Gingivitis and Periodontal Disease (Gum Disease)

Periodontitis, also generally called gum disease or periodontal disease, begins with bacterial growth in your mouth and may end -- if not properly treated -- with tooth loss due to destruction of the tissue that surrounds your teeth.

What's the Difference Between Gingivitis and Periodontitis?

Gingivitis (gum inflammation) usually happens before periodontitis (gum disease). But not all gingivitis leads to periodontitis. Most people get gingivitis at some point in their lives, and its mild symptoms make it easy to ignore. But without treatment, it can turn into bigger problems for your mouth. The good news is that you can prevent or even reverse it by simply brushing your teeth, flossing, and having regular dental cleanings and checkups.

In the early stage of gingivitis, bacteria in plaque build up, causing the gums to become inflamed and to easily bleed during tooth brushing. Although the gums may be irritated, the teeth are still firmly planted in their sockets. No irreversible bone or other tissue damage has occurred at this stage.

When you forget to brush, floss, and rinse with mouthwash, a sticky film of bacteria and food called plaque builds up around your teeth. The gunk releases acids that attack your teeth’s outer shell, called enamel, and cause decay. After 72 hours, plaque hardens into tartar, which forms along the gum line and makes it hard to clean your teeth and gums completely. Over time, this buildup irritates and inflames your gums, causing gingivitis.

In a person with periodontitis, the inner layer of the gum and bone pull away from the teeth and form pockets. These small spaces between teeth and gums collect debris and can become infected. The body's immune system fights the bacteria as the plaque spreads and grows below the gum line.

Toxins or poisons -- produced by the bacteria in plaque as well as the body's "good" enzymes involved in fighting infections -- start to break down the bone and connective tissue that hold teeth in place. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. When this happens, teeth are no longer anchored in place, they become loose, and tooth loss occurs. Gum disease is the leading cause of tooth loss in adults.

What Causes Gum Disease?

Plaque is the primary cause of gum disease. However, other factors can contribute to periodontal disease. These include:

• Hormonal changes, such as those occurring during pregnancy, puberty, menopause, and monthly menstruation, make gums more sensitive, which makes it easier for gingivitis to develop.
• Illnesses may affect the condition of your gums. This includes diseases such as cancer or HIV that interfere with the immune system. Because diabetes affects the body's ability to use blood sugar, patients with this disease are at higher risk of developing infections, including periodontal disease and cavities.
• Medications can affect oral health, because some lessen the flow of saliva, which has a protective effect on teeth and gums. Some drugs, such as the anticonvulsant medication Dilantin and the anti-angina drug Procardia and Adalat, can cause abnormal growth of gum tissue.
• Bad habits such as smoking make it harder for gum tissue to repair itself.
• Poor oral hygiene habits such as not brushing and flossing on a daily basis, make it easier for gingivitis to develop.
• Family history of dental disease can be a contributing factor for the development of gingivitis.

What Are the Symptoms of Gum Disease?

Gum disease may progress painlessly, producing few obvious signs, even in the late stages of the disease. Although the symptoms of periodontal disease often are subtle, the condition is not entirely without warning signs. Certain symptoms may point to some form of the disease. The symptoms of gum disease include:

• Gums that bleed during and after tooth brushing
• Red, swollen gums. Healthy gums should be pink and firm.
• Persistent bad breath or bad taste in the mouth
• Receding gums
• Formation of deep pockets between teeth and gums
• Loose or shifting teeth
• Changes in the way teeth fit together upon biting down, or in the fit of partial dentures

Even if you don't notice any symptoms, you may still have some degree of gum disease. In some people, gum disease may affect only certain teeth, such as the molars. Only a dentist or a periodontist can recognize and determine the progression of gum disease.

How Does My Dentist Diagnose Gum Disease?

