Gum disease, or gingivitis, is inflammation of the tissues surrounding and supporting the teeth and is most commonly a result of poor dental hygiene. Gingivitis is a very common condition and varies widely in severity. It is characterized by red, swollen gums that bleed easily when teeth are brushed or flossed. Gingivitis is not the same thing as periodontitis, although sometimes a person may be affected by both.
What Causes Gum Disease?
Your gums actually attach to the teeth at a lower point than the gum edges that we see. This forms a small space called a sulcus. Food can get trapped in this space and cause a gum infection or gingivitis.
Plaque is a thin film of bacteria. It constantly forms on the surface of your teeth. As plaque advances, it hardens and becomes tartar. You can develop an infection when plaque extends below the gum line.
Left unchecked, gingivitis can cause the gums to separate from the teeth. This can cause injury to the soft tissue and bone supporting the teeth. The tooth may become loose and unstable. If infection progresses, you may ultimately lose your tooth or need a dentist to remove it.
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.
Gum Disease Symptoms and Signs
A person with gingivitis will typically have one or more of the following:
- Red, swollen gums that bleed very easily, even during brushing or flossing
- A bad taste or mouth odor
- White spots or plaques on the gums
- Gums that look like they’re pulling away from the teeth
- Pus between gums or teeth
- A change in the way the teeth fit together in the mouth, or spaces opening up between teeth
- Change in the way partial dentures fit
As gingivitis progresses (chronic gingivitis), the affected person may develop receding gums or areas where the root of the tooth becomes uncovered by the shrinking, diseased gums. Deep pockets may develop around the teeth that trap food, plaque, and debris. If gingivitis advances to periodontal disease, the person may lose gum tissue or bone around the teeth and the teeth may become loose or fall out. These changes can develop either very slowly or very rapidly and can affect either a few teeth or the entire mouth. If oral hygiene is almost never done or if the person becomes immune-compromised, acute necrotizing ulcerative gingivitis may develop (ANUG, formerly termed trench mouth). This is a painful condition where infected gums swell, ulcerate, and slough off dead tissue.
It is possible to have gingivitis and not notice any signs or symptoms, so regular visits to the dentist are vital in diagnosing the disease and taking steps in curing or reversing gum disease.
Who gets Gum Disease?
People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.
Treatment for Gum Disease
The goals of treatment for gingivitis are to identify and eliminate the factors that are making the person more susceptible to gum disease. Most factors can be eliminated by establishing more consistent and thorough oral hygiene habits and professional dental cleanings. If there are certain risk factors such as smoking or uncontrolled diabetes that are contributing to the gum disease, they need to be addressed or eliminated to have success in reversing gingivitis. After the plaque and tartar are removed by a dentist or hygienist, the patient can usually reverse gum disease by brushing and flossing after every meal and using a daily mouth rinse. These are the over-the-counter treatments that everyone should use to prevent and cure gum disease.
In cases where gingivitis has led to periodontal disease and there are deep pockets that are difficult to clean, the patient may require deep scaling and root planing to clean teeth that are surrounded by deep pockets. They may need surgical treatment to gain access to all the tooth surfaces for a thorough cleaning. This surgical procedure is called flap surgery and can be combined with a pocket-reduction surgery to make the areas around the teeth easier for the patient to clean with brushing and flossing. This procedure consists of numbing the gums and then lifting them back to clean the teeth and sometimes reshape the bone. The gums are then repositioned around the teeth so there aren’t the deep pockets that existed before treatment.
Soft-tissue grafts are used to cover up root surfaces that have been exposed by receding gums. This can help eliminate sensitive teeth and protect the root surfaces that are softer and more difficult to clean.
Antibiotic therapy can be combined in various ways to help treat gingivitis, periodontal disease, and especially ANUG. Chlorhexidine is an antibiotic mouthwash that can be used under direction of a dentist to help reduce the bacteria that cause gum disease.