If you are cleaning your mouth as well as your dentist or dental hygienist would like
If you are using the correct toothbrush, between-teeth cleaning system (floss or interdental brush), and mouth rinse
If an oral probiotic would help your condition
If you should use a fluoride mouthrinse
If your gums bleed, or if you notice any blood when you rinse after toothbrushing
If your teeth are sensitive to hot or cold
If you have diabetes, or a history of stroke or heart disease
All your prescription medicines
Brush your teeth with fluoride toothpaste twice a day
Perform between-teeth cleaning at least once per day
To have regular dental check-ups as advised by your dentist or dental hygienist
To follow the techniques your dental hygienist has demonstrated to you on the best ways to keep your mouth clean and healthy
To change your toothbrush at least every three months
Gum disease is not normal – it is avoidable and preventable
There are two main categories of gum diseases (also known as periodontal disease): gingivitis and periodontitis. Each category has its own stages of progression – early or mild, moderate, and advanced or severe.
Gingivitis is by far the most common category and is most commonly caused by the build-up of dental plaque and its inadequate removal. Dental plaque is a biofilm of bacteria and the byproducts produced by the bacteria. The gums become inflamed – red and swollen – and may bleed easily, especially during toothbrushing or flossing. When the dental plaque is removed by thorough oral hygiene, the cause of the inflammation subsides and the gums will return to a healthier state.
Gingivitis is reversible and may recur. However, plaque left on the teeth for a long time will become hardened by the minerals in saliva and will not be easily removed by normal oral hygiene methods. This hardened material is calculus (also known as tartar) and can only be removed by a dentist or dental hygienist through a prophy (dental prophylaxis) or scaling procedure.
The stages of early, moderate, or advanced gingivitis refer to the strength of the inflammatory reaction of the body. Gingivitis may occur on only one or two teeth, in several areas of the mouth, or around all teeth and gums. Its prevention is based upon good oral hygiene practices, using a correctly designed toothbrush, interdental cleaning aids, and an anti-plaque mouth rinse.
Periodontitis is also quite common, but not as common as gingivitis. It affects almost half of the adult population of the United States, with 38.5% having moderate or severe disease. It has some similar features to gingivitis.
Periodontitis occurs when the challenge from the dental plaque to the body’s defenses is stronger, and the reaction of both the bacteria and the body’s defenses results in the irreversible destruction of the tissues that surround the tooth and hold it into the jawbone. In this process, the destruction includes the attachment of the gum to the tooth. The loss of this attachment or seal allows the bacteria and their byproducts to get under the gums and help to destroy the surrounding bone and the ligament that connects the bone to the tooth. The gums may also start to recede, making the teeth look longer and yellower.
Without dental treatment, the disease process usually progresses intermittently and, over time, may result in the total destruction of the attachment of the tooth to the jaw, as well as the surrounding bone. This may result in the loss of the tooth by an extraction procedure.
Gingivitis and periodontitis are separate diseases, but it is not unusual for a patient with periodontitis to have some gingivitis as well.
Like gingivitis, periodontitis may occur just on one tooth, several teeth, or all teeth and gums. Periodontitis is one of the two most common causes of tooth loss. The other cause is tooth decay or cavities.
The best action you can take is to visit your dentist regularly. You dentist will be able to advise you regarding how frequently those visits should be. For most individuals, a recall examination or dental check-up will be every six months or one year. For individuals at greater risk of a gum disease, the frequency may be three months or even more often.
By examining you at the appropriate time interval, your dental team can work with you to keep your mouth healthy and to provide any treatment necessary when the disease is in its early or mildest stages.
However, if between recall appointments you notice any blood in your toothpaste when spat into the washbasin, any tooth sensitivity, or any change in the appearance of your gums, then you should contact your dental office and seek advice.
The main cause of gum diseases is the accumulation and build-up of dental plaque and the body’s reaction to it through inflammation. Dental plaque is a biofilm of bacteria and their byproducts, which is constantly growing on the surfaces of the teeth and on some of the soft tissues, especially the tongue.
Dental plaque that is less than 24 hours old is generally considered harmless. If not removed thoroughly, after 1–2 days, the types of bacteria change to become harmful and cause the body to react by inflammation.
Figure: Dental plaque forms in the crevice around the tooth, as well as most other surfaces in the mouth. If left undisturbed, the body reacts to it through inflammation.
There are no warning signs until after the disease process has started. The most common sign of gum disease is the presence of blood during toothbrushing. Redness of the gum margins is also a sign. Gum disease is inflammation and, like all inflamed tissues, inflamed gums bleed very easily. The action of even gentle toothbrushing will cause the inflamed gums to bleed. This most common sign of gum disease is the presence of blood mixed in with toothpaste when it is spat or rinsed from the mouth.
Bleeding may occur in all stages of gum disease. This is very often the only signal that you have some form of gum disease. Normally, there is no pain.
