Gum Disease

Topic Overview

Illustration of a tooth What is gum disease?

Gum disease is an infection of the tissues and bones that surround and support the teeth. It is also called periodontal disease.

The two stages of gum disease are called gingivitis and periodontitis. Gingivitis (say “jin-juh-VY-tus”) is mild gum disease that affects only the gums, the tissue that surrounds the teeth. Periodontitis (say “pair-ee-oh-don-TY-tus”) is gum disease that gets worse and spreads below the gums to damage the tissues and bone that support the teeth.

  • Gingivitis causes red, swollen gums that bleed easily when the teeth are brushed. Because gingivitis usually doesn't cause pain, many people don't get the treatment they need.
  • Periodontitis develops if gum disease gets worse. The gums pull away from the teeth, leaving deep pockets where germs called bacteria can grow and damage the bone that supports the teeth. Gums can also shrink back from the teeth. This can make the teeth look longer. Teeth may become loose, fall out, or have to be pulled out by a dentist.

What causes gum disease?

Your mouth constantly makes a clear, sticky substance called plaque that contains bacteria. The bacteria in plaque make poisons, or toxins, that irritate the gums and cause the gum tissues to break down. If you don't do a good job of removing plaque from your teeth, it can spread below the gums and damage the bone that supports the teeth. With time, the plaque hardens into a substance called tartar that has to be removed by a dentist or dental hygienist.

You are more likely to get gum disease if you:

  • Do not clean your teeth well.
  • Smoke or chew tobacco.
  • Have someone in your family who has gum disease.
  • Have a condition that makes it harder for your body to fight infection, such as:
    • Uncontrolled diabetes, AIDS, or leukemia.
    • A high level of stress.
    • A poor diet that’s low in nutrients.

What are the symptoms?

It may be hard to tell if you have a mild case of gum disease. Healthy gums are pink and firm, fit snugly around the teeth, and do not bleed easily. But mild cases of gum disease (gingivitis) cause:

  • Gums that are red, swollen, and tender.
  • Gums that bleed easily during brushing or flossing.

As gum disease gets worse (periodontitis), the symptoms are easier to see, such as:

  • Gums that pull away or shrink from the teeth.
  • Bad breath that won't go away.
  • Pus coming from the gums.
  • A change in how your teeth fit together when you bite.
  • Loose teeth.

How is gum disease diagnosed?

To find out if you have gum disease, your dentist will do an exam to look for:

  • Bleeding gums.
  • Hard buildups of plaque and tartar above and below the gums.
  • Areas where your gums are pulling away or shrinking from your teeth.
  • Pockets that have grown between your teeth and gums.

Your dentist or dental hygienist may take X-rays of your teeth to look for bone damage and other problems.

How is it treated?

If you have a mild case of gum disease, you will probably be able to take care of it by brushing and flossing your teeth every day and getting regular cleanings at your dentist's office.

If your gum disease has become worse and you have periodontitis, your dentist or dental hygienist will clean your teeth using a method called root planing and scaling. This removes the plaque and tartar buildup both above and below the gum line. You may also need to take antibiotics to help get rid of the infection in your mouth. If your gum disease is severe, you may need to have surgery.

How can you prevent gum disease?

Gum disease is most common in adults, but it can affect anyone, even children. So good dental habits are important throughout your life:

  • Brush your teeth 2 times a day, in the morning and before bedtime, with a fluoride toothpaste.
  • Floss your teeth once each day.
  • Visit your dentist for regular checkups and teeth cleaning.
  • Don't use tobacco products.

If you think you have a mild case of gum disease, make sure to take care of it before it gets worse. Keeping your teeth and gums healthy and getting regular checkups from your dentist can keep the disease from getting worse.

Having gum disease may increase a pregnant woman's risk of having a premature, low-birth-weight baby.1 Also, studies have found a direct link between heart disease and the bacteria that cause gum disease.2 So taking good care of your teeth and gums may have benefits beyond keeping your mouth healthy.

Frequently Asked Questions

Learning about gum disease:

Being diagnosed:

Getting treatment:

Ongoing concerns:

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  Dental care: Brushing and flossing your teeth

Cause

Gum disease is caused by the growth of bacteria on the teeth and gums. Bacteria are present in plaque, a clear, sticky substance your mouth produces. If plaque is not removed promptly, it builds up on the teeth.

