Gum Disease - Causes, Symptoms & Treatment

What is Gum Disease? 

Gum disease, or periodontal disease, is an inflammatory condition of the gums and other tissues surrounding the teeth.

You have four different tissues surrounding your teeth, all of which can be affected by gum disease. Together, these tissues are called the periodontium:³

1. Your gums (gingiva)
2. The outer parts of your tooth roots (cementum)
3. The bone sockets your teeth sit in (alveolar bone) 
4. The ligaments connecting your teeth to their sockets (periodontal ligament) 

Early-stage gum disease, known as gingivitis, can cause swelling and bleeding of the gums. Good oral hygiene can effectively reverse gingivitis.¹

In some cases, however, gingivitis progresses into periodontitis, which affects the bone holding the teeth in the bone. Periodontitis can ultimately lead to tooth loss and contribute to systemic disease.^{1, 2}

Gingivitis vs. Periodontitis 

According to Whitney DiFoggio, RDH, BS, “gingivitis is the lowest stage of gum disease where the edges of the gingiva (aka gums) are inflamed and swollen, but everything underneath the gums, including the bone, are still intact. Gingivitis is reversible.”

“Without treating gingivitis, the gums will progress into a more advanced stage of gum disease called periodontitis. Periodontitis is no longer reversible since tissues start pulling away from the tooth, which causes the bone underneath to start shrinking,” she adds. “Periodontitis has a range of different stages from mild to severe, depending on the status of the gum tissue and loss of bone.”

In early or mild gum disease, only your gums are inflamed, hence the name gingivitis.¹ In periodontitis, the other three tissues begin to suffer as well.⁴ While gingivitis does not always lead to periodontitis, periodontitis is always preceded by gingivitis. Unlike gingivitis, periodontitis actually destroys tissue.^{4, 5}

What Causes Gum Disease?

There are many contributing factors to gum disease. The most significant factor is the diverse array of bacteria and fungi that live in your mouth (oral microbiome).

The presence of some oral organisms is normal and natural and can have a protective effect against foreign bacteria.⁶ But if poor oral hygiene causes an imbalance in the oral microflora, various diseases such as gum disease can result.^{5, 6, 7}

The primary risk factors for gum disease include:^{7, 8,  9, 10, 11}

• Poor oral care (not brushing or flossing enough)
• Diabetes (due to raised blood glucose levels)
• Certain medications (which can cause gingival enlargement)
• Poor diet (not drinking enough water, eating processed carbs, and not getting enough fresh fruits and vegetables)
• Sharing bacteria (bacteria that cause gum disease can get passed between family members that share food and utensils)
• Smoking
• Psychological stress
• Hormonal changes (e.g., during pregnancy)
• Poor immune function
• Vitamin deficiencies, such as B, C, D, E, and K

Gingivitis Causes

Gingivitis is largely caused by poor oral hygiene, which allows oral bacteria to cause inflammation of the gingiva.^{1, 7} These bacteria form plaque, which is a biofilm that sticks to your teeth. This plaque eventually hardens into tartar, which can cause bone loss.

Regular brushing and flossing disrupts the formation of plaque, thus preventing gingivitis.^{1, 6}

Periodontitis Causes 

Periodontitis always starts as gingivitis, making poor oral hygiene an important factor in its development. Tobacco smoking is a major risk factor for advanced gum disease, due to decreased blood flow to the gingiva. This results in decreased healing potential, allowing gum disease to progress.^{2, 7, 8} 

One study found that smokers had nearly double the rate of moderate to severe periodontitis when compared to nonsmokers.⁸

Symptoms of Gum Disease

Early stages of gum disease may have few symptoms. Sometimes, by the time someone sees a dentist, they are already at a more advanced stage of disease.

Gingivitis Symptoms

Gingivitis can cause your gums to appear red, swollen, itchy, and/or tender. Your gums may also bleed easily, leading you to spit out blood when you brush or floss your teeth. Bad breath (halitosis) or a persistent bad taste can also be a symptom of gingivitis.

Periodontitis Symptoms

All of the symptoms of gingivitis (swollen gums, gum bleeding, bad breath) can also occur in periodontitis. Other symptoms of more advanced gum disease include:^{1, 7}

• Deep spaces or pockets between your teeth and gums due to lost connective tissue (attachment loss)
• Loose teeth
• Increased tooth sensitivity due to gum recession 
• Pain while chewing
• Food getting stuck between teeth
• Bite changes

Diagnosing & Treating Gum Disease

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.¹

They’ll also review your medical history to see whether any medications, habits (smoking, for example), or pre-existing conditions (such as diabetes) may be contributing factors.

Gingivitis Treatment

Gingivitis can generally be reversed with good oral hygiene. To start, your dentist may perform a cleaning.

Periodontitis Treatment

Unlike gingivitis, periodontitis cannot be reversed. It can be slowed down in some cases, and treatment can repair tissue damage.

To start, your dentist may perform a deep cleaning procedure known as scaling and root planing. Scaling removes tartar (hardened plaque) from your teeth and gumline. Planing (smoothing) is performed on the roots of your teeth to help prevent future tartar buildup.

Your dentist will also encourage you to maintain good oral hygiene. Maintaining a healthy lifestyle is also important (e.g., avoid tobacco and eat healthy, nutritious foods).

If the periodontitis does not respond to the initial scaling and root planing, surgical treatment may be indicated. 

According to Dr. Khushbu Gopalakrishnan, one of NewMouth’s in-house dentists, “there are new surgical therapies 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.”

Can Gum Disease Cause Other Health Problems?

Tooth and bone tissue loss can result from untreated periodontal disease. Bacteria causing gum disease can also enter the bloodstream, spreading to other parts of the body.

Studies show gum disease increases the risk of:^{19, 20}

• Pneumonia
• Heart disease
• Stroke
• High blood pressure
• Diabetes
• Preeclampsia (a potentially dangerous pregnancy complication characterized by high blood pressure)
• Pre-term labor
• Low-birthweight in babies
• Infertility
• Erectile dysfunction
• Alzheimer’s disease

Periodontitis has been linked to higher levels of inflammatory markers in the bloodstream. It is a known risk factor for diabetes and cardiovascular disease.^{13, 14} Stroke, high blood pressure, and even cognitive issues in older people have also been linked to periodontal disease.^{15, 16, 17}

How to Prevent Gum Disease 

Gum disease can be prevented with proper oral hygiene, including a diet optimized for oral health.^{1, 7, 18} Regular brushing and flossing keep oral bacteria in check and disrupt plaque before it can turn into tartar.^{2, 5}

Adequate intake of vitamins and other nutrients helps reduce or prevent inflammation.^{11, 18} Lower intake of simple carbohydrates can also take away a major fuel source for plaque-forming bacteria.¹⁸

Avoiding smoking and having good overall health will also eliminate major risk factors for gum disease.^{1, 7}

Summary

• Gum disease is caused by oral bacteria, which form a biofilm that eventually causes inflammation
• Early-stage gum disease, or gingivitis, only affects the gums and may or may not progress to more advanced disease
• Advanced gum disease, known as periodontitis, affects the deeper tissues of the periodontium and can cause tooth loss and systemic health complications
• Gingivitis can be reversed, but periodontitis cannot (though it can be treated)
• Good oral hygiene and overal health, a balanced diet, and avoiding tobacco help prevent gum disease