Periodontal (Gum) Disease

Periodontal disease is an infection of the tissues that support the teeth.
Teeth are supported by the gums, or gingiva. A tooth's root is anchored to its socket by fibers called periodontal ligaments.
The gums do not attach to the teeth as firmly as one might think. A shallow, V-shaped gap called a sulcus exists between the teeth and the gums. Periodontal disease affects this gap. Eventually, in periodontal disease, the tissues supporting the tooth break down. If only the gums are involved in this breakdown, the disease is called gingivitis. If only the connecting tissues and bone are involved, it is called periodontitis.

Periodontal (Gum) Disease Causes

Plaque is a sticky film of bacteria that clings to the surface of teeth and gums. Brushing and flossing every day may not completely remove all the plaque, especially around the gum line. The bacteria in the plaque produce toxins that may injure the gums and supporting tissues.
Plaque that is not completely removed within 48 hours hardens into a rough deposit called tartar or calculus. Once tartar develops, the only way to remove it is by having the teeth professionally cleaned. Tartar below the gum line causes inflammation and infection. Because this process is often painless, a person may be unaware a problem exists.
Causes or factors that worsen gum disease include the following:
  • Because of a dulled immune response and less oxygen in the mouth, smokers are 2-7 times more likely to develop periodontitis than nonsmokers.

  • Diabetes worsens periodontal disease. If a person's blood sugar level is poorly controlled, a worse infection, poor healing, and a greater loss of bone and connective tissue are likely.

  • Stress increases certain hormones that make a person more susceptible to infection. Pregnancy and birth control pills can also increase hormone levels.
  • Steroids, antiseizure medicines, cancer medicines, and blood pressure medicines can all affect the gums. Some drugs decrease the flow of saliva, irritating the mouth and making it prone to infection.


When to Seek Medical Care

A dentist provides major care for diseases of the teeth and gums.
A person should visit his or her dentist for the following concerns:
  • Gums start to bleed.
  • Gums are swollen and sore.
  • Bad smelling breath or a bad taste develops in the mouth.
  • Gums become very red or very pale.
  • Teeth are painful.
  • Teeth are loose in their sockets.
If any of the above symptoms are present, plus fever, sweats, chills, or face swelling, go to a hospital's emergency department. Other reasons to go to an emergency department include the following:
  • The tongue feels swollen or pushes up from the floor of the mouth.
  • Swelling develops below the chin, especially if it is red, tender, and warm.


Periodontal (Gum) Disease Symptoms

  • Gingivitis

    • Gingivitis includes swelling and bleeding of the gums, bad breath, or a bad taste in your mouth. Good teeth-brushing and flossing can reverse the affects of gingivitis.

    • Acute necrotizing ulcerative gingivitis (ANUG) is an advanced and invasive form of gingivitis that causes sore gums and a whitish membrane on the gums. It requires antibiotics as part of the treatment.

  • Periodontitis

    • Periodontitis occurs when bacterial toxins and enzymes destroy the connective tissue and bone.

    • The gums draw back, and the roots of the teeth are exposed. The teeth may become very sensitive to temperature changes, or new cavities can develop.

    • The pocket between the tooth and the gums deepens; plaque in this area is very difficult to remove. Bacteria invade the surrounding structures.

    • When the gums pull away from the teeth, pus develops between the teeth and the gums or the permanent teeth become loose in their sockets. Only a dentist can decide whether the teeth can be saved.


Periodontal (Gum) Disease Treatment

Self-Care at Home
Good oral hygiene prevents periodontal disease.
  • Brush the teeth at least twice every day. Brushing removes plaque from the inner, outer, and chewing surfaces of each tooth. A dental hygienist can demonstrate the proper technique.
  • Get a new toothbrush every 3 months.
  • Use a toothpaste that contains fluoride.
  • Floss every day. Flossing removes plaque between the teeth that a toothbrush cannot reach.
  • Use a mouthwash that kills bacteria.
  • Eat a well-balanced diet; avoid too many sweets.

Medical Treatment

If the dentist diagnoses periodontal disease, the first treatment will probably include scaling and root planing. More than one visit may be needed for this treatment. Scaling removes plaque and tartar from below the gum line down to the bottom of each pocket.
  • A local anesthetic (Novocain) may be needed to reduce discomfort.
  • The roots of the teeth are smoothed. Smoothing allows the gums to reattach to their roots.
  • Antibiotics and a special mouth rinse may be needed.
  • If pockets are still present after scaling and planing, surgery may be needed.