Gum Disease: Symptoms, Causes, & Treatment

Gum disease is an inflammation of gums (gingiva), which can extend to the jawbone and tooth-supporting tissues. It is triggered mainly by bacteria in the dental plaque, a sticky, colorless layer that forms on teeth surfaces. The dental plaque consists of food debris and bacteria. If plaque is not removed by daily toothbrushing and flossing, it will harden (tartar) and cause gum inflammation, bleeding, and recession. Bacteria infect not only gums but also the tooth-supporting tissues such as the jawbone and connective tissues. Eventually, the advanced stage of gum disease may lead to tooth loss.

Gum Disease Stages

There are 3 stages:

  • Gingivitis: it is the early stage of gum disease. It is characterized by gum bleeding during toothbrushing or flossing. With inadequate oral hygiene, the dental plaque accumulates on teeth surfaces and on the gum line. Bacteria in the dental plaque produce toxins that cause the inflammation of gums. At the early stage, the inflammation affects gums and doesn’t extend to the tooth-supporting tissues. The early-stage can be reversed by proper oral hygiene and professional cleaning.
  • Periodontitis: at this stage, the inflammation extends to the tooth-supporting tissues such as the jaw bone and connective tissues, causing irreversible damage. This will lead to gum recession and the formation of pockets that trap food and dental plaque. The damage can be stopped and prevented by improved oral hygiene and professional scaling and polishing.
  • Advanced periodontitis: if periodontitis is left untreated, the damage of jawbone and connective tissues will continue and your teeth will become loose. In the end, this will lead to tooth loss.

Stages of Gum Disease
Gum Disease Stages: Gingivitis, Periodontitis, and advanced Periodontitis

Gum Disease Symptoms

Healthy gums are pink, tightly attached to the tooth, and don’t bleed. The symptoms of gum disease include:

The Early Stage (Gingivitis)

  • Redness and swelling of the gum.
  • Gum bleeding while brushing or flossing or eating.
  • Bad breath.
  • Gum recession.

The Advanced Stage (Periodontitis)

  • Pain in the affected area.
  • Painful chewing.
  • Loss of the bone surrounding and supporting the tooth.
  • Formation of periodontal pockets.
  • Persistent bad breath and/or bad taste.
  • Periodontitis can cause pus formation from the gingival margin.
  • Misaligned teeth.
  • Loose teeth or tooth loss.

Gum Disease Causes

Inadequate oral hygiene is the most common cause of gum disease. The oral bacteria and food debris accumulate on tooth surfaces forming a layer known as dental plaque. The oral bacteria decompose food debris and produce toxins that attack the gingiva, causing gingival inflammation. The symptoms of this inflammation include redness, swelling, and bleeding. These inflammatory processes can cause resorption of the jawbone surrounding the tooth, gingival pockets, and eventually tooth loss. Other causes of gum disease include mechanical damage of the gingiva, for example, due to excessive tooth brushing, poorly fitting dentures, or tooth grinding.

Gum Disease Risk Factors

In addition to the lack of oral hygiene, there are many factors that may promote the development of gingival inflammation, these factors include:

  • Some drugs such as hypertension medication (nifedipine), or medications for the suppression of the immune system in transplant patients.
  • Hormonal changes such as during pregnancy and puberty.
  • Mouth breathing.
  • Dry mouth condition (xerostomia)
  • Improper diet.
  • Low salivary flow.
  • Diabetes mellitus.
  • Vitamin C deficiency.
  • Alcohol and nicotine consumption.

Diagnosis of Gum Disease

The dentist will review your medical history to detect any factors that could be promoting the development of gingival inflammation such as certain drugs or nicotine and alcohol consumption.

In order to diagnose gum disease, the dentist uses a special instrument known as a “periodontal probe”. He/She examines whether the gum has a healthy pale pink color and fills the interdental space or whether it has a red color and swollen at the gingival margin. Also, he/she checks whether the dental plaque is present and whether the gum starts to bleed easily. The dentist scans the existing gingival pockets. In this way, he/she can determine how deeply they are, exactly where they are, and the degree of surrounding tissue inflammation due to gum disease.

The dentist performs these examinations to determine the so-called periodontal screening index (PSI). it is used for the early detection of periodontal disease. Using an x-ray, the dentist can detect the bone loss caused by periodontal disease. With the saliva test, the dentist can determine the types of bacteria in the oral cavity.

