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Gingivitis & Periodontitis: Symptoms & Treatment of Gum Disease

teeth, oral hygiene, tartar
Credit: botazsolti Shutterstock

There are two types of diseases that can affect the gums: gingivitis and periodontitis. Together, gingivitis and periodontitis are referred to as gum disease or periodontal disease.

The National Institute of Health defines periodontal (gum) disease as “inflammation and infection that destroys the tissues that support the teeth, including the gums, the periodontal ligaments, and the tooth sockets (alveolar bone).”

Both types of gum diseases are fairly common among adults in the United States and both can be stopped or their symptoms lessened with effective care.

Gingivitis

Gingivitis is a mild form of gum disease, but without proper treatment it can lead to the more serious periodontitis. It is characterized by red and irritated gums. Gingivitis is quite common, with many people having it to different strengths.

Gingivitis is primarily caused by poor oral hygiene, which allows plaque to build up on teeth. Plaque is an invisible, sticky substance that develops on the teeth when sugars and starches in food interact with normal mouth bacteria. It develops quickly, which is why it is important to brush and floss every day to remove it.

If it is not removed, plaque can turn into tartar, a hard deposit at the base of the tooth. Both plaque and tartar inflame gums and produce bacteria and toxins that cause gums to get infected with gingivitis.

In addition to oral hygiene, gingivitis can be caused by uncontrolled diabetes, some systemic diseases and infections, and misaligned teeth, rough-edged fillings, ill-fitting or unclean mouth appliances. Additionally, there is a hormonal component to gingivitis, as changes in hormones can cause greater gum sensitivity. For this reason, pregnant women sometimes get gingivitis and the disease often develops during puberty or young adulthood.

Symptoms

Healthy gums are characterized by pale pink color and firmness. Gingivitis is usually not painful, so many people suffering from it do not realize that it is present or a problem.

Symptoms include:

  • Bleeding gums, even with gentle tooth-brushing
  • Tender gums, especially when touched
  • Bright red, dusky red, or purple-red-colored gums
  • Swollen gums
  • Mouth sores
  • Shiny-looking gums
  • Bad breath

Prevention

The best way to prevent gingivitis is to practice good oral hygiene. Brush your teeth twice a day and floss at least once a day. Get your teeth professionally cleaned by a dentist every six months.

If your symptoms are especially bad, dentists may recommend brushing and flossing after every meal and before bed. They may also recommend plaque-removal devices such as special toothbrushes, toothpicks and water irrigation tools. Prescribed anti-plaque and anti-tartar toothpastes and rinses can also help.

Treatment

Gingivitis usually gets better after a professional cleaning if proper oral hygiene is continued at home.

During the cleaning, the dentist or dental hygienist will remove all plaque and tartar in a process called “scaling.” If you have misaligned teeth or poorly fitting fillings, crowns, or bridges, the dentist will discuss fixing them.

Teeth during cleaning, dentist, dental
The same teeth as above, after the tartar has been removed during dental treatment.
Credit: botazsolti Shutterstock

Periodontitis

If gingivitis is not treated, it may lead to periodontitis — a much more serious disease. It can lead to the destruction of gums, mouth bones, tissue, and teeth.

If plaque spreads too much below the gum line, its toxins can cause the tissues and bone that support the teeth break down. Gums pull away from the teeth, forming spaces called pockets, which become infected. If not treated, teeth may become loose and have to be removed. Periodontitis can also increase the risk of heart attack or stroke.

Periodontitis is fairly common though it is largely preventable with good oral hygiene.

There are several types of periodontitis, including:

  • Chronic periodontitis, the most common form and characterized by pocket formation and gum recession. It can occur at any age but is most common in adults. The disease usually progresses slowly.
  • Aggressive periodontitis, characterized by rapid loss of gums and bone destruction.
  • Periodontitis as a manifestation of systemic diseases, associated with heart disease, diabetes, respiratory diseases, and others. It usually sets in at a young age.
  • Necrotizing periodontal disease, characterized by necrosis of gum tissue, periodontal ligaments, and alveolar bones, causing lesions. It is most common in people with systemic conditions like HIV, malnutrition, and immunosuppression.

Symptoms

As with gingivitis, it is important to remember that healthy gums are pale pink and firm. Note other changes, including:

  • Swollen gums
  • Bright red, purplish, or dusky red gums
  • Tender gums
  • Receding gums, which making teeth look longer than normal
  • New spaces developing between teeth
  • Loose teeth
  • A change in the way your teeth fit together when you bite
  • Pus around teeth and gums
  • Bad breath
  • Bad taste in mouth

Prevention

As with gingivitis, the primary way to prevent periodontitis is through good oral hygiene. Brush your teeth twice a day and floss at least once a day, with increased regularity if your dentist suggests. Make sure you get your teeth professionally cleaned every six months. If you have dry mouth, take blood pressure medicine, or smoke, you should consider getting your teeth professionally cleaned more often.

Treatment

There are both non-surgical and surgical treatments for periodontitis, depending on its severity.

Nonsurgical treatments include:

  • Scaling: the removal of tartar and bacteria from teeth and beneath gums. This is usually done in a standard professional teeth cleaning. 
  • Root planing: smoothing the root surfaces to discourage further buildup of tartar and bacterial toxins.
  • Antibiotics

Surgical treatments include:

  • Flap surgery (pocket reduction surgery): Lifting back gum tissue, exposing the roots for more effective scaling and root planing. The underlying bone may be recontoured so that it will be easier to clean the area around the gums.
  • Soft tissue grafts: This reinforces soft tissue lost to gum recession. A small amount of tissue from the roof of the mouth is relocated to the gumline in order to reduce further gum loss, cover exposed roots, and improve appearance.
  • Bone grafting: This is done when the bone around the tooth root has been destroyed and helps prevent tooth loss by holding the tooth in place. It also promotes bone regrowth.
  • Guided tissue regeneration: Promote regrowth of bone through the use of a biocompatible fabric being placed between the bone and tooth. The material prevents unwanted tissue from growing so that the bone can grow back.
  • Enamel matrix derivative application: Another form of guided tissue regeneration that requires applying gel to a diseased root. The gel contains the same proteins as in developing tooth enamel and stimulates healthy bone and tissue growth.

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