The author of the article
Boris Lipovetskiy, DMD, 31 years experience
Do your gums bleed when you brush your teeth? Have you noticed bad breath or frequent inflammation of the soft tissues in your mouth? These common problems may be signs of gum disease, also known as periodontal disease. If you have these symptoms, you should see a dentist.
In this article, we will explain what it is and how to recognize the early signs. Our dentist discusses the causes, symptoms, and treatments of gum disease, and what can happen if it is left untreated.
Content:
What is gum disease?
Gum disease is a chronic inflammation that affects the tissues and ligaments that support the teeth. It is a general term for inflammatory and infectious processes. The soft tissues of the periodontium hold the teeth in their sockets (alveoli). They prevent food, bacteria, and saliva from reaching the roots and penetrating the gums. Gum problems begin with the accumulation of plaque on the teeth. If not removed, it hardens into tartar, leading to gum inflammation and gingivitis. If untreated, gingivitis can progress to periodontitis, which may affect the connective and bone tissue, increasing the risk of tooth loss.
How common is Gum Disease (Periodontal Disease)?
Gum disease is the leading factor in tooth loss among adults. According to the Centers for Disease Control and Prevention (CDC), nearly half (47.2%) of adults over the age of 30 and 70.1% of patients over the age of 65 in the U.S. have some form of periodontitis. It is particularly common among smokers: pathologies are identified in 64.2% of individuals who use cigarettes, vapes, IQOS, or chewing tobacco. As doctors, we believe this underscores the need for effective prevention and treatment measures for gum diseases.
Symptoms of Gum Disease
The signs of periodontal disease are quite typical. In the early stages, the following symptoms may appear:
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Red, swollen gums (painful to touch) -
Discomfort when chewing, itching, and swelling -
Bleeding when brushing teeth or using dental floss (early gingivitis) -
Persistent bad breath or bad taste in the mouth (due to bacteria) -
Gum recession – the soft tissues pull away from the roots, causing a gummy smile -
Tooth displacement – periodontitis leads to loosening or shifting of teeth -
Accumulation of pus or infection in the soft tissues
As the disease progresses, symptoms become more pronounced. In the later stages, the following may occur:
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Misalignment of teeth or dentures -
Receding gum from the crown of the tooth – formation of deep periodontal pockets -
Recession (loss) of gum tissue -
Resorption (breakdown) of bone tissue around the necks of the teeth -
Loosening and mobility of teeth
Doctor's Opinion
Periodontal disease often develops slowly and without symptoms or with very mild symptoms. If you notice any of these symptoms, the disease may already be at a moderate or severe stage. It is recommended to consult a periodontist for evaluation and treatment.
Causes of Gum Disease
The main cause of gum disease is the accumulation of a sticky film around the necks of the teeth. This is bacterial or pigmented plaque, consisting of food debris, food or tobacco dyes, and compounds of saliva with calcium and phosphate salts. Over time, plaque hardens into tartar. Plaque is relatively easy to remove, but tartar can only be removed by a dentist using specialized tools.
Excessive plaque buildup around the teeth occurs due to:
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Poor oral hygiene Untimely removal of soft plaque allows it to harden into tartar.
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Incorrect bite Gaps between misaligned teeth are difficult to clean with a brush and toothpaste.
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Improperly fitted dental prostheses or fillings Overhanging edges of prostheses or fillings can injure the mucous membrane. Additionally, disrupted occlusal contacts between the teeth of the upper and lower jaws after restorations can contribute to periodontal inflammation.
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Smoking traditional and electronic cigarettes, chewing tobacco Tar and nicotine accelerate plaque deposition.
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Excessive consumption of strong black tea and coffee They contain dyes that actively accumulate on the tooth surface.
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Insufficient saliva production (xerostomia) Poor washing of teeth by saliva accelerates plaque deposition.
Additional factors that provoke or exacerbate periodontal disease include:
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Hormonal changes in women During puberty, pregnancy, and menopause, general and local immunity decreases, accelerating bacterial growth in the oral cavity and plaque accumulation around the teeth.
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Endocrine diseases The most significant risk factor is insulin-dependent decompensated diabetes mellitus.
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Taking certain medications Glucocorticosteroids, oral contraceptives, anticonvulsants, and medications for angina worsen periodontal conditions, reduce immunity, and contribute to xerostomia.
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Immune system diseases Patients diagnosed with HIV, AIDS, cancer, or autoimmune diseases are at higher risk.
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Vitamin and mineral deficiencies Primarily a lack of vitamin C.
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Exposure to heavy metals Poisoning with bismuth or lead provokes inflammation and destruction of the gum line.
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Genetic factors The risk of periodontal disease is higher in individuals whose close relatives suffer from periodontal inflammation.
Types of Gum Disease
Gingivitis is the mildest type of gum inflammation, often caused by plaque buildup. It can be easily and quickly resolved with proper treatment. Gingivitis usually presents as red, swollen gums that may bleed when brushing or using dental floss. Bad breath and gum recession are also common symptoms.