During a dental exam, your dentist typically checks for these things:

• Gum bleeding, swelling, firmness, and pocket depth (the space between the gum and tooth; the larger and deeper the pocket, the more severe the disease)
• Teeth movement and sensitivity and proper teeth alignment
• Your jawbone, to help detect the breakdown of bone surrounding your teeth

How Is Gum Disease Treated?

The goals of gum disease treatment are to promote reattachment of healthy gums to teeth; reduce swelling, the depth of pockets, and the risk of infection; and to stop disease progression. Treatment options depend on the stage of disease, how you may have responded to earlier treatments, and your overall health. Options range from nonsurgical therapies that control bacterial growth to surgery to restore supportive tissues. A full description of the various treatment options is provided in Gum Disease Treatments.

How Can Gum Disease Be Prevented?

Gingivitis can be reversed and gum disease can be kept from getting worse in nearly all cases when proper plaque control is practiced. Proper plaque control consists of professional cleanings at least twice a year and daily brushing and flossing.

Brush your teeth twice a day. Use a soft-bristled brush and fluoride toothpaste. Replace your toothbrush every 3 months, or sooner if the bristles become frayed. Old, worn-out ones won't clean teeth as well. Brushing gets rid of plaque on the surfaces of the teeth that can be reached.

Flossing removes food particles and plaque from in between the teeth and under the gum line. Floss every day. Don’t wait until something gets stuck between your teeth. Daily flossing gets plaque out of places your toothbrush can't reach. You can also try interdental cleaners, picks, or small brushes that fit in between teeth. Ask your dentist how to use them so you don't damage your gums.

Rinse your mouth. Antibacterial mouthwash not only prevents gingivitis, it fights bad breath and plaque. Antibacterial rinses can reduce bacteria that cause plaque and gum disease, according to the American Dental Association. Ask your dentist which mouthwash would work best for you.

Other health and lifestyle changes can cut the risk of gum disease, lessen how severe it is, and slow how fast it develops. They include:

• Stop smoking. Not only is smoking bad for your heart and lungs, it can harm your teeth and gums. Smokers are seven times more likely to get gum disease than nonsmokers, and smoking can lower the chances of success of some treatments.
• Reduce stress. Stress may make it hard for your body's immune system to fight off infection.
• Maintain a balanced diet. Bacteria in your mouth feed on sugars and starches from food, fueling them to release the acids that attack tooth enamel. Junk food and candy have a lot of extra sugar and starch. Avoid them to keep your teeth and gums healthy. Proper nutrition helps your immune system fight infection. Eating foods with antioxidants -- for example, those containing vitamin E (vegetable oils, nuts, green leafy vegetables) and vitamin C (citrus fruits, broccoli, potatoes) -- can help your body repair damaged tissue.
• Avoid clenching and grinding your teeth. These actions may put excess force on the supporting tissues of the teeth and could increase the rate at which these tissues are destroyed.

Despite following good oral hygiene practices and making other healthy lifestyle choices, the American Academy of Periodontology says that up to 30% of Americans may be more likely to get gum disease because of their genes. And those who are genetically predisposed may be up to six times more likely to get some form of gum disease. If anyone in your family has gum disease, it may mean that you are at greater risk as well. If you are more likely to have gum disease, your dentist or periodontist may recommend more frequent checkups, cleanings, and treatments to better manage the condition.

If it's been 6 months since you last saw the dentist, set up a cleaning to remove tartar and plaque buildup from your teeth. Ask your dentist about the proper way to brush. Bearing down too hard or missing spots can lead to gingivitis. After a cleaning, your gums should get better within a week or so as long as you brush twice a day, and floss and rinse once a day.

Is Gum Disease Linked to Other Health Problems?

According to the CDC, researchers have uncovered potential links between gum disease and other serious health conditions. In people with healthy immune systems, the bacteria in the mouth that makes its way into the bloodstream is usually harmless. But under certain circumstances, these microorganisms are associated with health problems such as stroke and heart disease. Diabetes is not only a risk factor for gum disease, but gum disease may make diabetes worse.

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