Gum disease: causes, risks, prevention and when to see your dentist

Lindsay Boyers

People say the eyes are the window to your soul, but your mouth may be the window to your health. It's estimated that up to 50% of Americans currently have mild gum disease, or gingivitis, while up to 80% have dealt with the more severe form, periodontitis, at some point. And it's not just your teeth that are at risk. According to family dentist Kristy Gretzula, DMD, gum disease has been linked to a higher risk of diabetes and heart problems, like atherosclerosis, heart attack and stroke.

To help you better understand gum disease, our team spoke with two dentists and one periodontist who gave us the lowdown on what causes it and what you can do to prevent it.

Gum disease is an infection and inflammation of the tissues surrounding and supporting teeth. There are two primary forms: gingivitis and periodontitis.

Gingivitis is the mildest form and is quite common. It causes localized irritation, swelling and redness of your gums. If gingivitis isn't treated, it can progress to periodontitis, a more severe form of gum disease.

There are different stages of periodontitis, from mild to advanced, but they all go beyond the gums, affecting the deeper tissues and bones that support the teeth.

Symptoms of gum disease aren't always obvious. "Periodontal disease is often silent, meaning symptoms — particularly pain — may not appear until an advanced stage of the disease," says Y. Natalie Jeong, DMD, periodontist and professor and chair at Tufts University Department of Periodontology.

However, she recommends being on the lookout for the following signs and symptoms:

  • Red, swollen or tender gums or other pain in your teeth or mouth

  • Bleeding while brushing and flossing or when eating certain foods

  • Receding teeth — gums that are receding or pulling away from the teeth, causing the teeth to look longer than before

  • Loose or separated teeth

  • Pus between your gums and teeth

  • Mouth sores

  • Persistent bad breath

  • A change in the way your teeth fit together when you bite

  • A change in the fit of partial dentures

You may not have all of these symptoms since they largely depend on the stage of gum disease. There are four, from gingivitis to advanced periodontitis.

According to restorative dentist Naomi Levy Goldman, DMD, the lack of pocketing around the teeth separates gingivitis from periodontal disease. "We use a small probe to measure the space that exists between the tooth and the gum tissue that surrounds it. If this space is between 1 mm and 3 mm, the pocket is classified as healthy. If the measurement is higher than 3 mm, this is the beginning of periodontal disease," she says. When you hear your hygienists calling out numbers during your cleaning, they're measuring this.

Here's a breakdown of the four stages and their most common symptoms.

  • Gingivitis: As mentioned, gingivitis is the earliest stage. You may notice red, swollen gums that likely bleed easily during brushing or flossing. Bad breath and tender gums are also common in this stage.

  • Early periodontitis: In this stage, inflammation moves deeper into the gum tissues, causing pockets between the gums and teeth. The gums may begin to recede, making the teeth appear longer. Gums may bleed more, and there may be some bone loss.

  • Moderate periodontitis: As the gum disease progresses, pockets get deeper. Gums recede even more, and you may notice loose or shifting teeth. Bad breath, bleeding gums and moderate bone loss are also hallmarks of this stage.

  • Advanced periodontitis: This is the most severe stage. In advanced periodontitis, you'll have deep gum pockets, significant bone loss, loose or shifting teeth and possibly pus between the teeth and gums. Teeth are more likely to fall out at this stage, or you might have to get them removed.

Gum disease is typically caused by an accumulation of bacterial plaque — a sticky, colorless film — on the teeth and gums due to poor oral hygiene. If plaque isn't adequately removed through regular brushing and flossing, it can harden into tartar, which can only be removed by a dentist or dental hygienist. If that tartar isn't cleaned off regularly, it can cause gum infection and inflammation.

However, there's also a genetic component. "If a close family member has gum disease, there's a higher chance that you might also develop it, even with good oral hygiene practices," says Gretzula.

There are also other contributing factors:

  • Tobacco use

  • Hormonal changes

  • Certain medications

  • Other systemic conditions, like diabetes

These can include bone and tissue deterioration, loosening of teeth, dental infections and eventually tooth loss.