What happens if gingivitis is not treated?
If left untreated, gingivitis can progress to a more severe stage of gum disease called periodontitis. The inflammation spreads to the connective tissues and jawbone, potentially leading to the formation of deep periodontal pockets, tooth loosening, and tooth loss.Periodontitis is an advanced form of gum disease that occurs when untreated gingivitis allows plaque to spread below the gum line. Pus may form in periodontal pockets, and the soft tissues may pull away from the tooth roots. Bone resorption and tooth mobility begin.
How does periodontitis develop?
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Initial stage: Pockets between the teeth and gums form up to 3.5 mm. -
Moderate stage: Pockets deepen to 6 mm, leading to jawbone destruction and tooth loosening. -
Severe stage: Pockets deepen to 12 mm, with significant bone loss. Teeth become very loose and may fall out. Symptoms include severe pain, pus between the gums, and recession.
Types of Periodontitis:
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Necrotizing periodontitis: The most severe type, characterized by necrosis and ulceration of the gum papillae. It occurs in patients with weakened immune systems or after chemotherapy. -
Periodontitis as a complication of systemic disease: Diagnosed when the amount of plaque and tartar is disproportionate to the severity of periodontal inflammation, often caused by hematological or genetic disorders. -
True periodontitis: Develops as a complication of gingivitis.
Doctor's Opinion
Complications of periodontitis can lead to jawbone atrophy and tooth loss. In such cases, a full mouth reconstruction – a comprehensive restoration of function and aesthetics – may be required. This procedure is more intensive and costly. If you notice any symptoms of gum disease or if it has been a long time since your last dental check-up, it is recommended to call and schedule a consultation at a dental clinic. Early detection and treatment of gum disease can save you from serious complications.
Possible Complications of Periodontal Disease
The main complication of gum disease is tooth loss, which results from the destruction of the ligament attachment, periodontal recession, and bone resorption.
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Tooth loosening: This is most common with periodontitis. Gingivitis does not cause the destruction of periodontal ligaments that surround the teeth. -
Chronic infections: Continuous inflammation can provoke the development of chronic infections in the nasopharynx. -
Diabetes complications: Gum disease can worsen the course of diabetes. -
Autoimmune diseases: The hyperactivation of the immune system in response to inflammatory processes can lead to the development of autoimmune diseases.
Important!
Tooth loss is not the most severe complication of periodontal disease, as the systemic health impacts can be more significant. Continuous inflammation and infection can have broader implications for overall health, highlighting the importance of timely treatment and management of gum disease.
Diagnosis of Gum Disease
To select an effective treatment method, it is necessary to accurately determine the type and stage of gum disease. For this, a periodontist conducts the following procedures:
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Oral examination In cases of gingivitis, a significant amount of plaque and tartar will be visible. With periodontitis, deep periodontal pockets with purulent contents can be observed. In periodontosis, there is a loss of soft and hard tissues without signs of inflammation.
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Probing The dentist uses a special dental tool to check the depth of the gum pockets. If the depth is no more than 3 mm, it indicates the initial stage of gingivitis. If this measurement exceeds 3 mm, periodontitis is diagnosed.
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Patient interview The dentist inquires about any chronic diseases that might have caused or worsened periodontal diseases. They also ask about the medications the patient is taking and whether the patient currently smokes or has smoked in the past.
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Radiography Targeted and panoramic X-rays help assess the condition of the tooth roots and the surrounding hard tissues. These images can reveal resorption or densification of the bone and indicate the severity of these changes.
Gum Disease Treatment
The goal of treating periodontal diseases is to completely halt or slow their progression. Treatment aims to restore the attachment of the gums to the teeth, eliminate infection and dental deposits, and reduce bleeding and swelling.
There are several types of dental procedures for treating periodontal inflammation. The method or combination of methods is chosen based on the type of disease, its stage, and the presence of complications.
Professional teeth cleaning is used for all types and stages of periodontal diseases. For gingivitis, simply removing dental deposits is often sufficient. For periodontitis and periodontosis, this method is the initial stage of treatment.
Additionally, the following procedures are conducted:
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Educating the patient on the correct technique for brushing teeth at home -
Antibiotic therapy for purulent contents in periodontal pockets -
Rinsing and applying wound healing, anti-inflammatory, and antibacterial solutions and gels -
Blood glucose level correction
Deep teeth cleaning is applied at all stages of periodontitis and periodontosis. It includes:
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Removing all soft and hard deposits above and below the gum line using an ultrasonic device. High-frequency vibrations break down tartar, which is then washed away with water. -
Smoothing and polishing the roots. This procedure results in smooth roots, preventing bacteria, food particles, and pigmented plaques from sticking to them.
Several deep cleaning procedures may be necessary to completely eliminate tartar and pus in periodontal pockets, with a 2-3 week interval between sessions.
Gum contouring (gingivectomy) is performed for deep periodontal pockets of 6 mm or more. This surgical method treats advanced periodontitis.
