Gum disease is one of the most common oral health problems in the United States, and also one of the easiest to overlook. It often starts painlessly, with gums that bleed a little when you brush. Left alone, it can progress to the point where teeth loosen. This guide explains the warning signs, how the stages differ, who is at higher risk, and what treatment involves.
How common is it?
According to the CDC, about 4 in 10 U.S. adults aged 30 or older had some level of periodontitis (mild, moderate or severe) in 2009–2014, and about 60% of adults 65 or older had it.
Gingivitis vs. periodontitis
Gingivitis
Gingivitis is the mildest form of gum disease. The CDC describes it as inflammation in which the gums become red, swollen and may bleed easily. It is reversible: daily brushing and flossing plus professional cleanings can usually bring the gums back to health.
Periodontitis
If gingivitis is not treated, it can lead to periodontitis, a chronic inflammatory condition that destroys the tissues supporting the teeth, including bone. The CDC explains that periodontitis cannot be reversed, but it can be slowed and managed with professional treatment. Along with tooth decay, it is one of the two leading causes of tooth loss.
Warning signs to watch for
The CDC and the National Institute of Dental and Craniofacial Research list signs that include:
- Red, swollen or tender gums.
- Gums that bleed easily, for example when brushing or flossing.
- Gums pulling away from the teeth, making teeth look longer.
- Loose or sensitive teeth.
- Pain when chewing.
- Persistent bad breath.
- A change in how your teeth fit together when you bite, or in how a partial denture fits.
Importantly, the CDC notes that gum disease can become serious before you notice symptoms, which is why regular checkups matter. See how often to see the dentist.
What causes it
Plaque, a sticky film of bacteria, constantly forms on teeth. If it is not removed, it can harden into tartar (calculus), which brushing cannot remove. NIDCR explains that only a professional cleaning removes tartar. Bacteria in plaque and tartar trigger inflammation. Over time, bacteria can spread below the gumline, forming “pockets” between the teeth and gums, and the inflammation can damage gum tissue and bone.
Who is at higher risk
The CDC and NIDCR identify several risk factors:
- Smoking and tobacco use. NIDCR calls this the most significant risk factor. The CDC reports that about 62% of adult current smokers aged 30 or older had periodontitis in 2009–2014. Tobacco can also make treatment less successful.
- Diabetes. The CDC lists diabetes among the conditions linked to gum disease.
- Older age and genetics.
- Poor oral hygiene.
- Medications with oral side effects.
- Stress, hormonal changes (such as pregnancy or menopause), poor nutrition or obesity, and some systemic illnesses.
- Crooked teeth, clenching or grinding.
How it is diagnosed
NIDCR describes a typical evaluation. The dentist or hygienist examines your gums for inflammation, bleeding and recession, and uses a small probe to measure the space (pocket) around each tooth. In a healthy mouth, NIDCR says these pockets are usually between 1 and 3 millimeters; deeper pockets can be a sign of periodontal disease. The dentist also checks for loose or shifting teeth, reviews your medical history, and may take X-rays to look for bone loss.
How it is treated
Treatment depends on how advanced the disease is. Options described by the CDC and NIDCR include:
- Improved home care and professional cleanings for gingivitis.
- Scaling and root planing, a “deep cleaning” of tooth and root surfaces below the gumline.
- Medication, such as a prescription rinse or medicine placed under the gums.
- Surgery for advanced cases.
- Behavior changes, especially quitting tobacco.
Your dentist may refer you to a periodontist, a specialist in the supporting tissues of the teeth, recognized by the ADA National Commission. See our guide to dental specialists. For what deep cleanings cost and how they are billed, see dental cleaning costs.
Prevention
NIDCR and the CDC recommend:
- Brushing twice a day with a fluoride toothpaste.
- Cleaning between teeth daily with floss, an interdental brush, a pick or a water flosser recommended by your dental professional.
- Regular checkups and professional cleanings, at least yearly or as often as your dentist recommends.
- Quitting all forms of tobacco.
If your gums bleed regularly, do not wait for them to “settle down.” Book an exam. You can find a dentist or periodontist near you in our directory.
Frequently asked questions
Can gum disease be reversed?
Gingivitis, the early stage, is usually reversible with good home care and professional cleanings. Periodontitis cannot be reversed but can be slowed and managed.
Is bleeding when I brush normal?
Bleeding gums are a common sign of gum inflammation. It is worth having a dentist check, especially if it happens regularly.
What is the biggest risk factor for gum disease?
NIDCR describes smoking or using tobacco products as the most significant risk factor.
What is a deep cleaning?
A deep cleaning, or scaling and root planing, removes plaque and tartar below the gumline and smooths root surfaces. It is a common treatment for periodontitis.
Photo: Emeric Kalil / Pexels
Sources
- CDC – About Periodontal (Gum) Disease
- NIH / NIDCR – Periodontal (Gum) Disease
- ADA National Commission on Recognition of Dental Specialties and Certifying Boards – Recognized Dental Specialties
By the Dentists Reviews Editorial Team.
This is general information, not medical advice. Talk to a licensed dentist about your own situation. See our disclaimer.
