Topic Overview
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 types 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 more severe gum
disease that 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 causes the gums to 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.
In more severe gum disease (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 or dental hygienist 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: | |
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 things 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
Milder types of
gum disease (gingivitis) cause:
- 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 may 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
Milder types of
gum disease (gingivitis) start 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 mild gum disease
If you have
a milder type of
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:
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
put directly on the gums, swallowed as pills or capsules, or swished around 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
Milder types of
gum disease (gingivitis) that are not treated
promptly or that do 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 put 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 now and then
so you can see if you are brushing effectively. Disclosing tablets are chewable
and will color any plaque left on the teeth after brushing. You can get them
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:
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 reduces 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:
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 put directly on the gums (topical), swallowed as pills or capsules,
swished around 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:
- 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.
Other Places To Get Help
Organizations
| American Academy of Periodontology |
| 737 N Michigan Avenue |
| Suite 800 |
| Chicago, IL 60611-2690 |
| Phone: | 312-787-5518 |
| Fax: | 312-787-3670 |
| Email: | member.services@perio.org |
| Web Address: | www.perio.org/index.html |
| |
The American Academy of Periodontology is an association of dental
professionals specializing in the prevention, diagnosis, and treatment of
diseases affecting the gums and the supporting structures of the teeth. The
Academy's purpose is to advocate, educate, and set standards that advance the
periodontal and general health of the public and promote excellence in the
practice of periodontics. The Academy publishes the Journal of Periodontology. The Web site includes consumer information on gum disease and its
treatment as well as a section on the latest research. |
|
| American Dental Association |
| 211 East Chicago Avenue |
| Chicago, IL 60611-2678 |
| Phone: | (312) 440-2500 |
| Web Address: | www.ada.org |
| |
The American Dental Association (ADA), the professional
membership organization of practicing dentists, provides information about oral
health care for children and adults. The ADA can also help you find a dentist
in your area. |
|
| KidsHealth for Parents, Children, and
Teens |
| Nemours Home Office |
| 10140 Centurion Parkway |
| Jacksonville, FL 32256 |
| Phone: | (904) 697-4100 |
| Web Address: | www.kidshealth.org |
| |
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health, from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest. |
|
| National Institute of Dental and Craniofacial Research
(NIDCR) |
| National Institutes of Health |
| Bethesda, MD 20892-2190 |
| Phone: | 1-866-232-4528 toll-free |
| Fax: | (301) 480-4098 |
| Email: | nidcrinfo@mail.nih.gov |
| Web Address: | www.nidcr.nih.gov |
| |
The National Institute of Dental and Craniofacial Research (NIDCR)
is a governmental agency that provides information about oral, dental, and
craniofacial health. By conducting and supporting research, the NIDCR aims to
promote health, prevent diseases and conditions, and develop new diagnostics
and therapeutics. |
|
References
Citations
- 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.
- 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.
- 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.
- Robinson PG, et al. (2005). Manual versus powered
toothbrushing for oral health. Cochrane Database of Systematic Reviews (2). Oxford: Update Software.
- 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
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
|---|
| Primary Medical Reviewer | Adam Husney, MD - Family Medicine |
|---|
| Specialist Medical Reviewer | Steven K. Patterson, BS, DDS, MPH - Dentistry |
|---|
| Last Revised | August 5, 2011 |
|---|