Gingivitis and Periodontal Disease (Gum Disease)
Periodontitis, also generally called gum disease or periodontal disease, begins with bacterial growth in your mouth and may end (if not properly treated) with tooth loss due to destruction of the tissue that surrounds your teeth.
What's the Difference Between Gingivitis and Periodontitis?
Gingivitis (gum inflammation) usually precedes periodontitis (gum disease). However, it is important to know that not all gingivitis progresses to periodontitis.
In the early stage of gingivitis, bacteria in plaque build up, causing the gums to become inflamed and to easily bleed during tooth brushing. Although the gums may be irritated, the teeth are still firmly planted in their sockets. No irreversible bone or other tissue damage has occurred at this stage.
When gingivitis is left untreated, it can advance to periodontitis. In a person with periodontitis, the inner layer of the gum and bone pull away from the teeth and form pockets. These small spaces between teeth and gums collect debris and can become infected. The body's immune system fights the bacteria as the plaque spreads and grows below the gum line.
Toxins or poisons -- produced by the bacteria in plaque as well as the body's "good" enzymes involved in fighting infections -- start to break down the bone and connective tissue that hold teeth in place. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. When this happens, teeth are no longer anchored in place, they become loose, and tooth loss occurs. Gum disease is the leading cause of tooth loss in adults.
What Causes Gum Disease?
Plaque is the primary cause of gum disease. However, other factors can contribute to periodontal disease. These include:
- Hormonal changes, such as those occurring during pregnancy, puberty, menopause, and monthly menstruation, make gums more sensitive, which makes it easier for gingivitis to develop.
- Illnesses may affect the condition of your gums. This includes diseases such as cancer or HIV that interfere with the immune system. Because diabetes affects the body's ability to use blood sugar, patients with this disease are at higher risk of developing infections, including periodontal disease and cavities.
- Medications can affect oral health, because some lessen the flow of saliva, which has a protective effect on teeth and gums. Some drugs, such as the anticonvulsant medication Dilantin and the anti-angina drug Procardia and Adalat, can cause abnormal growth of gum tissue.
- Bad habits such as smoking make it harder for gum tissue to repair itself.
- Poor oral hygiene habits such as not brushing and flossing on a daily basis, make it easier for gingivitis to develop.
- Family history of dental disease can be a contributing factor for the development of gingivitis.
What Are the Symptoms of Gum Disease?
Gum disease may progress painlessly, producing few obvious signs, even in the late stages of the disease. Although the symptoms of periodontal disease often are subtle, the condition is not entirely without warning signs. Certain symptoms may point to some form of the disease. The symptoms of gum disease include:
- Gums that bleed during and after tooth brushing
- Red, swollen, or tender gums
- Persistent bad breath or bad taste in the mouth
- Receding gums
- Formation of deep pockets between teeth and gums
- Loose or shifting teeth
- Changes in the way teeth fit together upon biting down, or in the fit of partial dentures.
Even if you don't notice any symptoms, you may still have some degree of gum disease. In some people, gum disease may affect only certain teeth, such as the molars. Only a dentist or a periodontist can recognize and determine the progression of gum disease.
How Does My Dentist Diagnose Gum Disease?
During a dental exam, your dentist typically checks for these things:
- Gum bleeding, swelling, firmness, and pocket depth (the space between the gum and tooth; the larger and deeper the pocket, the more severe the disease)
- Teeth movement and sensitivity and proper teeth alignment
- Your jawbone, to help detect the breakdown of bone surrounding your teeth
How Is Gum Disease Treated?
The goals of gum disease treatment are to promote reattachment of healthy gums to teeth; reduce swelling, the depth of pockets, and the risk of infection; and to stop disease progression. Treatment options depend on the stage of disease, how you may have responded to earlier treatments, and your overall health. Options range from nonsurgical therapies that control bacterial growth to surgery to restore supportive tissues. A full description of the various treatment options is provided in Gum Disease Treatments.
How Can Gum Disease Be Prevented?
Gum disease can be reversed in nearly all cases when proper plaque control is practiced. Proper plaque control consists of professional cleanings at least twice a year and daily brushing and flossing. Brushing eliminates plaque from the surfaces of the teeth that can be reached; flossing removes food particles and plaque from in between the teeth and under the gum line. Antibacterial mouth rinses can reduce bacteria that cause plaque and gum disease, according to the American Dental Association.
Other health and lifestyle changes that will decrease the risk, severity, and speed of gum disease development include:
- Stop smoking. Tobacco use is a significant risk factor for development of periodontitis. Smokers are seven times more likely to get gum disease than nonsmokers, and smoking can lower the chances of success of some treatments.
- Reduce stress . Stress may make it difficult for your body's immune system to fight off infection.
- Maintain a well-balanced diet. Proper nutrition helps your immune system fight infection. Eating foods with antioxidant properties -- for example, those containing vitamin E ( vegetable oils, nuts, green leafy vegetables) and vitamin C (citrus fruits, broccoli, potatoes) -- can help your body repair damaged tissue.
- Avoid clenching and grinding your teeth. These actions may put excess force on the supporting tissues of the teeth and could increase the rate at which these tissues are destroyed.
Despite following good oral hygiene practices and making other healthy lifestyle choices, the American Academy of Periodontology says that up to 30% of Americans may be genetically susceptible to gum disease. And those who are genetically predisposed may be up to six times more likely to develop some form of gum disease. If anyone in your family has gum disease, it may mean that you are at greater risk, as well. If you are more susceptible to gum disease, your dentist or periodontist may recommend more frequent check-ups, cleanings, and treatments to better manage the condition.
Is Gum Disease Linked to Other Health Problems?
According to the CDC, researchers have uncovered potential links between gum disease and other serious health conditions. In people with healthy immune systems, the bacteria in the mouth that makes its way into the bloodstream is usually harmless. But under certain circumstances, these microorganisms are associated with health problems such as stroke and heart disease. Diabetes is not only a risk factor for gum disease, but gum disease may make diabetes worse.