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Gum Disease: Types, Causes, Symptoms and Treatments

Gum disease can only be diagnosed by a dentist.

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Koh Sze Kiat/E+/GettyImages

According to the Centers for Disease Control and Prevention (CDC), nearly half of American adults ages 30 and older have gum disease, and about 8% have what is considered severe gum disease, according to a study by July 2018 in ​The Journal of the American Dental Association​, a phase associated with tooth loss that may be linked to other health conditions such as diabetes.

Early gum disease – also called periodontal disease – can be easily treated and even reversed. Once it reaches a certain point, however, the disease can only be managed, not cured, by the American Dental Association (ADA).

Here, learn what causes gum disease, how it is treated, and how to prevent it.

Gum disease, also called periodontal disease or periodontitis, is a bacterial infection that starts in the soft tissues of your gums. If not properly treated, it can destroy your gum tissue over time and lead to a host of oral health issues.

Some 700 species of bacteria and other microbes naturally reside in our mouths, according to the National Institutes of Health (NIH). They feed on the sugar in the foods we eat and form plaque, a sticky, invisible film that builds up on your teeth, says Deborah Foyle, DDS, clinical associate professor in the department of periodontics at Texas A&M School of Dentistry in Dallas. .

If not removed – with brushing, flossing and regular dental checkups – this plaque hardens into tartar, which can trigger a wave of tooth and gum cavities.

There are two main types of periodontal disease:

  • Gingivitisis an early gum disease. It affects the line where your gums meet your teeth and usually produces mild symptoms (like red, swollen gums that bleed when you brush your teeth). Diligent oral hygiene can stop it dead. “Gingivitis is easily reversible,” says Dr. Foyle. “It is curable without any lasting damage provided you catch it early enough.”
  • Periodontitisis what happens if gingivitis is left untreated. The plaque spreads below the gum line and the gums begin to pull away from the teeth, creating pockets. These pockets harbor more bacteria. The infection grows and burrows deeper into the gum tissue. Eventually, it can reach the jaw bone, which can then no longer anchor the teeth. According to the University of Illinois Chicago College of Dentistry (UIC), the most serious form of gum disease is chronic periodontitis.

Some experts also refer to four stages of gum disease: “initial”, “early”, “established”, and “advanced”. This is based on a fundamental science review from March 1976 in ​Laboratory investigation​.

Although research is still ongoing, chronic periodontitis has been linked to a higher risk of diabetes, lung disease, heart disease, rheumatoid arthritis, and stroke.

Several factors can contribute to the buildup of plaque and tartar that lead to gum disease. Chief among them is smoking or using other forms of tobacco.

According to the CDC, smokers are twice as likely to develop gum disease as non-smokers. Not only do smokers produce more plaque, but the habit also reduces the amount of oxygen available in the blood to help damaged gums heal, according to the Oral Health Foundation. Lack of blood flow can also mask early symptoms of bleeding, according to the UIC.

Other risk factors include:

  • Poor oral hygiene
  • Crooked teeth, harder to clean
  • Family history of gum disease
  • Changing Hormones During Pregnancy
  • Diabetes
  • Obesity
  • Certain medications, such as steroids, birth control pills, and calcium channel blockers (used to lower blood pressure)
  • A diet high in starch and sugar
  • HIV/AIDS, leukemia and other conditions that compromise the immune system
  • Stress
  • Too much alcohol
  • Faulty fillings or bridges that don’t fit well
  • Teeth grinding (bruxism)

According to the American Academy of Periodontology, early-stage gum disease (gingivitis) may have no warning signs.

When symptoms of gum disease appear, they may include:

  • Gums that bleed when brushing, flossing, or eating hard foods
  • Red and painful gums
  • Persistent bad breath (due to gases released by bacteria)
  • Receding gums
  • Teeth moving or separated from each other
  • Changes in the way your teeth or dentures fit together when you bite down
  • Teeth ache
  • Bright red or purplish gums
  • Sores or pus in the mouth
  • sensitive teeth

How is gum disease diagnosed?

Gum disease is usually diagnosed by a dentist. They will take your medical history, ask you about symptoms, and find out if you have any risk factors such as diabetes, smoking, or a family history of the disease.

