Gum Disease — Symptoms, Causes & Treatment | MyMedicPlus

Gum disease (periodontal disease) is a bacterial infection affecting the gum tissue and supporting bone structures of the teeth. It ranges from gingivitis (reversible gum inflammation) to periodontitis (irreversible destruction of the periodontal ligament and alveolar bone supporting the teeth). Severe periodontal disease is the 6th most prevalent condition globally, affecting approximately 19% of adults and being a major cause of tooth loss. Periodontal disease is also associated with systemic conditions including cardiovascular disease, diabetes, and adverse pregnancy outcomes. Beyond local oral effects, periodontal disease has substantial systemic implications — bacteria from inflamed periodontal tissue enter the bloodstream continuously, contributing to systemic inflammation measured by elevated CRP and IL-6. This systemic inflammatory burden links periodontal disease to cardiovascular disease, worsened diabetes control, and adverse pregnancy outcomes. Periodontal disease is a multifactorial disease involving pathogenic bacteria, host immune response, genetic susceptibility, and environmental risk factors.

The primary cause is dental plaque — a biofilm of bacteria (particularly Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia in the 'red complex') that accumulates on teeth and below the gum line when oral hygiene is inadequate. Calculus (tartar) — mineralized plaque — harbors bacteria beneath the gumline and cannot be removed by brushing alone. Risk factors include smoking (doubles risk and impairs healing), diabetes (bidirectional relationship — poorly controlled diabetes worsens gum disease and vice versa), hormonal changes (pregnancy, puberty), certain medications causing gingival overgrowth, genetic susceptibility, stress, dry mouth, and crowded teeth. Genetic factors account for 50% of periodontitis susceptibility — variants in interleukin-1 (IL-1) and tumour necrosis factor (TNF) genes are associated with increased severity. Poorly controlled diabetes impairs neutrophil function and promotes advanced glycation end-products (AGEs), dramatically increasing periodontal tissue susceptibility to bacterial damage.

Gingivitis presents as painless red, swollen gums that bleed easily on brushing or flossing. Bad breath (halitosis) is common. Periodontitis progresses with deepening periodontal pockets (normal sulcus depth 1–3mm; periodontitis causes pockets 4mm or deeper), gum recession exposing tooth roots, tooth sensitivity to temperature and pressure, loose or shifting teeth, changes in bite (occlusion), and eventually tooth loss. Acute necrotizing ulcerative gingivitis (ANUG — 'trench mouth') causes rapid-onset painful ulceration, gray pseudomembrane, and characteristic foul odor, more common in immunocompromised individuals and smokers. Periodontal abscesses present acutely with localized painful swelling, purulent discharge, and systemic upset, requiring drainage and antibiotics. Aggressive periodontitis (previously juvenile periodontitis) affects young patients with rapid bone loss disproportionate to plaque levels, often involving specific pathogens such as Aggregatibacter actinomycetemcomitans.

Comprehensive periodontal examination includes probing periodontal pocket depths at 6 sites per tooth using a calibrated probe, assessment of gum bleeding on probing (indicating active inflammation), recession measurement, furcation involvement (bone loss between roots of multi-rooted teeth), and tooth mobility assessment. Dental radiographs (periapical and bitewing X-rays) show bone loss levels. The 2018 AAP/EFP classification categorizes periodontitis by severity (Stage I–IV) and complexity, and grades by risk factors and progression rate. Salivary and microbiome testing can identify specific pathogens in research and specialized clinical settings. The Periodontal Staging and Grading system (2018 World Workshop) classifies disease by Stages I–IV (severity) and Grades A–C (risk of progression), replacing previous classification schemes. Grade C periodontitis (rapid progression, risk modifiers including diabetes and smoking) requires more intensive treatment and monitoring frequency.

Gingivitis is fully reversible with professional scaling to remove plaque and calculus above the gum line combined with improved home oral hygiene. Periodontitis treatment begins with non-surgical therapy: scaling and root planing (deep cleaning under local anesthesia) removes bacterial deposits from root surfaces below the gum line. Adjunctive antimicrobial agents (subgingival antimicrobial chips, local delivery of doxycycline or minocycline, or systemic metronidazole plus amoxicillin in aggressive disease) improve outcomes. Surgical treatment — flap surgery (open debridement), osseous surgery, or regenerative procedures (bone grafts, guided tissue regeneration) — is indicated when non-surgical therapy is insufficient to resolve deep pockets (above 5–6mm) with ongoing disease activity. Photodynamic therapy (PDT) using photosensitising agents and laser light is an adjunct for selected patients. Full-mouth disinfection protocols (treating all quadrants within 24–48 hours) reduce bacterial recolonisation between sessions. Host modulation therapy using sub-antimicrobial dose doxycycline (20 mg twice daily) as an adjunct to SRP reduces matrix metalloproteinase activity and tissue destruction in refractory cases. Maintenance supportive periodontal therapy (SPT) every 3 months is essential to maintain treatment gains long-term.

Advanced periodontitis causes tooth loss, which impairs chewing function, nutrition, speech, and facial aesthetics. The systemic links of periodontal disease include increased risk of cardiovascular disease (periodontal bacteria cause endothelial inflammation and arterial plaque), worsened glycemic control in diabetes (inflammation increases insulin resistance), adverse pregnancy outcomes (preterm birth, low birth weight), and associations with rheumatoid arthritis, Alzheimer's disease, and chronic kidney disease. Dental implants placed to replace extracted teeth are themselves susceptible to peri-implantitis — a similar destructive infectious process around implant surfaces.

Brush teeth twice daily for 2 minutes with a fluoride toothpaste using a soft-bristled or electric toothbrush. Clean interdentally daily with floss, interdental brushes, or water flossers — where the majority of periodontal disease originates. Professional dental cleaning every 6 months (3 months for periodontitis patients) removes calculus deposits that cannot be removed at home. Quit smoking — smoking is the single most important modifiable risk factor and also impairs treatment response. Control blood sugar if diabetic. Avoid dry mouth medications where possible. Early treatment of gingivitis prevents progression to irreversible periodontitis.

See your dentist promptly if you notice: bleeding gums when brushing or flossing (even mild, occasional bleeding from gums is not normal — it is a sign of gingivitis); persistent bad breath despite good oral hygiene; gum recession (teeth appearing longer, or exposed roots visible); loose teeth or a change in how teeth bite together; or new gaps developing between teeth. Periodontitis is painless until advanced — do not wait for pain to seek dental review. See a dentist urgently for: a painful swelling in the gum or jaw (dental abscess — requires drainage and antibiotics); a tooth becoming very loose or tender to pressure; or a mouth ulcer persisting more than 3 weeks without healing (urgent referral to exclude oral cancer). Patients with diabetes should have dental examinations at least every 6 months — poor periodontal health worsens glycaemic control and vice versa.