People say that the eyes are the window to your soul, but your mouth can be the window to your health. It is estimated that up to 50% of Americans currently have mild gingivitis or gingivitis, while up to 80% have experienced the more severe form, periodontitis, at some point. And it’s not just your teeth that are at risk. According to the family dentist Christy GrejulaDMD, gum disease has been linked to a higher risk of diabetes and heart problems such as atherosclerosis, heart attack and stroke.
To help you better understand gum disease, our team spoke to two dentists and a periodontist to find out what causes it and what you can do to prevent it.
What is gum disease?
Gingivitis is an infection and inflammation of the tissues that surround and support the teeth. There are two main forms: gingivitis and periodontitis.
Gingivitis is the mildest form and is quite common. It causes local irritation, swelling and redness of your gums. If gingivitis is not treated, it can develop into periodontitis, a more serious form of gingivitis.
There are different stages of periodontitis, from mild to advanced, but all go beyond the gums, affecting the deeper tissues and bones that support the teeth.
What are the symptoms of gingivitis?
The symptoms of gingivitis are not always obvious. “Periodontal disease is often silent, meaning that symptoms—particularly pain—may not appear until an advanced stage of the disease,” he says. Y. Natalie JeongDMD, periodontist and professor and chair in the Department of Periodontology at Tufts University.
However, he recommends being on the lookout for the following signs and symptoms:
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Red, swollen or tender gums or other pain in your teeth or mouth
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Bleeding when brushing and flossing or eating certain foods
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Receding teeth — gums receding or receding from the teeth, causing the teeth to appear longer than before
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Loose or split teeth
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Pus between your gums and teeth
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Sores in the mouth
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Persistent bad breath
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A change in the way your teeth fit together when you bite down
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Change in partial denture application
The stages of gum disease
You may not have all of these symptoms, as they largely depend on the stage of gingivitis. There are four, from gingivitis to advanced periodontitis.
According to the restorative dentist Naomi Levy Goldman, DMD, the lack of pockets around the teeth separates gingivitis from periodontal disease. “We use a small probe to measure the space between the tooth and the surrounding gum tissue. If this space is between 1 mm and 3 mm, the pocket is classified as healthy. If the measurement is greater than 3 mm , that’s the beginning of periodontal disease,” he says. When you hear your hygienists call out numbers during your cleaning, they’re counting that.
Here’s a breakdown of the four stages and their most common symptoms.
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Gingivitis: As mentioned, gingivitis is the earliest stage. You may notice red, swollen gums that may bleed easily when brushing or flossing. Bad breath and tender gums are also common at this stage.
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Early periodontitis: At this stage, the inflammation moves deeper into the gum tissues, causing pockets between the gums and teeth. The gums may begin to recede, making the teeth appear longer. The gums may bleed more and there may be some bone loss.
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Moderate periodontitis: As gum disease progresses, the pockets deepen. The gums recede even more and you may notice loose or displaced teeth. Bad breath, bleeding gums and moderate bone loss are also characteristic of this stage.
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Advanced periodontitis: This is the most serious stage. In advanced periodontitis, you will have deep gum pockets, significant bone loss, loose or displaced teeth, and possibly pus between the teeth and gums. Teeth are more likely to fall out at this stage or you may need to have them removed.
What are the common causes of gum disease?
Gum disease is usually caused by the build-up of bacterial plaque – a sticky, colorless film – on the teeth and gums due to poor oral hygiene. If plaque is not adequately removed by regular brushing and flossing, it can harden into tartar, which can only be removed by a dentist or dental hygienist. If this tartar is not cleaned regularly, it can cause gum infection and inflammation.
However, there is also a genetic component. “If a close family member has gum disease, you’re more likely to develop it, even with good oral hygiene practices,” says Gretzula.
There are other contributing factors:
What are the risks associated with gum disease?
These can include bone and tissue wear and tear, loosening of teeth, dental infections and eventually tooth loss.
