Periodontal Disease (Gum Disease)

What is periodontal disease?

Periodontal disease — also called gum disease — refers to inflammation and infection of the tissues that support your teeth. Poor oral hygiene can result in gum disease. But some people are more prone to this condition than others are, even with proper brushing and flossing.

How common is periodontal disease?

Almost half of all adults in the United States have some form of gum disease. It’s the leading cause of tooth loss.

What are the symptoms of periodontal disease?

Periodontal disease symptoms may include:

• Reddish or purplish gums.
• Bleeding.
• Soreness.
• Bad breath (halitosis).
• Unpleasant taste.
• Pain when chewing.
• Gum recession (gums that pull away from your teeth).
• Loose teeth.
• A change in the way your teeth fit together.

Periodontal disease stages

Healthy gums are firm to the touch. They don’t bleed or swell. But periodontal disease can cause discolored (reddish or purplish), swollen, bleeding gums. Left untreated, gum disease can cause destruction of your underlying jawbone, leading to possible tooth loss.

The breakdown of tissues around your teeth happens gradually. In fact, most people don’t experience pain with gum disease — especially during the early stages. So, it’s important to know the warning signs.

There are four stages of gum disease:

1. Gingivitis. This is the earliest stage of gum disease. It starts with red, puffy gums that may bleed when you brush or floss. At this stage, there’s no bone loss. As a result, gingivitis is totally reversible with proper treatment.
2. Mild periodontitis. The bacteria have seeped beneath your gums, affecting the supporting bone. Your gums may pull away from your teeth, creating pockets around them. Plaque and bacteria like to hide in these pockets, where your toothbrush and floss can’t reach.
3. Moderate periodontitis. Left untreated, bacteria begin to erode the ligaments, soft tissues and bone that hold your teeth in place. You may notice bad breath and pus (infection) around your gum line. Some people develop pain at this stage.
4. Advanced periodontitis. As periodontal disease worsens, bone loss continues. This can cause your teeth to become loose and eventually fall out.

When treated early enough, gum disease is reversible. But if you’ve already lost bone around your teeth due to infection, the disease is too advanced to reverse. However, you can manage it with proper treatment and consistent, diligent oral hygiene.

What causes periodontal disease?

Buildup of dental plaque is the No. 1 cause of periodontal disease. Plaque contains many different kinds of bacteria that can potentially infect your gums. That’s why you’re more likely to get gum disease if you have poor oral hygiene. In some people, genes play a role in gum disease by changing the way their immune system responds to bacteria.

Gum disease risk factors

A risk factor is something that increases your chance of getting a disease or condition. Possible periodontal disease risk factors include:

• Smoking or other tobacco use.
• Poor oral hygiene.
• Diabetes.
• Autoimmune diseases, including lupus, scleroderma and Crohn’s disease.
• Hormonal changes, particularly during puberty, pregnancy and menopause.
• Stress.
• Genetics (you’re more likely to get gum disease if your parents, grandparents or siblings have it).
• Heart disease.

Is periodontal disease contagious?

The bacteria that cause gum disease can pass from person to person. While you can’t catch gum disease through brief casual contact, repeated and long-term contact through saliva (such as kissing) may increase your risk for periodontal disease.

What are the complications of periodontal disease?

Unless you get treatment, gum disease continues to worsen, wreaking havoc on your oral health. It leads to a vicious cycle of infection that can end in tooth loss.

Research has also proven that gum disease has a direct impact on your overall health and well-being. There’s a link between gum disease and other health issues like heart disease, stroke and diabetes.

How do dentists diagnose periodontal disease?

A dentist can tell you if you have gum disease during a routine examination. They’ll look for plaque buildup on your teeth and ask you about your symptoms. They may refer you to a periodontist (gum specialist) for further evaluation and treatment.

A dentist or periodontist will measure the pockets around your teeth using an instrument called a periodontal probe. This tells them how much bone you’ve lost around your teeth. The deeper the pockets, the more severe the gum disease you have. Your periodontist will check your bite, how loose your teeth are and how much your gums are pulling away from your teeth (receding).

Additionally, they’ll take dental X-rays. These images show the areas of bone loss in detail. They can also look at older X-rays to see how your bone has changed over time.

Is periodontal disease curable?

Gum disease isn’t curable, but it’s manageable with appropriate treatment. You can’t cure it because once you lose structural support around your teeth, you don’t usually get all of it back. However, periodontal treatment can reduce infection and rebuild your bone and tissue to some degree.

Another factor is genetics. There are many different types of oral bacteria. Some people are simply more prone to having the kind that causes gum disease.

One stage of gum disease is totally reversible — gingivitis (very early periodontal disease). If you detect gingivitis early enough, you can reverse it with regular dental cleaning and diligent oral hygiene.

How is periodontal disease treated?

There are several periodontal treatments available. The one that’s right for you depends on the severity of your condition and a number of other factors, including:

• Your health.
• Whether you smoke.
• What treatments you’ve had in the past.

Dental cleaning and improved oral hygiene

People who have very early periodontal disease (gingivitis) may be able to reverse the condition with routine dental cleaning and improved oral hygiene. Because there’s no bone loss yet, this conservative approach gets rid of harmful oral bacteria before the disease has a chance to progress.

Proper oral hygiene includes brushing two to three times a day, flossing daily and visiting your dentist for regular exams and cleanings.

