Periodontal (gum) disease is an infection of the tissues that hold your teeth in place. It’s typically caused by poor brushing and flossing habits that allow plaque—a sticky film of bacteria—to build up on the teeth and harden. In advanced stages, periodontal disease can lead to sore, bleeding gums; painful chewing problems; and even tooth loss.
Causes of gum disease
Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “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 a professional cleaning by a dentist or dental hygienist can remove tartar.
There are a number of risk factors for gum disease, but smoking is the most significant. Smoking also can make treatment for gum disease less successful. Other risk factors include diabetes; hormonal changes in girls and women; diabetes; medications that lessen the flow of saliva; certain illnesses, such as AIDS, and their medications; and genetic susceptibility.
Symptoms of gum disease include:
- 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
At a dental visit, a dentist or dental hygienist will:
- Examine your gums and note any signs of inflammation.
- Use a tiny ruler called a “probe” to check for and measure any pockets around the teeth. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.
- Ask about your medical history to identify conditions or risk factors (such as smoking or diabetes) that may contribute to gum disease.
The dentist 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.
Links between gum disease and disparate health issues
Gums and the brain
Although spatially the gums are near the brain, one wouldn’t normally associate dental complaints with neurological conditions. Risk of cognitive decline in older men increases as more teeth are lost. Periodontal disease and caries, major reasons for tooth loss, are also related to cognitive decline.
Researchers have also linked periodontal disease with an increased buildup of beta-amyloid in the brain — the neurological hallmark of Alzheimer’s. Other experiments have produced evidence that one type of bacteria commonly found in cases of periodontitis — Porphyromonas gingivalis — can be found in the brains of individuals with Alzheimer’s.
The heart of the matter
Although not everyone with heart disease has gum disease, and not everyone with gum disease has heart disease, there does appear to be a correlation. Of course, individuals who smoke or drink large quantities of alcohol are more likely to have both oral and cardiovascular issues, but there appears to be more to the relationship than shared risk factors alone.
Some think that the link between gum and heart could involve inflammation. It is possible that inflammation in the gums sets off a cascade that, ultimately, sparks inflammation in the cardiovascular system.
Alternatively, the link between heart and gum diseases may be due to bacteria. Bacteria in the gums can enter the blood supply and be propelled to distant destinations, including the heart, where they can cause inflammation and damage.
Cancer risk increase
Once again, gum disease and cancer do not, on the surface, appear to have much in common. A study published in 2008 investigated tooth loss and cancer in 48,375 men. The authors concluded that there was, indeed, a link between gum disease and cancer. Periodontal disease was associated with a small, but significant, increase in overall cancer risk.
Why might this be the case? The researchers found that an enzyme produced by a type of bacteria commonly associated with gum disease — Treponema denticola — commonly appears in certain tumors of the gastrointestinal system.
An estimated 50 percent of men over the age of 40 experience erectile dysfunction. It is a complex condition that can result from both psychological and physiological factors. Some well-known risk factors include smoking tobacco, drinking alcohol, and hypertension. According to some scientists, periodontal disease might also increase the risk of erectile dysfunction. Because erectile dysfunction and gum disease have shared risk factors, including smoking and diabetes, it has been difficult to ascertain whether gum disease is an independent risk factor for erectile dysfunction.
Erectile dysfunction is often due to malfunctioning blood vessels; specifically, the smooth muscles lining the walls of blood vessels lose their ability to relax. This is referred to as endothelial dysfunction, and it prevents vasodilation in the penis and, consequently, erections.
Gums and lungs
Of course, the mouth is a shared gateway to the gums and the lungs, making a link between gum and lung diseases less surprising than some of the other.
A study published in February 2019 investigated the records of 1,380 men. The authors found a significant relationship between chronic periodontitis and a reduction in respiratory function. This link remained significant, even after controlling for confounding variables, such as smoking. Once again, inflammation may be the link between the two conditions. If the tubes in the lungs that carry air are inflamed, they become narrower and air flow is restricted.
Aside from the probable role of inflammation, bacteria present in the mouth might also be breathed into the lungs. Once in the lungs, the bacteria could trigger infections that directly lead to inflammation.
How is it treated?
Early treatment of gum disease is very important. It can help prevent permanent gum damage, control infection, and prevent tooth loss. For treatment to work:
- Brush your teeth 2 times a day and floss 1 time a day.
