the depth of the space between the teeth and gum. Healthy gums have a gap of 1-3mm. The pocket depth is measured using a dental ruler called a probe or measure. This test is usually painless.
- Taking a full medical history to identify if there is any family history or factors which put you at increased risk
- Taking X-rays to determine how much bone has been lost
- Taking 3D Photos: In some cases, dentists may use intraoral cameras to capture images of your gums, which can aid in diagnosis and treatment planning.
- Using Assessment Tools: Dentists often use standardised assessment tools, such as the Periodontal Six Point Pocket Charting, to evaluate disease severity
Causes & Risk Factors
Many things can increase your vulnerability to gum disease (see risk factor below) however, in all cases, the disease is triggered by plaque, which contains bacteria, bacterial products and food debris.
Plaque Causes Gum Disease
When plaque is allowed to build up on your teeth and gums, some species of bacteria irritate the gums and initiate an immune response. Immune cells are recruited to the area to get rid of the bacteria and cause the typical signs and symptoms of the disease.
The longer the plaque remains undisturbed the more inflamed the gums become.
This persistent swelling causes the gums to pull away from the teeth creating spaces called periodontal pockets. Plaque gets into these pockets causing damage and destruction of the connective tissues and bone that holds the teeth in place.
The longer the disease goes untreated the worse the damage gets.
Risk factors
Gum disease can affect anyone, but certain factors can increase the risk of it developing.
These include:
- Poor oral hygiene
- Incorrect tooth brushing
- Ignoring the early warning signs
- Immune response – which can be influenced by smoking, systemic health conditions and stress
- Food impaction
- Ill-fitting dental appliances
- Smoking
- Diabetes
- Poor dietary choices
- Obesity
- Certain medications – for example, Dilantin (seizure control), Cyclosporine (anti-rejection drugs for organ transplantation), and calcium channel blocking drugs (hypertension control) can affect your oral health
- Systemic diseases – 16 diseases are known to increase the risk including leukaemia, HIV, Down syndrome, Ehlers–Danlos syndrome, Crohn’s disease, Marfan syndrome and Klinefelter syndrome
- Hormones – hormonal changes that happen during puberty, pregnancy and menopause
- Genetics
- Trauma to the gum – chemical injury, physical injury, and internal injury as well as by embedding of foreign body reactions
- Gum infections
- Stress
Complications
If the disease is left untreated it can lead to several complications. Some of the potential complications include:
- Gum recession: as bone is destroyed the gums can recede – the gum tissue pulls away from the teeth, exposing the roots and making the teeth more prone to decay and tooth sensitivity.
- Tooth loss: the destruction of the tissue and bone that support the teeth can cause them to fall out or require extraction.
- Abscesses: pockets of infection can form in the gums or the bone around the teeth.
- Increased risk of developing other health conditions: The bacteria and consequential immune response have been shown to contribute to the development of diseases distant from the body. This is because they can enter the bloodstream and travel throughout the body. They don’t just act at the site of the initial infection. There is evidence to suggest that gum disease may increase the risk of developing conditions such as heart disease, and cancer. It can also lead to premature birth and low birth weights.
- Increased risk of elevated sugar levels and uncontrollable diabetes which then affects your gum disease.
Prevention & Treatment
Preventing Gum Disease
Prevention is better than treatment! There are several things you can do
- Have excellent oral hygiene
- Look out for warning signs – if you notice your gums are becoming red and inflamed take action with the advice above
- Eat a balanced diet
- Quit smoking
- Control diabetes
Don’t ignore gum disease – it won’t go away.
How To Treat Gum Disease
Treatment options depend on the severity.
Treating Gingivitis
Gingivitis can often be reversed with daily performed self-care and regular professional cleaning. Dental hygienists can remove plaque and tartar that build up above and below the gum line.
Periodontitis Treatment
Periodontitis may require more intensive treatment. Treatment options for periodontitis may include:
- Improved oral hygiene: the dentist will start by giving you information on how best to clean your teeth so bacteria is disrupted and any professional treatments are effective.
- Scaling and root planing: This procedure involves cleaning the teeth and the roots of the teeth below the gum line to remove plaque and tartar.
- Secure loose teeth: splits can be used to secure any wobbly teeth whilst the health of your gums improves
- Remove ill-fitting dental appliances: badly fitted crowns can make cleaning your teeth difficult and can be a breeding ground for bacteria
- Mouth guards – to help revive the damaging effects of bruxism on the bone
- Gum surgery: In more advanced cases, surgery may be necessary to remove infected tissue.
- Gingival Graft: repair damaged tissue, or regenerate lost bone.
- Receding gums: if the recession is causing sensitivity or aesthetic concerns composite resin, porcelain veneers, or fluoride varnishes may be used. Special toothpaste can be used to help with sensitivity.
- Lifestyle changes: Making changes to your diet and quitting smoking can help improve the health of your gums.
- Some dentists recommend mouthwash and waterpiks.
Can I Treat Gum Disease at Home?
You can treat gum disease at home. In fact, the single most important thing you can do is daily performed self-care.
This includes:
- Brushing your teeth twice a day – Use a soft-bristled electric toothbrush and fluoride toothpaste.
- Cleaning the spaces between the teeth with interdental brushes or single-tufted toothbrushes to disrupt the sticky plaque that can get trapped between the teeth
If your gum disease has advanced it can be difficult to disrupt bacteria hiding within periodontal pockets, so professional help is needed. There’s good news – you can now disrupt the bacteria and food debris in periodontal pockets with electric toothbrushes!
What’s The Outlook For People With Periodontal Disease?
The prognosis can vary widely depending on several factors, including the severity of the disease, the individual’s overall health, and their response to treatment. Early detection and intervention can often lead to better outcomes, but even in more advanced cases, effective management and treatment can help individuals maintain their teeth and gum health.