  • The bacteria in plaque feed on sugars in the foods you eat and drink and produce poisons (toxins) and other chemicals.
  • The toxins irritate your gums, causing them to swell and bleed easily when brushed.
  • Plaque can harden into a mineral buildup called calculus or tartar, which further irritates the gums and causes them to pull away from your teeth.

While bacteria are the direct cause of gum disease, a number of other factors also affect the health of your gums. You are more likely to have gum disease if:

  • You smoke cigarettes or use spit tobacco.
  • Gum disease runs in your family.
  • You are a woman going through the hormonal changes caused by puberty, menopause, or pregnancy.
  • You take certain medicines, such as birth control pills, antidepressants, or some heart medicines.
  • You have a condition that makes it harder for your body to fight infection, such as:

Symptoms

Early-stage gum disease (gingivitis) causes:

  • Red, swollen, tender gums.
  • Gums that bleed easily when brushed or flossed. Healthy gums do not bleed with regular brushing and flossing.

Because gingivitis usually isn't painful, you may not notice the symptoms and may not get the treatment you need. If you don't get treated, the disease will progress.

Advanced gum disease (periodontitis) causes more noticeable symptoms, such as:

  • Gums that pull away or recede from the teeth.
  • Persistent bad breath.
  • Pus coming from the gums.
  • A change in how your teeth fit together when you bite, or a change in the fit of partial dentures.
  • Loose teeth.

If you use tobacco, you have a higher risk of gum disease. Your gums may actually bleed less, even though they are unhealthy, and you may not realize it's a problem until its too late. If you use tobacco, you will need to see your dentist more often.

What Happens

Early-stage gum disease (gingivitis) starts when bacteria are left on teeth and gums and plaque forms. Plaque and the acids it produces irritate the gums, causing them to become red and swollen.

  • Plaque can harden into tartar (or calculus), a mineral buildup that also irritates gums and must be removed by a dental professional.
  • Untreated gingivitis can progress to advanced gum disease (periodontitis), causing gums to pull away from the teeth or recede down the root. This creates deep pockets. Plaque can grow in the pockets, further damaging the gums and breaking down bones that support the teeth.
  • Bone damage can loosen teeth, causing them to fall out or have to be removed.

If a woman has gum disease during pregnancy, she may be at greater risk of having a premature, low-birth-weight baby.1

Studies have found a direct link between heart disease and the bacteria that cause gum disease.2 So taking good care of your teeth and gums may have benefits beyond keeping your mouth healthy.

What Increases Your Risk

You are more likely to have gum disease if you don't brush and floss your teeth regularly or well enough to remove plaque.

You are at greater risk for gum disease if:

  • You smoke cigarettes or use spit tobacco. Tobacco use is believed to be one of the biggest risks for gum disease. Tobacco decreases your ability to fight infection, interferes with healing, and makes you more likely to have serious gum disease that results in tooth loss.
  • Gum disease runs in your family. If you have a family history of gum disease, you are much more likely than normal to develop it, even if you take good care of your teeth and gums.
  • You are a woman going through the hormonal changes caused by puberty, menopause, or pregnancy.
  • You have a disease that reduces your ability to fight infection, such as uncontrolled diabetes, AIDS, or leukemia.
  • You are under a lot of stress. Stress can weaken your immune system and make you more likely to develop infections.
  • You eat a diet that is low in vitamins and minerals, which can weaken your immune system, or high in sugary foods and other carbohydrates (grains, pasta, bread), which help plaque grow.
  • You take certain medicines, such as:
    • Seizure-control drugs like phenytoin (Dilantin, Phenytek).
    • Calcium channel blockers, which are used to control high blood pressure or for people with certain heart problems.
    • Cyclosporine, a medicine that suppresses the immune system. It is used to keep the body from rejecting transplanted organs.
    • Birth-control pills.
    • Medicines used to treat cancer (chemotherapy).
    • Drugs that block androgen to treat prostate cancer.3

When To Call a Doctor

Call a dentist if you have symptoms of gum disease, such as:

  • Loose teeth or teeth that have shifted, creating spaces between your teeth.
  • Pus coming from your gums.
  • Gums that have pulled away or receded from your teeth.
  • Bad breath that doesn't go away when you brush and floss.
  • Red, swollen, or tender gums.
  • Gums that bleed easily when brushed.