Scaling and root planing

Scaling and root planing is similar to routine dental cleaning. But it cleans deeper beneath your gums, removing plaque and bacteria where your toothbrush and floss can’t reach. Periodontists recommend this treatment for people with mild gum disease.

During this procedure, a dental hygienist cleans (scales) the plaque from your teeth and then smooths out (planes) your root surfaces to keep bacteria from reattaching. The procedure is usually done in at least two visits using local anesthesia.

Pocket reduction surgery

People with moderate to advanced gum disease may need pocket reduction surgery (also called osseous surgery). The goal is to remove plaque and tartar that are so deep under the gums that your hygienist can’t reach it. During this procedure, a periodontist makes an incision (cut) in your gums and creates a flap. This allows them to temporarily move your gums back from your teeth roots.

Next, they’ll clean the plaque, tartar and bacteria from your teeth roots and smooth out any rough areas. Once complete, they’ll reposition your gums and close the incision with stitches.

Oftentimes, periodontists combine pocket reduction surgery with other regenerative procedures, such as bone grafting, gum grafting or guided tissue regeneration.

LANAP (Laser-assisted new attachment procedure)

Some periodontists also offer pocket reduction with LANAP. This procedure treats periodontitis using a handheld laser. The laser targets diseased gum tissue while leaving healthy tissue intact.

LANAP is a less-invasive alternative to traditional pocket reduction surgery. But results are mixed.

Bone grafting

Your periodontist may use a dental bone graft to replace bone that you’ve lost to gum disease. Once they clean the infection out, they’ll place bone grafting material into the areas where the bone has eroded. This material acts as scaffolding or a space-holder, giving your body time to regenerate its own bone over time.

Gum grafting

If you’ve lost gum tissue to periodontal disease, your dentist may recommend gum graft surgery, also called tissue grafting. This procedure covers exposed teeth roots and adds thickness to your gum line.

During this procedure, a periodontist will add tissue to the areas of gum recession. This tissue may come from the roof of your mouth, or your provider may purchase it from a licensed bone and tissue bank.

Guided tissue regeneration (GTR)

Usually, periodontists use guided tissue regeneration in combination with a bone graft. GTR helps repair periodontal defects (areas of broken-down bone) and prevents soft tissue from growing into these areas.

During GTR, a periodontist places an artificial membrane between your gums and the newly placed bone grafting material. Soft tissue regenerates faster than bone, so the membrane keeps that space open so new bone can grow there instead of soft tissue.

Platelet-rich fibrin (PRF) and platelet-rich plasma (PRP)

Platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) contain growth factors that speed up healing and tissue regeneration. A periodontist can get PRF and PRP from a small sample of your blood. They’ll spin the sample in a centrifuge (a lab machine that spins rapidly, using centrifugal force) to separate plasma from your red blood cells. Then they’ll place the platelet-rich plasma or fibrin at the surgical site.

In addition to boosting healing, this type of therapy can also shorten recovery times and reduce post-surgical pain. And because it comes from your own blood, it’s completely safe.

Can I prevent periodontal disease?

Yes, in most cases, you can prevent gum disease with consistent and proper oral hygiene. Some people are more prone to gum disease due to genetics or other health conditions. In these instances, you may need more frequent cleanings with your dental hygienist.

How can I lower my risk for periodontal disease?

To reduce your risk for gum disease:

• Brush your teeth two to three times every day.
• Floss between your teeth daily.
• Use an antibacterial mouthwash.
• Avoid smoking and other tobacco use.
• Visit your dentist for regular cleanings and exams.

What’s the outlook for people with periodontal disease?

Periodontal disease isn’t life-threatening. But it can lead to other health conditions that may require treatment, especially if the infection spreads to other areas of your body.

Gum disease isn’t curable. But it’s manageable with proper treatment. If you have gum disease, early detection and treatment can help you better manage your oral health.

When should I see a dentist?

If you develop bleeding, tender or swollen gums, you should see a dentist as soon as possible. Early detection is key. If you need more than a routine dental cleaning, your dentist will refer you to a periodontist for treatment.

What questions should I ask my periodontist?

If you have gum disease, here are a few questions you may want to ask your periodontist:

• What stage gum disease do I have?
• Will I need surgical or nonsurgical treatment?
• Do you offer sedation dentistry options?
• How long will recovery take?
• When can I go back to work or school?
• How often do I need dental cleanings?

What does gum disease look like?

Early signs of gum disease include swollen, tender and reddish or purplish gums. You may see a buildup of plaque on your teeth. As the disease worsens, you may notice loose teeth and pus along your gum line.

How long can you keep your teeth with periodontal disease?

It depends on the severity of your condition. There’s no hard and fast rule, because everyone is different. In general, the sooner you treat gum disease, the less likely you are to lose teeth.

A note from Cleveland Clinic

Periodontal disease is usually painless, especially in the early stages. It’s important to know the warning signs so you can get appropriate treatment before the disease worsens. Left untreated, gum disease can take a toll on your oral and overall health. The infection can spread to other areas of your mouth and other parts of your body, increasing your risk for several health conditions, including heart disease, stroke and diabetes.

If you have swollen, tender or bleeding gums, tell your dentist. They can help you get rid of infection and get back on track to healthy teeth and gums.