- See your dentist regularly for checkups and cleanings.
- Don’t smoke or use any tobacco products.
For gingivitis, your dentist may prescribe antibiotics to help fight the infection. They can be put directly on the gums, swallowed as pills or capsules, or swished around your teeth as mouthwash. Your dentist may also recommend an antibacterial toothpaste that reduces plaque and gingivitis when used regularly.
For periodontitis, your dentist or dental hygienist may clean your teeth using a method called root planing and scaling. This removes the plaque and tartar buildup both above and below the gum line.
You may need surgery if these treatments don’t control the infection or if you have severe damage to your gums or teeth. Surgery options include:
- Gingivectomy to get rid of the pockets between the teeth and gums where plaque can build up.
- A flap procedure to clean the roots of a tooth and repair bone damage.
- Extraction to remove loose or very damaged teeth.
After surgery, you may need to take antibiotics or other medicines to aid healing and prevent infection.
Scaling and root planning (SRP)
Your first step in treating periodontitis is a conservative, nonsurgical treatment called scaling and root planning (SRP). A dentist or dental hygienist provides this treatment by scraping and removing the plaque and tartar off of your teeth and root surfaces by scaling, and then smoothing away any roughness on the roots to prevent bacteria from gathering again.
Pocket Reduction Procedure
After scaling and root planning, if the gum tissue is not fitting snugly around the tooth and you can’t keep the deep pocket area clean, you may be a candidate for periodontal pocket reduction or flap surgery. By folding back the gum tissue, your dentist or periodontist can remove infectious bacteria and smooth areas of damaged bone, allowing the gum tissue to reattach to healthy bone.
Exposed roots due to gum recession can be covered with gum grafts, wherein gum tissue is taken from your palate or from another source and used to cover the roots of one or more teeth. Covering exposed roots helps reduce sensitivity and protects your roots from decay, while stopping further gum recession and bone loss.
Bone grafting is a surgical procedure that promotes the growth of bone in an area where bone has been destroyed by periodontal disease. During this type of treatment, your dentist or periodontist will eliminate bacteria and then place either natural or synthetic bone in the area of bone loss, along with tissue-stimulating proteins to help your body effectively regrow bone and tissue.
Anyone who has had treatment for advanced periodontal disease knows that meticulous homecare is the key to keeping periodontal disease from rearing its ugly head – again. Because personal oral care is a big part of any periodontal treatment plan, your dentist or dental hygienist will spend lots of time with you making sure you understand and implement proper brushing and flossing techniques at home.
In addition to not smoking, which inhibits the healing process, your dentist will also recommend keeping a close eye on your dentist with more frequent checkups and cleaning appointments. When dealing with periodontal disease, “an ounce of prevention is worth a pound of cure.
How can you prevent gum disease?
Gum disease is most common in adults, but it can affect anyone, even children. So good dental habits are important throughout your life.
- Brush your teeth 2 times a day, in the morning and before bedtime, with a fluoride toothpaste.
- Floss once each day.
- Visit your dentist for regular checkups and teeth cleaning.
- Don’t use tobacco products.
Am I likely to suffer from gum disease?
Probably. Most people suffer from some form of gum disease, and it is a major cause of tooth loss in adults. However, the disease develops very slowly in most people, and it can be slowed down to a rate that should allow you to keep most of your teeth for life.
How will smoking affect my gums and teeth?
Smoking can also make gum disease worse. People who smoke are more likely to produce bacterial plaque, which leads to gum disease. The gums are affected because smoking causes a lack of oxygen in the bloodstream, so the infected gums don’t heal. Smoking causes people to have more plaque and the gum disease to get worse more quickly than in non-smokers. Gum disease is still a major cause of tooth loss in adults.
What happens if gum disease is not treated?
Unfortunately, gum disease does not usually cause pain as it gets worse so you do not notice the damage it is doing. However, the bacteria are sometimes more active and this makes your gums sore. This can lead to gum abscesses, and pus may ooze from around the teeth. Over a number of years, the bone supporting the teeth can be lost. If the disease is left untreated for a long time, treatment can be more difficult.
How do I know if I have gum disease?
The first sign is blood on your toothbrush or in the toothpaste you spit out after cleaning your teeth. Your gums may also bleed when you are eating, leaving a bad taste in your mouth. Your breath may also become unpleasant.