Watchful Waiting

See your dentist regularly. If you have a history of dental problems, you may need to go two times a year. If you haven't gone to the dentist in the last year, make an appointment as soon as possible. A dental hygienist can remove plaque and scrape hard mineral deposits (tartar) from around your gum line. Regular checkups and cleanings will help you reverse and prevent further gum disease.

If you have gum disease, see your dentist right away. Waiting to have it treated will allow it to get worse and spread.

Who To See

A dentist or dental hygienist can evaluate your gum disease.

If your gum disease is severe, the dentist may refer you to a specialist, such as:

  • A periodontist. A periodontist is a dentist with 2 to 3 years of extra training in diagnosing and treating gum problems.
  • An oral or maxillofacial surgeon who specializes in mouth surgery.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Your dentist or dental hygienist will examine your gums and teeth for gum disease during regular visits. Using a small mirror and a tool called a probe, your dentist will look for:

  • Bleeding gums. The more spots that bleed, the more likely it is that your gum disease is severe.
  • Hard mineral deposits (tartar) above and below the gum line.
  • Areas where your gums are pulling away from your teeth and pockets that have formed between your teeth and gums. Your dentist or dental hygienist will use the probe to measure the depth of the spaces between your teeth and gums to see how deep the pockets are.

The dentist or dental hygienist may take X-rays of your teeth to look for bone damage and other problems.

Early Detection

Visiting your dentist or dental hygienist regularly is the best way to detect gum disease before it causes serious damage. Your dentist will determine how often you should be seen based on your risk for gum disease.

Treatment Overview

Early treatment of gum disease is very important. The goals of treatment are to prevent gum disease from permanently damaging tissues, control infection, and prevent tooth loss. For treatment to be effective, you will need to:

  • Keep your teeth clean by brushing two times a day and flossing one time a day.
  • See your dentist regularly for checkups and cleanings.
  • Avoid all tobacco use. Tobacco decreases your ability to fight infection, interferes with healing, and makes you more likely to have serious gum disease that results in tooth loss.

Treatment for early-stage gum disease

If you have early-stage gum disease (gingivitis), you may be able to reverse the damage to your gums:

  • Brush your teeth two times a day, in the morning and before bedtime.
  • Floss your teeth one time a day.
  • Use an antiseptic mouthwash, such as Listerine, or an antiplaque mouthwash.

For more information on how to care for your teeth, see:

Click here to view an Actionset. Dental care: Brushing and flossing your teeth.

Your dentist will want to see you for regular checkups and cleanings. Professional cleaning can remove plaque and tartar that brushing and flossing missed. After you have had gum disease, you may need to see your dentist every 3 or 4 months for follow-up.

Your dentist may prescribe antibiotics to help fight the infection. They can be applied directly on the gums, swallowed as pills or capsules, or swished around in your teeth as mouthwash. Your dentist may also recommend an antibacterial toothpaste that reduces plaque and gingivitis when used regularly.

Treatment for advanced gum disease

Early-stage gum disease (gingivitis) that is not treated promptly or that does not respond to treatment can progress to advanced gum disease (periodontitis). Periodontitis requires prompt treatment to get rid of the infection and stop damage to the teeth and gums, followed by long-term care to maintain the health of your mouth.

  • Your dentist or dental hygienist will remove the plaque and tartar both above and below your gum line. This procedure, called root planing and scaling, makes it harder for plaque to stick to the teeth.
  • Your dentist may give you antibiotics to kill bacteria and stop the infection. They may be applied directly on the gums, swallowed as pills or capsules, or inserted into the pockets in your gums.
  • You may need surgery if these treatments don't control the infection or if you already have severe damage to your gums or teeth. Surgery options may include:
    • Gingivectomy, which removes and reshapes loose, diseased gum tissue to get rid of the pockets between the teeth and gums where plaque can build up.
    • A flap procedure, which cleans the roots of a tooth and repairs bone damage.
    • Extraction, to remove loose or severely damaged teeth.
  • After surgery, you may need to take antibiotics or other medicines to aid healing and prevent infection.

