Gum disease: gingivitis and periodontitis explained simply

Healthy gums fit snugly around the teeth and do not usually bleed. When they become red, swollen or sore, it may be a sign of gum disease. This article explains what gum disease is, who is at risk, how it is treated and how to prevent it, using information from the NHS, the US National Institute of Dental and Craniofacial Research (NIDCR) and the US Centers for Disease Control and Prevention (CDC).

1. Introduction

Gum disease, also called periodontal disease, is inflammation and infection of the gums and the tissues that support the teeth ^{[2, 3]}. The CDC describes two common forms. Gingivitis (inflammation of the gums) is milder and reversible. Periodontitis is more serious, causes loss of the bone that holds the teeth, and cannot be reversed, although it can be managed ^[3].

The CDC reports that about 4 in 10 adults in the United States aged 30 and older had some level of periodontitis in 2009 to 2014, and that this rises with age ^[3].

2. Causes and risk factors

Gum disease is caused by plaque, a sticky film of bacteria that builds up on the teeth. If plaque is not cleaned away, it irritates the gums ^[1]. NIDCR explains that plaque left on the teeth can harden into tartar, which only a professional cleaning can remove, and that bacteria in plaque and tartar trigger inflammation that damages the gums and supporting tissues ^[2]. The CDC adds that bacteria can spread below the gum line, creating gaps called periodontal pockets, and that bacterial toxins worsen the inflammation ^[3].

Factors linked to a higher risk include ^{[1, 2, 3]}:

• Smoking and other tobacco use, which NIDCR describes as the most significant risk factor and which also slows healing
• Diabetes
• Hormonal changes, such as in pregnancy or menopause
• Stress
• Family history and genetics
• Some long-term illnesses and the medicines used for them, such as rheumatoid arthritis
• Poor oral hygiene
• Clenching or grinding the teeth, or crooked teeth

3. Signs and symptoms

Warning signs include ^{[1, 2, 3]}:

• Gums that bleed when you brush, floss or eat hard foods
• Red, swollen, tender or sore gums
• Gums that pull away from the teeth so the teeth look longer
• Persistent bad breath or a bad taste in the mouth
• Loose or sensitive teeth
• Pain when chewing, or a change in the way the teeth fit together

The CDC points out that gum disease can progress a long way before a person notices anything, which is why regular dental check-ups help catch it early ^[3]. The NHS lists possible complications of gum disease, including shrinking gums, loose or lost teeth and a dental abscess, a painful build-up of pus ^[1].

4. Diagnosis and tests

A dentist or dental hygienist examines the gums for redness, bleeding and recession. NIDCR explains that they measure the pockets between the teeth and gums with a small probe, where deeper pockets suggest gum disease, check whether teeth are loose, review your medical history and may take X-rays to look for bone loss ^[2]. You may be referred to a periodontist, a dentist who specialises in gum disease ^{[2, 3]}.

5. Treatment and management

Treatment depends on how advanced the disease is, and your dentist decides the plan.

Early disease

The NHS says early stages are managed with advice on cleaning, including the use of small interdental brushes, help to stop smoking, and professional cleaning by a hygienist ^[1]. NIDCR notes that early disease can often be reversed with careful daily brushing and flossing ^[2].

More serious disease

For advanced disease, treatment may include scaling and root planing, a deep cleaning of the tooth and root surfaces, prescribed medicines such as oral rinses, and sometimes surgery ^{[2, 3]}. The NHS also lists antibiotics, removing some teeth or gum surgery for serious cases ^[1]. Good home care is needed alongside any treatment ^[2].

6. Prevention and self-care

• Brush at least twice a day with fluoride toothpaste, and spit out the extra without rinsing with water ^[1].
• Clean between your teeth every day with floss or interdental brushes. NIDCR also mentions picks and water flossers if a dental professional recommends them ^{[1, 2]}.
• Do not use mouthwash straight after brushing ^[1].
• Do not smoke or use tobacco ^{[1, 2]}.
• Have regular check-ups and professional cleanings. The CDC suggests a check-up at least once a year, or more often if your dental team advises it ^[3].

7. Special groups

NIDCR lists diabetes as a risk factor for gum disease ^[2], and the NHS stresses regular dental and hygienist visits for people with type 2 diabetes ^[1]. Pregnancy is also a time when check-ups are especially important ^[1]. NIDCR notes that children with rare primary immunodeficiency disorders (conditions that weaken the immune system) are nearly ten times more likely to develop gum disease, and that conditions such as obesity and heart disease are linked to it ^[2].

8. When to see a doctor

See a dentist if your gums bleed when you brush or eat, if they are painful or swollen, or if you have bad breath that does not go away ^[1]. The NHS advises seeing a dentist urgently if your gums are very sore or swollen, if teeth are loose or falling out, or if you notice mouth ulcers, red patches or a lump in the mouth or on the lip ^[1]. If you cannot reach your dentist out of hours, ask your local health service for urgent dental advice.

In an emergency, call your local emergency number (112 in India, 911 in the United States).

9. Conclusion

Gum disease is common and often starts quietly. Gingivitis is reversible, but periodontitis causes lasting damage to the bone around the teeth. Thorough daily cleaning, not smoking, managing conditions such as diabetes and visiting the dentist regularly give the best chance of keeping your gums healthy. Your dentist will advise on the treatment that suits you.