Figure: The presence of blood on your toothbrush or in the washbasin is a sign of gum disease.
Other signs are:
- Red and swollen gums
The gum margins (where the gum ends around the tooth neck) may look reddened and swollen. The natural, healthy color of gums is pink, and they normally look quite thin and form a knife-edge at the tooth neck.
Pus, a yellow creamy fluid, may be seen close to the gum margin and around the tooth neck. This pus will be coming from an abscess or other heavily infected tissue alongside the root of the tooth in what the dental professional would refer to as a periodontal pocket.
- Loose teeth
A loose, mobile or wobbly tooth is caused by destruction of the bone that surrounds a tooth and anchors it into the jawbone. One or more loose teeth may be caused by advanced gum disease. Loose teeth, if caused by gum disease, will most likely exhibit all the other signs of gum disease.
Figure: Healthy gums are pale pink and form a knife-edge at the gum margin where they give way to the crown of the tooth.
Figure: In early stage gum disease, the gum margin begins to change from pink to red, especially between the teeth.
Figure: In moderate stage gum disease, the gums become redder over a larger area, and look swollen and puffy.
Figure: In advanced stage gum disease, the gums are very red, puffy, and swollen, bleed very easily, and there will generally be obvious deposits of plaque and calculus; the teeth may feel loose and pus may exude. The gums may have recession.
Gum disease is a ‘silent’ disease and few people with gum disease are aware of any symptoms at all. If symptoms do occur, they are generally pain and sensitivity in the tooth, rather than the gum itself. In the advanced stages of gum disease, there may be some tooth sensitivity where the roots have become exposed due to the gums receding.
If an abscess forms in a periodontal pocket, it may be very painful at first. The tooth will be tender to touch or to bite on.
Bad breath that does not go away may be a symptom of gum disease.
Gingivitis is a common condition in which the gums become inflamed and look red and swollen. The inflamed gums may bleed easily, especially during and immediately after toothbrushing or between-teeth cleaning (interdental brushing or flossing). Healthy gums are pale pink and not swollen, forming a knife-edge appearance where they meet the tooth.
Figure: Healthy gums are pale pink and form a knife-edge at the gum margin where they give way to the crown of the tooth.
Figure: In early stage gingivitis, the gum margin begins to change from pink to red, especially between the teeth.
Figure: In moderate stage gingivitis, the gums become redder over a larger area, and look swollen and puffy.
Gingivitis is caused by the build-up of dental plaque. Dental plaque is a biofilm of bacteria that causes the body to react by defending itself against the bacteria and their harmful byproducts (known as toxins). If dental plaque is not removed frequently and completely, it becomes harmful and the gums react to it by becoming inflamed and developing gingivitis.
If the dental plaque is removed by using correctly designed cleaning aids and a cleaning technique recommended by your dentist or dental hygienist, the gingivitis will subside and the gums return to their normal healthy state.
Gingivitis is reversible for most people. For some individuals, however, the build-up of dental plaque and the body’s reaction to it may lead to a much more serious condition known as periodontitis.
The cause of gingivitis is dental plaque. If dental plaque is not removed frequently and is allowed to build-up, it will become harmful. After about 24 hours, some of the types of bacteria in dental plaque change from being friendly to being harmful to the body. Therefore, it is important to thoroughly brush and clean between the teeth every day.
The harmfulness of dental plaque can be made worse and the inflammatory reaction of the body can be increased with these contributing factors:
- Hormonal changes in puberty and pregnancy
- Diabetes and poor blood-sugar control
- Increased stress
- Poor nutrition
- A compromised immune system (HIV, organ transplants, etc.)
- Certain prescription medications (ask your dentist or physician)
There are almost no noticeable symptoms of gingivitis. Teeth that become sensitive to cold or hot foods and drinks, or to sweet or acidic beverages, may be an indicator of gingivitis. The most common sign is to notice the presence of blood in toothpaste when spitting out or rinsing after toothbrushing.
Gum recession is a condition where there is a progressive loss of gum tissue around the tooth resulting in the root of the tooth becoming exposed. The tooth looks longer as the root begins to show, and it may appear more yellow. When the root of the tooth is exposed, it may also become sensitive to various stimuli. The crown of the tooth is covered with enamel, which has no nerves. The root of the tooth is not covered in enamel and the dentin that used to be covered by gum tissue is now exposed to the mouth. Like other parts of the body that lose their skin covering, the underlying tissue is sensitive. The same may happen to teeth roots when they become exposed due to gum recession.
Gum recession has many causes. Periodontitis is a common cause. However, even in healthy mouths, gum recession may occur due to aggressive brushing or other oral hygiene habits, or through misplaced teeth. Examples of aggressive toothbrushing and other habits are:
- Applying too much pressure with the toothbrush, or a scrubbing action
- Use of a tooth brush with very hard or stiff bristles
- Use of a very abrasive toothpaste or tooth powder
Various habits can also cause injury to the gums and eventually recession:
- Picking or scratching with a finger nail, tooth pick, or eating utensil
- Paper clips, pens, golf tees, etc.