After treatment, you will need to keep your mouth disease-free by preventing plaque buildup. You will need to brush carefully and thoroughly after all meals and snacks and floss daily. Your dentist will probably prescribe an antibacterial mouthwash.

Your dentist will schedule follow-up appointments regularly for cleaning and to make sure that the disease has not returned.

Prevention

You usually can prevent gum disease by brushing and flossing regularly, having regular dental visits for exams and cleaning, and eating a balanced diet.

Practice good dental habits:

  • Brush your teeth two times a day, in the morning and before bedtime, using fluoride toothpaste. Clean all sides of your teeth, and also brush your tongue. Plaque on the tongue can cause bad breath and is an ideal environment for bacteria. If you can't brush, chew sugar-free gum, especially one with xylitol.
  • Try an electric toothbrush that has a rotating and oscillating (back-and-forth) action. This type of toothbrush is better at removing plaque than a regular toothbrush.4 Look for one that has the American Dental Association (ADA) Seal of Acceptance.
  • Use an antiseptic mouthwash, such as Listerine, or a fluoride or antiplaque mouthwash.
  • Floss once a day. Any type of floss works, so choose a type you like. Curve the floss around each tooth into a U-shape, and gently slide it under the gum line. Move the floss firmly up and down several times to scrape off the plaque.
  • Use disclosing tablets periodically so you can see if you are brushing effectively. Disclosing tablets are chewable and will color any plaque left on the teeth after brushing. They are available at most drugstores.
  • See your dentist regularly as recommended to have your teeth cleaned and checked.

If your gums bleed when you brush or floss, the bleeding should stop as your gums become healthier and tighter to your teeth. But bleeding gums may be a symptom of gum disease and should be brought to the attention of your dentist.

For more information on how to take care of your teeth, see:

Click here to view an Actionset. Dental care: Brushing and flossing your teeth.

Making wise food choices can help you prevent gum disease:

  • Eat a healthy diet that includes whole grains, vegetables, and fruits; is low in fat and saturated fat; and is low in sodium. Good nutrition is vital for children, whose teeth are still developing. It is also critical for adults in order to have healthy gums and avoid tooth decay. For more information on making good food choices, see the topic Healthy Eating.
  • Mozzarella and other cheeses, peanuts, yogurt, and milk are good for your teeth. They help clear the mouth of harmful sugars and protect against plaque.
  • Avoid foods that contain a lot of sugar, especially sticky, sweet foods like taffy and raisins. The longer sugar stays in contact with the teeth, the more damage it will do.
  • Avoid bedtime snacks.

If you smoke or use spit tobacco, one of the best things you can do for yourself is to quit. Tobacco decreases your ability to fight infection and delays healing. Tobacco users are much more likely to develop gum disease than nonsmokers—up to six times more likely. They also have more serious gum disease that leads to tooth loss and that doesn't respond as well to treatment.5 Quitting is difficult. But many people find success through a combination of medicine, a stop-smoking program, and counseling. For more information on how to quit, see the topic Quitting Smoking.

Home Treatment

If your gums are mildly swollen and red, flossing every day and brushing your teeth in the morning and before bedtime can help reverse these symptoms of gum disease. For more information on how to care for your teeth, see:

Click here to view an Actionset. Dental care: Brushing and flossing your teeth.

The following steps can also help to reverse or prevent gum disease:

  • Use a tartar-control toothpaste that contains fluoride.
  • Use an antiseptic mouthwash, such as Listerine, or an antiplaque mouthwash.
  • Chew sugar-free gum after meals if you are unable to brush your teeth.
  • Carefully use a toothpick after meals if you are unable to brush your teeth right away.

If you smoke or use spit tobacco, the best thing you can do for yourself is to quit. Tobacco decreases your ability to fight infection and delays healing. Tobacco users are more likely than nonsmokers to have serious gum disease that leads to tooth loss and that doesn't respond as well to treatment.5 Quitting is difficult. But many people find success through a combination of medicine, a stop-smoking program, and counseling. For more information on how to quit, see the topic Quitting Smoking.

Medications

If brushing and flossing aren't effective in reversing gum disease, your dentist may prescribe antibiotics to help fight the infection. Antibiotics can be applied directly on the gums (topical), swallowed as pills or capsules, swished around in your teeth as mouthwash, or inserted into the pockets of advanced gum disease. Your dentist may recommend that you use a medicated toothpaste that contains an antibacterial ingredient that reduces plaque and gingivitis when used regularly.

