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Gum disease, or periodontal disease, is an inflammatory condition of the gums and other tissues surrounding the teeth. These tissues, collectively known as the periodontium, encompass:1
Early-stage gum disease, or gingivitis, can cause swelling and bleeding of the gums. In some cases, gingivitis progresses into periodontitis. This advanced stage affects the bone holding the teeth, leading to tooth loss and contributing to systemic disease. 2,3
There are many contributing gum disease risk factors. The most significant factor is your mouth's diverse array of bacteria and fungi.
The presence of some oral organisms is normal and natural and can have a protective effect against foreign bacteria. But if poor oral hygiene causes an imbalance in the oral microflora,
gum disease can occur.
The common causes of gum disease include:
Whitney DiFoggio, RDH, BS, explains the distinction between the two stages of gum disease:
Poor oral hygiene primarily causes gingivitis, which allows oral bacteria to cause inflammation of the gums. These bacteria form plaque, which hardens into tartar and causes bone loss.
“Gingivitis is the lowest stage of gum disease where the edges of the gingiva (gums) are inflamed and swollen, but everything underneath the gums, including the bone, is still intact. Gingivitis is reversible,” DiFoggio notes. She warns that if gingivitis remains untreated, it can progress into a more severe form of gum disease.
The most common gingivitis gum disease symptoms include:
Periodontitis always starts as gingivitis, making poor oral hygiene a critical factor in its development. Tobacco smoking is another significant risk factor for advanced gum disease due to decreased blood flow to the gums.
"Once it advances to periodontitis, the condition is no longer reversible. This is because the tissues begin to pull away from the tooth, leading to the bone beneath shrinking," DiFoggio elaborates.
"Periodontitis varies in severity, ranging from mild to intense, based on the health of the gum tissue and the degree of bone loss." A study found that smokers had nearly double the rate of moderate to severe periodontitis when compared to nonsmokers.4
The symptoms of gingivitis above can also occur in periodontitis. Other symptoms of more advanced gum disease include:
In early or mild gum disease, only your gums are inflamed. In periodontitis, the other three tissues also suffer.
While gingivitis doesn’t always lead to periodontitis, gingivitis always precedes periodontitis. Furthermore, periodontitis leads to tissue destruction, setting it apart from gingivitis.
Untreated gum disease can cause tooth and bone loss. Uncontrolled infection can also increase your risk for other systemic diseases, including cardiovascular and lung disease.
Other complications of untreated gum disease include:
According to the Centers for Disease Control and Prevention (CDC):4
Periodontal disease is more common in men than women (56.4% vs 38.4%), those living below the federal poverty level (65.4%), those with less than a high school education (66.9%), and current smokers (64.2%).
To maintain healthy gums and prevent gum disease, consider the following measures:
Your dentist can diagnose gum disease by examining your mouth. They may take X-rays and measure the pocket depth between your gums and teeth to determine the extent of attachment loss.
They’ll also review your medical history to see whether the following may be contributing factors:
Good oral hygiene can generally reverse gingivitis. However, periodontitis is irreversible. In some cases, you can slow it down, and treatment can repair tissue damage.
The primary goal of treating gum disease is to remove tartar buildup to prevent bacteria from spreading and causing bone loss. The type of gum disease treatment varies depending on the severity of the disease, including non-surgical and surgical therapies.
The most common non-surgical treatments for gum disease include:
Deep cleaning involves removing plaque and tartar from the gums with scaling and root planing.
Scaling is scraping the tartar from above and below the gum line.
Root planing removes rough tartar spots from the tooth’s root where disease-causing bacteria gather. Deep cleaning can cause bleeding, gum swelling, and discomfort.
Medications treat pain and control infection. They’re also effective in combination with surgical gum disease treatments.
Common medications that treat gum disease include:
Laser treatment removes plaque and tartar from the gum line as an alternative to deep cleaning. Laser treatment decreases the chance of swelling, bleeding, and discomfort associated with scaling and root planing.
Gum disease surgery may be required if deep cleaning and medication can’t control the infection. It may also be necessary if gum disease is severe and deep pockets remain.
Flap surgery removes tartar under the gums, then sutures them back in place. This ensures the gum tissue is tight against the tooth and reduces the size of periodontal pockets. Cleaning and maintaining healthy gums are easier after this surgery.
Gum disease can lead to bone loss around the tooth root. A bone graft involves placing natural or synthetic bone to stimulate regrowth where the bone is lost.
Gum disease also destroys soft tissue. A soft tissue graft uses a synthetic mesh material or natural tissue from your mouth to cover exposed tooth roots. This process helps reduce gum recession and improves the appearance of your smile.
Guided tissue regeneration is a bone grafting technique. It involves placing a mesh-like material in between the bone and connective tissue to prevent tissue from growing where the bone should be.
According to Dr. Khushbu Gopalakrishnan, one of NewMouth’s in-house dentists, “new surgical therapies are emerging for periodontitis, including LANAP, that you may want to discuss with your dentist. Don’t be disheartened by your diagnosis, and work with your dentist to maintain your natural teeth for as long as possible.”
Bacteria causing gum disease can enter the bloodstream, spreading to other body parts. Periodontitis also increases inflammatory markers in the bloodstream, a risk factor for diabetes and cardiovascular disease.
Gum disease also increases the risk of:
Tooth and bone tissue loss can result from untreated periodontal disease. It can also cause stroke, high blood pressure, and cognitive issues in older people.
The cost to treat gum disease varies depending on the severity of the disease, the geographical location of treatment, and if you have dental insurance. Depending on these factors, gum disease treatment can range from $500 to $10,000.5
After gum disease treatment, you may also need maintenance therapies that add to the cost. The estimated price for these procedures are:
After an initial diagnosis, a dentist might refer you to a periodontist (a dentist specializing in gum disease) for further treatment and evaluation.
Oral bacteria cause gum disease, which forms a biofilm that eventually causes inflammation. Early-stage gum disease, or gingivitis, only affects the gums and may or may not progress to a more advanced disease.
Advanced gum disease, or periodontitis, affects the deeper tissues of the periodontium. It can cause tooth loss and systemic health complications.
Gingivitis is reversible, but periodontitis isn’t, although it’s treatable. Good oral hygiene and overall health, a balanced diet, and avoiding tobacco help prevent gum disease.
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