Gum recession is very difficult and at times impossible to treat, as the lost tissue will not re-grow naturally and needs encouragement with surgery and various chemical agents. If the cause is not addressed the recession may continue or recur.
Figure: In gum recession, the teeth look longer and their roots look yellower.
Dental and medical research has been discovering that gum disease can be associated with a number of general health conditions. This means that if you have gum disease, it may increase your risk of certain systemic diseases such as diabetes, cardio-vascular disease, and stroke; and, if you already have any of those diseases, the gum disease may make them harder to control. In addition, if you have diabetes and your blood sugar level is not well controlled, it may lead to greater risk of gum disease or make your existing gum disease harder to control.
If you are pregnant, you may have swollen and bleeding gums due to hormonal changes. Having chronic gum disease may indicate an increased risk of having a premature, low birth-weight baby. However, this is not to say that the gum disease itself leads to the premature birth. No direct causal link has been discovered, only an increased risk.
Scientists still have much to learn about this link between oral health and general health, but the basis of the association is thought to be a result of inflammation. If you have any of the conditions mentioned, you should discuss your health with both your physician and your dentist.
Remove as much plaque as possible every day, following the techniques and using the oral hygiene aids (toothbrushes, between-teeth cleaning aids, rinses, etc.) recommended to you by your dentist or dental hygienist. Always buy the best quality aids that you can afford and use them as instructed.
Visit your dental office on a regular basis. Do not miss or postpone any check-up appointments. Working as a team, your dentist and dental hygienist can work with you to help keep your mouth healthy.
As the common cause of gum disease (both gingivitis and periodontitis) is dental plaque, the first line of treatment is removing the plaque and stopping it from building up in the future. Your dentist or dental hygienist will provide instructions in various techniques of plaque removal that are best for your individual circumstances. This will include the recommendation to use a specific type of toothbrush and between-the-teeth cleaning aids, such as an interdental brush or dental floss. An anti-plaque mouth rinse may be recommended as well. It is important to follow their advice and to use the exact technique and cleaning aids.
For gingivitis, the dentist or dental hygienist will perform a general prophylaxis (scaling and polishing) and, where necessary, make adjustments to or replace any other factors in your mouth that contribute to the accumulation of plaque. This includes recontouring or replacing fillings, crowns, and bridges, adjusting a removable denture (if worn), or even considering some orthodontic tooth movement or extraction of misplaced teeth. Most treatment for gingivitis is limited to better techniques of home care to prevent the build-up of plaque and a prophylaxis in the dental office, and regular recall visits to monitor any further development of gingivitis.
Treatments for periodontitis, on the other hand, are more complex. The initial stage of thorough plaque removal is similar to gingivitis, but in addition, the roots of the teeth must be cleaned under the gum line where periodontal pockets have formed. During your treatment for periodontitis, your dentist and dental hygienist will concentrate on thoroughly cleaning the surfaces of the tooth roots, a procedure known as root planing. Minor surgical procedures may be needed to access the inflamed tissues and the roots, and to recontour the gums to help re-establish their healthy shape and appearance. Your dentist may refer you to a Periodontist. Periodontists are dentists with two or three years of advanced training in gum health and dental implants.
It is important to think of your oral health as a collaborative effort between you and your dental professional. You're in charge of daily maintenance, while your dentist and hygienist have the task of closely examining your teeth and gums to identify any changes that could be a cause for concern. With gingivitis, the initial warning signs might go undetected, but with regular visits, your dental professional can keep your oral health in check. Your dentist and hygienist will be able to recommend how frequently you should have a check-up, depending on their assessment of your health and risk of disease. Most people will need check-ups every six or twelve months, but those at greatest risk may need to be checked at three-month intervals. Your dentist will advise you based upon their assessment of your mouth, as well as your overall health and risk of disease.
Clinically, gingivitis is reversible with thorough removal of plaque by yourself at home and/or a prophylaxis procedure in the dental office. Periodontitis is not reversible and causes lasting damage to the tissues and structures that hold the teeth to the jawbone. Both conditions have similar signs and symptoms, so it is important to have a regular dental check-up to determine which disease condition you may have.
Gingivitis can be reversed and controlled, and it generally has no permanent effects. Periodontitis can lead to a changed appearance of the teeth – they may appear longer as the gum recedes, or gaps may appear between the teeth as the teeth themselves become loose and drift around in the bone. Exposed roots appear stained and more yellow than the enamel-covered crown.
The effects of periodontitis usually cannot be reversed, and even if they can, the treatment is complicated and expensive. Many recent medical studies have shown there is a link between poor oral health and serious health conditions – like heart disease, stroke, and diabetes. By arming yourself with the right dental products, having regular check-ups, and being aware of how your oral health relates to overall health, you’ll be well on your way to healthier teeth and gums – and a healthier you.