If used properly, antibiotics safely treat gum disease by giving swollen, infected gums a chance to heal. Practice good dental care during and after treatment so that your teeth and gums stay healthy.

What to think about

Antibiotics alone usually cannot cure severe gum disease. In some cases, root planing and scaling combined with antibiotics is enough to stop severe gum disease, but surgery may be required.

Surgery

You may need surgery for severe gum disease (periodontitis) if it cannot be cured with antibiotics or root planing and scaling. Types of surgery include:

  • Gingivectomy. A gingivectomy removes and reshapes loose, diseased gum tissue to get rid of pockets between the teeth and gums. A gum specialist (periodontist) or oral surgeon often will do the procedure.
  • Flap procedure. A flap procedure cleans the roots of a tooth and repairs bone damage caused by gum disease. A periodontist or an oral surgeon often performs this procedure.
  • Tooth removal (extraction). If gum disease has loosened or severely damaged a tooth, your dentist may need to remove the tooth. If the procedure is complicated or risky, an oral or maxillofacial surgeon may do the extraction.

Other procedures may be needed to repair badly damaged gums:

  • A graft moves healthy gum tissue from one part of the mouth to another.
  • Guided tissue regeneration places a special lining between the gums and bone. The lining helps bone grow back and helps the gums reattach to the bone.

For surgery to be successful, you will need to:

  • Practice good dental care. For information on how to care for your teeth, see:
    Click here to view an Actionset.Dental care: Brushing and flossing your teeth.
  • See your dentist regularly for checkups. After you have had gum disease, you may need to see your dentist every 3 or 4 months for follow-up.
  • Avoid smoking or using spit tobacco. Tobacco decreases your ability to fight infection and delays healing. While quitting is not easy, many people succeed by using a combination of medicine, a stop-smoking program, and counseling. For more information on how to quit, see the topic Quitting Smoking.

What to think about

Gum surgery can introduce harmful bacteria into your bloodstream. You may need to take antibiotics before and after surgery if you have a condition that puts you at high risk for a severe infection or if infections are particularly dangerous for you. You may need to take antibiotics if you:

  • Have certain heart problems that put you at risk for a heart infection called endocarditis.
  • Have an impaired immune system.
  • Had recent major surgeries or have man-made body parts, such as an artificial hip or heart valve.

Other Treatment

If you have gum disease, your dentist may do a procedure called root planing and scaling. Root planing and scaling is one of the most effective ways to treat gum disease before it becomes severe. Root planing and scaling removes plaque and tartar buildup between the gums and the teeth down to the roots.

Your dentist may give you antibiotics to speed healing after root planing and scaling.

If your dentist can remove all the plaque and tartar from the roots of your teeth, and if you follow treatment with good dental care, your gums should heal and reattach to the teeth. You must brush and floss daily after root planing and scaling. Without proper dental care, your gum disease may get worse.

Other nonsurgical procedures that may be done to cure or prevent gum disease are:

  • Gingival curettage, which removes the inner lining of the gums if it becomes damaged or infected.
  • Splinting, which uses wire to secure loose teeth to one another to make them more stable.

References

Citations

  1. Task Force on Periodontal Treatment of Pregnant Women (2004). American Academy of Periodontology statement regarding periodontal management of the pregnant patient. Journal of Periodontology, 75(3): 495.
  2. Humphrey LL, et al. (2009). Periodontal disease and coronary heart disease incidence: A systematic review and meta-analysis. Journal of General Internal Medicine, 23: 2079–2086.
  3. Famili P, et al. (2007). The effect of androgen deprivation therapy on periodontal disease in men with prostate cancer. Journal of Urology, 177(3): 921–924.
  4. Robinson PG, et al. (2005). Manual versus powered toothbrushing for oral health. Cochrane Database of Systematic Reviews (2). Oxford: Update Software.
  5. Hodges KO (2009). Periodontal diseases. In NO Harris, et al., eds., Primary Preventive Dentistry, 7th ed., pp. 46–66. Upper Saddle River, NJ: Pearson.

Credits

Author Jeannette Curtis
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Arden Christen, DDS, MSD, MA, FACD - Dentistry
Last Updated August 21, 2009

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