When it comes to maintaining your health, you may be overlooking one of the most important parts of your body: your mouth. Gum disease is the most common oral disease, with studies estimating that up to 80% of Americans have dealt with periodontal disease at some point during their lives. The prevalence of gum disease is concerning as gingivitis and periodontitis can have serious consequences for your overall health. According to family dentist Kristy Gretzula, DMD, gum disease may put you at a higher risk of diabetes, heart attack and stroke. What's more, for adults over 65 years of age, having poor oral health can negatively affect your nutrition status and quality of life.
We spoke with three dentists and one periodontist to help you better understand what gum disease is, what your treatment options are and how to prevent it in the first place.
Gum disease is an infection and inflammation of the tissues surrounding and supporting teeth. There are two primary forms: gingivitis and periodontitis.
As explained by Arlene Asante, DMD, dentist and owner of First Class Smiles Bethesda, gingivitis is, "a common and mild form of gum disease that causes irritation, redness, and swelling of the gingiva, the part of your gum around the base of your teeth."
If not treated, gingivitis can progress to periodontitis, a more severe form of gum disease that can lead to tooth loss.
There are different stages of periodontitis, from mild to advanced, but they all go beyond the gums, affecting the deeper tissues and bones that support the teeth.
Symptoms of gum disease aren't always obvious, and many people may not realize they have it until they see their dentist. "Periodontal disease is often silent, meaning symptoms — particularly pain — may not appear until an advanced stage of the disease," says Y. Natalie Jeong, DMD, periodontist and professor and chair at Tufts University Department of Periodontology.
Signs and symptoms to be on the lookout for include:
Gums that are red, swollen or tender
Pain in your teeth or mouth, especially when chewing
Gums that bleed easily when brushing or flossing
Persistent bad breath that doesn't go away after brushing your teeth
Loose or separated teeth
Receding gumlines, causing the teeth to look longer than before
Pus between your gums and teeth
Mouth sores
A change in the way your teeth fit together when you bite
A change in the fit of partial dentures
"Gingivitis and periodontal disease are related but distinct stages of gum disease, with key differences in their severity, symptoms, and effects on oral health," explains Asante.
Which symptoms you experience largely depend on the stage of gum disease. There are four, from gingivitis to advanced periodontitis.
Here's a breakdown of each stage and its most common symptoms.
Gingivitis: As mentioned, gingivitis is the earliest and mildest stage. You may notice red, swollen gums that likely bleed easily during brushing or flossing. Bad breath and tender gums are also common in this stage. However, deeper structures of the teeth aren't affected yet.
Early periodontitis: When left untreated, gingivitis can result in inflammation moving deeper into the gum tissues, causing pockets between the gums and teeth. Food, plaque and bacteria get trapped in these pockets, resulting in an infection. Noticeable signs include receding gums,making the teeth appear longer. Gums may bleed more, and there may be some bone loss.
Moderate periodontitis: As the gum disease progresses, pockets get deeper. Gums recede even more, and you may notice loose or shifting teeth. Bad breath, bleeding gums, pain when chewing and moderate bone loss are also hallmarks of this stage.
Advanced periodontitis: This is the most severe stage and a major cause of tooth loss in adults. In advanced periodontitis, you'll have deep gum pockets, significant bone loss, loose or shifting teeth, painful abscesses and possibly pus between the teeth and gums.
Gum disease is typically caused by a bacterial infection that results from an overgrowth of dental plaque — a sticky, colorless film — on the teeth and gums.
If plaque isn't adequately removed through regular brushing and flossing, it can harden into tartar, which can only be removed by a dentist or dental hygienist. If that tartar isn't cleaned off regularly, it can cause gum infection and inflammation.
However, as Asante points out, poor oral hygiene isn't the only culprit. There can be many contributing factors to gum disease, including:
Genetics
Tobacco use
Hormonal changes, especially during pregnancy
Crooked teeth
Broken fillings
Improperly-fitted dentures
Other systemic conditions, like diabetes
Certain medications, including steroids, anticonvulsants, calcium channel blockers, chemotherapy and oral contraceptives
In some cases, gum disease may not be due to plaque overgrowth. Having an impacted tooth or certain fungal or viral infections can also result in infected gums.
These can include bone and tissue deterioration, loosening of teeth, dental infections and eventually tooth loss.
These issues can be especially problematic for older adults, as loose or missing teeth can make it harder to eat, resulting in an increased risk for nutritional deficiencies. Poor oral health has also been shown to negatively affect older adults' mental health and increase their risk for many chronic diseases.
Regardless of age, several studies have also shown a link between periodontal disease and other health issues, including:
Cardiovascular disease: While the exact mechanism isn't fully understood, gum disease may significantly increase the risk of heart disease, stroke and atherosclerosis.