According to Jeong, several studies have also shown a relationship between periodontal disease and other health problemsincluding:
Gum disease has also been linked to other health conditions such as rheumatoid arthritis, Alzheimer’s disease, depression, certain cancers and Kidney Diseasealthough more research is needed to understand how they might be linked.
Treatment of gingivitis
Treatment options depend on the severity of the condition. It usually starts with a professional exfoliation and root planing, also known as a deep clean.
During a deep cleaning, the dentist or periodontist removes plaque and calculus from below the gum line and the roots of the teeth. “Radical planing [also] allows your periodontist to smooth the root of the tooth to prevent plaque or toxins from adhering in the future,” says Jeong. Depending on your case, antibiotics may also be prescribed to help control the bacterial infection in the gums.
Many people respond well to deep cleansing and do not need further treatment. However, severe cases may require surgery. There are two surgical options in these cases.
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Flap/Pocket Reduction Surgery: In advanced gum disease, flap surgery may be needed to reduce the depth of the pocket and make it easier to clean the teeth and gums. During this procedure, the gum is removed from the tooth, the roots are cleaned, and the gum is sewn back into place.
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Bone or tissue grafts: If there is significant bone or tissue loss around the teeth, grafting procedures may be required to regenerate the lost bone or soft tissue. If your teeth are extremely sensitive, Jeong says you may also need a gum graft—your dentist or periodontist will take gum tissue, usually from the roof of your mouth, and place it where there is little or no gum tissue. (as above a receding gum line).
If your dentist recommends surgery, don’t worry. “We have a lot of techniques that we use now that weren’t there before, and people might be a little intimidated by the process, but it’s not something to be afraid of,” says Jeong.
Prevention of gum disease
However, it is always best to prevent gum disease if you can. Fortunately, most cases can be avoided with good oral hygiene. Our experts recommend:
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Brush twice a day for at least 2 minutes
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Using one Electric Toothbrushif possible
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Floss once a day
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Using one water thread once a day
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Schedule professional dental cleanings every six months or more often if you have gum disease
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Eating less sugar
Gretzula also says a nutrient-dense diet is crucial, focusing on vitamin C and calcium, which can support gum health.
When to see your dentist
If you think you have gum disease, you should see your dentist as soon as possible to prevent further bone loss and tissue damage around the teeth. Even if you don’t think you have gum disease, it’s essential to keep a regular schedule with your dentist to keep your gums and teeth healthy.
For most people, a hygiene visit every six months, followed by twice-daily brushing and once-daily flossing and water is ideal, according to Goldman. “For patients who tend to build up with calculus more quickly or patients diagnosed with periodontal disease, three to four months of regular maintenance is recommended,” he says.
Frequent questions
Is there anything you can do to fix gum disease at home?
It depends on how advanced the gum disease is. “Daily flossing or using a Waterpik can be used to correct gingivitis at home, provided there is no tartar buildup creating the inflammation,” says Goldman. However, if tartar is present, it must first be professionally removed.
Can salt water help gum disease?
Yes, salt water can help with gum disease in the early stages of gingivitis, according to Gretzula. “Salt water has anti-inflammatory properties that can help reduce swelling and soothe inflamed gums. [also] they promote healing by creating a slightly hypertonic environment, which helps reduce the number of bacteria and supports tissue repair,” he says. That said, if your gum disease has progressed to one of the later stages, salt water may not be as effective.
Is it possible to reverse gum disease?
You can reverse gum disease if you catch it early, but not after it has progressed to a certain point. “In the later stages of gum disease, the supporting structures of the teeth, including bone and connective tissue, have been extensively damaged or destroyed. Once bone loss occurs, it is difficult to regenerate,” says Gretzula, adding that current treatment options do not fully restore the connective tissue that anchors the teeth.
Meet our experts
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Naomi Levy GoldmanDMD, owner and cosmetic and restorative dentist, Levy Goldman Dentistry, Peabody, Mass.
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Christy GrezulaDMD, Dentist, Hawley Lane Dental, Stratford, Conn.
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Y. Natalie JeongDMD, Professor and Chair, Department of Periodontology, Tufts University, Boston
