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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
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
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.”
Meet the Expert
Whitney DiFoggio (aka Teeth Talk Girl) is a registered dental hygienist (RDH) with a BS in dentistry. She educates and inspires over 5 million people every month about dental health. Whitney has been featured in WebMD, Mashable, Well + Good, The Washington Post, & more. She also is verified on social media with over 335,000 followers.
“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
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
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 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
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 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.
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
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 can generally be reversed with good oral hygiene. To start, your dentist may perform a cleaning.
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.”
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
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
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