The dentist can also measure the space between your gums and your teeth with a small ruler called a probe. This will indicate if you have any pockets where bacteria can breed. A normal pocket is usually 1 to 3 millimeters deep. Anything deeper than 4 millimeters can signal periodontitis, according to the Mayo Clinic.

X-rays to check for bone loss may also be taken. If you have periodontitis, your dentist can stage and assess the severity. They can also refer you to a periodontist, a specialist who treats gum disease, says Alice G. Boghosian, DDS, dentist in Glenview, Illinois and consumer advisor for the ADA.

Gum disease treatments

Only your dentist can tell for sure if you have gum disease, which is why it’s so important to get regular checkups (even if you have dental anxiety). The treatment of gum disease depends on the progression of the disease. Early-stage gum disease (gingivitis) is easily cured with regular brushing and flossing combined with checkups.

Non-surgical treatments to treat more advanced periodontitis include:

  • Antibiotics:Mouthwashes, gels or pills can help fight bacterial infections.
  • Scaling or root planing:The dentist uses different instruments to remove plaque and tartar from the teeth and gums.

Surgical treatments for periodontitis may include:

  • Pocket or flap reduction surgery:The dentist opens the flaps of a pocket to clean better, then sews them back together, often in a new position.
  • Tissue regeneration:These techniques stimulate the growth of new gum tissue.
  • Soft tissue grafts:The dentist takes tissue from another source (like the roof of your mouth) and uses it to consolidate areas where the gumline is receding.
  • Bone grafts:This only happens when the bones are destroyed. The dentist uses pieces of donated or synthetic bone, or bone from other parts of your body, to hold the teeth in place.
  • Bone regeneration:This new technology stimulates bone regeneration, according to the Oral Health Foundation.
  • Dental implants:Implants are synthetic teeth intended to replace those you have lost.

Regardless of the treatment you receive, you will still need to take care of your teeth at home and take steps to reduce your risk factors, such as quitting smoking, reducing alcohol and stress, and limiting food and drink rich in sugar.

Can gum disease be prevented?

“The best prevention for gum disease is regular visits to the dentist, brushing twice a day, and flossing once a day,” says Dr. Boghosian.

The ADA recommends brushing your teeth twice a day for two minutes each time. Why two minutes? “A quick brush isn’t going to remove plaque,” notes Dr. Foyle.

Find a toothbrush with rounded bristles that are relatively soft so they don’t cause your gums to recede further, she adds. Remember to replace it every three to four months.

The best toothpaste for gum disease (and cavities) is one that contains fluoride.

A toothbrush can only reach the top, front and back of the teeth. It cannot pass between the teeth.

“In order to effectively remove the plaque between the teeth, you must use dental floss or an interdental cleaner [like a pick or “water flosser”] of some kind,” says Dr. Boghosian. ” It’s essential.


For best results, floss before brushing your teeth. This loosens food particles and other dirt between your teeth so they can be brushed away by your toothbrush.

Checkups should occur every six to 12 months, recommends the Mayo Clinic. Not only will it detect cavities and gum disease, but it can also open a window into other aspects of your health.

“Oral health is linked to overall systemic health,” says Dr. Boghosian.

In one case, a patient’s abnormally bright magenta gums led to the diagnosis and treatment of liver disease. Another of Dr. Boghosian’s patients was unable to control his blood sugar until his periodontitis was treated.

What about mouthwash and hydrogen peroxide?

There is no clear role for mouthwash or hydrogen peroxide in maintaining oral health. Hydrogen peroxide may help gingivitis by oxygenating (killing) bacteria and plaque, according to a May-June 2016 study in the ​Journal of the International Society of Preventive and Community Dentistry​. “It works a little, but it’s not a cure,” says Dr. Foyle.

Mouthwash can rinse out some bacteria and make your mouth cleaner, she adds.

Gum disease occurs when plaque made up of bacteria builds up on your teeth. If not removed, it can destroy both your gums and your bones.

Early gum disease is called gingivitis and can be cured with good oral hygiene. More advanced gum disease or periodontitis can be treated but not cured.

The best way to prevent gum disease is to brush and floss regularly and keep appointments with your dentist.

See a dentist if you have bleeding, swollen or sore gums. Seek emergency help if your teeth start to fall out or if you notice any sores or bumps in or around your mouth.