After gingivectomy, the size of the gum pockets is reduced, allowing them to fit more tightly against the tooth roots. This reduces the accumulation of plaque, food, bacteria, and saliva, thereby decreasing the risk of infection.
Important!
Classical removal of inflamed gums with a scalpel is a quite painful operation that requires significant anesthesia and recovery time.
In our clinic, we use lasers for treating gum disease. This allows for precise removal of infected tissues, reducing trauma and shortening rehabilitation time.
Bone grafting (osteoplasty) is performed for severe forms of periodontitis and periodontosis when the diseases have led to bone tissue loss. This deficiency may be in the area of several teeth or the entire jaw. The bone grafting procedure is similar to that before teeth implantation. Artificial bone material or the patient's own hard tissue taken from another part of the jaw is transplanted into the jaw. After the donor material integrates, the attachment of the teeth improves, and they stop loosening.
PRF and PRP are used in the advanced stages of periodontitis and periodontosis, when significant periodontal recession and bone resorption are noted. The transplantation of fibrin and plasma is performed in conjunction with gum contouring or osteoplasty.
PRF and PRP accelerate growth factors, collagen production, and osteoblast activity. Their transplantation:
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Speeds up wound healing -
Stimulates the regeneration of soft and hard tissues -
Increases the integration of artificial or natural bone materials -
Reduces inflammatory processes -
Accelerates epithelial cell division -
Improves blood supply to the periodontium
Doctor's Opinion
Are you afraid to visit the dentist due to fear of judgment or painful procedures when your gums are inflamed? Don't worry. I understand that deciding to see a dentist can be difficult.
Regardless of the condition of your gums, I will discuss the problem with you as respectfully as possible. I will conduct a comprehensive diagnosis and select the appropriate therapy for you based on the clinical picture. During the examination and treatment, I use advanced minimally invasive technologies and a holistic approach.
Prevention of Gum Disease
Proper oral hygiene is a key factor in preventing and avoiding the recurrence of periodontal inflammation. Dentists recommend:
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Brushing teeth in the morning and evening Use a toothbrush marked "Soft" and toothpaste with abrasiveness up to 60 RDA for inflamed periodontium. These products will not injure the mucous membrane or provoke bleeding.
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Removing plaque from the tongue Use the ribbed side of the toothbrush or a special scraper to reduce the number of pathogenic bacteria in the mouth.
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Rinsing the mouth after every meal It's best to use an antibacterial mouthwash with herbal extracts to reduce bleeding. If you don't have mouthwash on hand, plain water will do.
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Cleaning interdental spaces of food residues Use floss, interdental brushes, or an irrigator. Removing food particles from between the teeth helps reduce the risk of recurrent gingivitis.
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Undergoing professional teeth cleaning It is recommended at least once every six months. If recurrences are frequent, professional cleaning should be done every three months.
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Attending preventive oral exams Visit the dentist every six months. This allows for the timely detection and quick resolution of problems in the early stages.
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Maintaining a balanced diet Ensure your daily diet is rich in essential vitamins and minerals. Incorporate fresh vegetables, fruits, citrus, greens, nuts, cheeses, and vegetable oils, and minimize the consumption of sweets, fast food, and sodas.
Important!
Smokers may experience recurrences of gingivitis and periodontitis even if they fully adhere to dental hygiene and treatment recommendations. Quitting smoking significantly reduces the risk of gum inflammation.
FAQ
No, gum diseases themselves are not contagious. They are not transmitted through everyday contact. However, the bacteria present in the mouth of a patient can be potentially dangerous. The risk exists when kissing, using the same cutlery, or eating from the same dishes.
Sources of information
- Gingivitis. James T. Ubertalli, DMD, Hingham, MA. — Reviewed/Revised Apr 2024
- Gum Disease. Rosa Colombo. Department of Health Sciences, University of Milan, Italy. Journal of Clinical Dentistry and Oral Health (2021) Volume 5, Issue 3
- Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal diseases and dental caries. Helen V Worthington, Laura MacDonald, Tina Poklepovic Pericic, Dario Sambunjak, Trevor M Johnson, Pauline Imai, Janet E Clarkson. — 10 April 2019
- Periodontal Disease. Centers for Disease Control and Prevention, 2013
- Periodontal (Gum) Disease: Causes, Symptoms, and Treatments. U.S. Department of Health and Human Services. National Institutes of Health
- Periodontitis in US Adults. National Health and Nutrition Examination Survey 2009-2014. Paul I. Eke, PhD, MPH, Gina O. Thornton-Evans, DDS, Liang Wei, MS, Wenche S. Borgnakke, DDS, PhD, Bruce A. Dye, DDS, MPH, Robert J. Genco, DDS, PhD
- Periodontitis (Pyorrhea). James T. Ubertalli, DMD, Hingham, MA. — Reviewed/Revised Apr 2024
- Treatment of periodontitis for glycaemic control in people with diabetes mellitus. Terry C Simpson, Janet E Clarkson, Helen V Worthington