Complications of Gum Disease

If gum disease is left untreated, it can cause more severe complications. The infection will spread to tooth-supporting tissues. Gum disease complications may include:

  • The damage of periodontal ligament: it is also known as PDL, connective tissue fibers that provide an attachment of the tooth to the jawbone.
  • Jawbone loss: untreated gum disease increases the damage of the alveolar bone that supports teeth.
  • Gum abscess
  • Gum recession
  • Loose and shifted teeth
  • Tooth loss

Also, gum disease has been associated with an increased risk for some medical conditions such as:

  • Heart disease: several studies have indicated that gum disease increases the risk of heart disease and stroke.
  • Diabetes: researches have suggested that gum disease may make it more difficult for diabetic patients to control their blood sugar. Also, diabetic patients have a higher risk of gum disease.
  • Respiratory disease: research has found that bacteria in the oral cavity especially in people with gum disease, can be aspirated into the lungs and cause respiratory diseases such as pneumonia.

Treatment Of Gum Disease

After the diagnosis is performed by a dentist, a professional dental cleaning is carried out to remove dental plaque (the main trigger). The treatment depends on the stage of gum disease. The treatment can range from nonsurgical (to control the growth of bacteria), to surgical (to restore the tooth-supporting tissues).

Nonsurgical treatment (in the early stage)

In the early stage of gum disease, the nonsurgical treatment involves less invasive procedures, involving:

  • Scaling and polishing: this procedure is used to remove dental plaque, tartar, and bacteria from tooth surfaces, above and below the gum line. It is performed using a special instrument such as “periodontal scaler”, or an ultrasonic device, or a laser. Also, the dentist will polish your teeth to smooth the tooth surfaces and remove stains.
  • Root planing: this procedure is a deep cleaning under the gum. It is performed under a local anesthetic by a dentist or periodontist, to smooth the tooth surface, and prevent the further build-up of tartar, and bacteria. Also, it will provide a clean surface for the reattachment of the gum to tooth surfaces.

Surgical treatment (in the advanced stage)

In the advanced stage of gum disease, the surgical procedures involve:

  • Flap surgery: it is also known as “pocket reduction surgery”. The dentist or periodontist will make small incisions. Then, he/she will perform scaling and root planing to remove bacteria and tartar. The surrounding bone will be smoothed to limit places where harmful bacteria can hide and grow. The gum tissue is then sutured back in place.
  • Soft tissue grafts: gum disease can cause gum recession. The dentist will take a small amount of tissue from the palate (the roof of the oral cavity) and stitch it to the affected area. This procedure can help treat the gum recession and cover exposed tooth roots. Also, it can restore the aesthetic appearance of your mouth.
  • Bone grafts: this procedure is performed to replace the destructed bone and to hold the tooth in place. The bone graft can be synthetic or taken from your bone or other sources. It promotes the regrowth of bone, to restore the stability of your teeth.
  • Guided tissue regeneration: the dentist performs a flap surgery and places a small piece of mesh-like fabric between your bone and tooth. This procedure promotes the regrowth of bone and gum tissue to support your teeth and prevent tooth loss.


  • Antibiotic: such as metronidazole and amoxicillin. Antibiotics may be prescribed to control bacterial infection. Amoxicillin can’t be prescribed for patients who are allergic to penicillin.
  • Painkiller: it is prescribed to help reduce pain and discomfort such as paracetamol and ibuprofen.
  • Mouthwash: the dentist may prescribe a mouthwash containing chlorhexidine or hydrogen peroxide to treat gum disease. Mouthwashes that contain chlorhexidine shouldn’t be used for more than 2 weeks because it can cause tooth discoloration and taste irritation.

Gum Disease Prevention

In order to prevent gum disease, you should follow these instructions:

  • Maintain good oral hygiene:
    • Brush your teeth at least twice a day to remove dental plaque that accumulates on teeth surfaces.
    • Floss your teeth once a day to prevent the accumulation of plaque in the interdental spaces.
  • Drink enough amount of water: to prevent dry mouth condition and prevent the inflammation of the gums.
  • Avoid smoking: chewing or smoking tobacco decreases the blood circulation and increases the risk of gum disease.
  • Eat a balanced diet: A balanced diet with plenty of vitamins and minerals can keep your gum tissue healthy. And avoid sugary food and drinks.
  • Breath from your nose: mouth breathing can cause dry mouth condition (xerostomia) and lead to gingival inflammation. Visit your general practitioner if you have a problem with a sinus infection (sinusitis).
  • Chew sugar-free gum: to stimulate the production of saliva and prevent the inflammation of gums.
  • Follow the proper technique for toothbrushing: to prevent gum recession.
  • Regular dental visits: you should visit your dentist regularly at least twice a year for professional cleaning.

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