Diabetes: "Gum disease and diabetes have a bidirectional relationship, meaning that gum disease can make it harder to control blood sugar levels, and uncontrolled diabetes can increase the risk of gum disease," says Jeong. Because of this, managing gum disease is especially important for people with diabetes.
Respiratory problems: Several studies have shown that people with periodontal disease are at an increased risk for several respiratory conditions, including COPD, asthma, obstructive sleep apnea, and pneumonia.
Pregnancy complications: Pregnant women with untreated gum disease may be at higher risk of complications such as preterm birth, low birth weight, preeclampsia, and perinatal mortality.
Gum disease has also been linked to other health conditions, such as rheumatoid arthritis, Alzheimer's disease, mental health disorders, certain cancers and kidney disease, although more research is needed to understand how they may be connected.
According to restorative dentist Naomi Levy Goldman, DMD, gum disease is typically diagnosed by a dentist or oral hygienist. "We use a small probe to measure the space that exists between the tooth and the gum tissue that surrounds it. If this space is between 1 mm and 3 mm, the pocket is classified as healthy. If the measurement is higher than 3 mm, this is the beginning of periodontal disease," she says. When you hear your hygienists calling out numbers during your cleaning, they're measuring this.
Gum disease may be treated with teeth cleanings, medications and surgery, depending on the condition's severity.
Usually treatment begins with professional scaling and root planing, also known as deep cleaning.
During a deep cleaning, your dentist or periodontist removes plaque and tartar from beneath the gum line and roots of the teeth. "Root planing [also] allows your periodontist to smooth the tooth root to prevent future plaque or toxins from adhering," says Jeong.
Some practices offer laser-based cleanings, which are typically less painful than scaling and root planing.
Depending on your case, antibiotics or an antiseptic mouthwash may also be prescribed to help control bacterial infection in the gums.
Many people respond well to deep cleaning and don't require any further treatment. However, if there are signs of bone or gum tissue loss, surgery may be indicated. There are two surgical options in these cases.
Flap surgery/pocket reduction surgery: The goal of this surgery is to reduce pocket depth and make cleaning the teeth and gums easier. During the procedure, the gum is lifted away from the tooth, the roots are cleaned, and the gum is sewn back into place.
Bone or tissue grafts: If there's significant bone or tissue loss around the teeth, grafting procedures may be necessary to prevent further loss and regenerate bone or soft tissue.
If your dentist does recommend surgery, don't worry. "We have a lot of techniques that we utilize now that didn't exist in the past, and people may be a bit intimidated by the procedure, but it's not something to be scared about," says Jeong.
According to Asante, "preventing or slowing the progression of gum disease involves a combination of good oral hygiene practices, regular dental care and lifestyle choices."
Our experts recommend:
Brushing twice daily for at least 2 minutes
Using an electric toothbrush, if possible
Flossing once per day, ideally with a water flosser
Visiting your dentist every 6 months (or more frequently if you have gum disease) for professional cleanings.
Eating a balanced diet, especially foods rich in vitamin C and calcium
Eating fewer sugary and starchy foods
Avoiding (or stopping) tobacco use
If you show any signs or symptoms of gum disease, it's important to make an appointment with your dentist to help prevent bone loss and tissue damage around the teeth. Plus, when caught early, gum disease is reversible and relatively easy to treat.
To keep an eye on gum health, our experts recommend scheduling professional cleanings every six months, in addition to maintaining good oral hygiene at home. "For patients who tend to build up with tartar more quickly, or patients with a diagnosis of periodontal disease, regular three- to four-month maintenance is recommended," advises Goldman.
"Daily flossing or use of a Waterpik can be used to fix gingivitis at home, provided there is no tartar buildup creating the inflammation," says Goldman. Eating a balanced diet that's low in sugary foods can also help prevent additional plaque buildup during the early stages of gum disease. However, if tartar is present, it needs to be professionally removed first.
Gretzula explains that because salt water has anti-inflammatory properties and may help reduce bacterial accumulation, it may be helpful for early stages of gum disease.
That said, if gum disease has progressed to one of the later stages, salt water may not be as effective.
The early form of gum disease, known as gingivitis, can be reversed. However, once it progresses to periodontitis, the damage is irreversible and can only be slowed. "In the later stages of gum disease, the supporting structures of the teeth, including bone and connective tissues, have been extensively damaged or destroyed. Once bone loss occurs, it is challenging to regenerate," says Gretzula, adding that current treatment options don't fully restore the connective tissue that anchors the teeth.
Naomi Levy Goldman, DMD, owner and cosmetic and restorative dentist, Levy Goldman Dentistry, Peabody, Mass.
Kristy Gretzula, DMD, Dentist, Hawley Lane Dental, Stratford, Conn.
Y. Natalie Jeong, DMD, professor and chair at Tufts University Department of Periodontology, Boston
Arlene Asante, DMD, owner and dentist at First Class Smiles of Bethesda