According to Jeong, several studies have also shown a link between periodontal disease and other health issues, including:

Gum disease has also been linked to other health conditions, such as rheumatoid arthritis, Alzheimer's disease, depression, certain cancers and kidney disease, although more research is needed to understand how they may be connected.

Treatment options depend on the condition's severity. Usually it begins with professional scaling and root planing, also known as deep cleaning.

During a deep cleaning, your dentist or periodontist removes plaque and tartar from beneath the gum line and roots of the teeth. "Root planing [also] allows your periodontist to smooth the tooth root to prevent future plaque or toxins from adhering," says Jeong. Depending on your case, antibiotics may also be prescribed to help control bacterial infection in the gums.

Many people respond well to deep cleaning and don't require any further treatment. However, severe cases may need surgery. There are two surgical options in these cases.

  • Flap surgery/pocket reduction surgery: In advanced gum disease, flap surgery may be needed to reduce pocket depth and make cleaning the teeth and gums easier. During this surgery, the gum is lifted away from the tooth, the roots are cleaned, and the gum is sewn back into place.

  • Bone or tissue grafts: If there's significant bone or tissue loss around the teeth, grafting procedures may be necessary to regenerate lost bone or soft tissue. If your teeth are exceptionally sensitive, Jeong says you might also need gum grafting — your dentist or periodontist will take gum tissue, usually from the roof of your mouth, and place it where there is little to no gum tissue (like over a receding gum line).

If your dentist does recommend surgery, don't worry. "We have a lot of techniques that we utilize now that didn't exist in the past, and people may be a bit intimidated by the procedure, but it's not something to be scared about," says Jeong.

Still, it's always best to prevent gum disease if you can. Fortunately, most cases are avoidable with good oral hygiene. Our experts recommend:

  • Brushing twice daily for at least 2 minutes

  • Using an electric toothbrush, if possible

  • Flossing once per day

  • Using a water flosser once per day

  • Scheduling professional dental cleanings every six months, or more frequently if you have gum disease

  • Eating less sugar

Gretzula also says a nutrient-rich diet is crucial, focusing on vitamin C and calcium, which can support gum health.

If you think you have gum disease, you should see your dentist as soon as possible to prevent further bone loss and tissue damage around the teeth. Even if you don't think you have gum disease, it's essential to maintain a regular schedule with your dentist to keep your gums and teeth healthy.

For most people, a hygiene visit every six months, followed by twice-daily brushing and once-daily flossing and water flossing is ideal, according to Goldman. "For patients who tend to build up with tartar more quickly, or patients with a diagnosis of periodontal disease, regular three- to four-month maintenance is recommended," she says.

It depends on how advanced the gum disease is. "Daily flossing or use of a Waterpik can be used to fix gingivitis at home, provided there is no tartar buildup creating the inflammation," says Goldman. However, if tartar is present, it needs to be professionally removed first.

Yes, salt water can help with gum disease in the early stages of gingivitis, according to Gretzula. "Salt water has anti-inflammatory properties that can help reduce swelling and soothe inflamed gums. Salt water can [also] promote healing by creating a slightly hypertonic environment, which helps reduce bacterial count and supports tissue repair," she says. That said, if gum disease has progressed to one of the later stages, salt water may not be as effective.

You can reverse gum disease if you catch it early but not once it's advanced to a certain point. "In the later stages of gum disease, the supporting structures of the teeth, including bone and connective tissues, have been extensively damaged or destroyed. Once bone loss occurs, it is challenging to regenerate," says Gretzula, adding that current treatment options don't fully restore the connective tissue that anchors the teeth.

  • Naomi Levy Goldman, DMD, owner and cosmetic and restorative dentist, Levy Goldman Dentistry, Peabody, Mass.

  • Kristy Gretzula, DMD, Dentist, Hawley Lane Dental, Stratford, Conn.

  • Y. Natalie Jeong, DMD, professor and chair at Tufts University Department of Periodontology, Boston

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