Gum Disease Explained: Causes, Symptoms, And Treatments

Taking proper care of your teeth and gums is important. As you probably already know, good oral hygiene habits include brushing twice daily at a minimum, flossing every day, and visiting your dentist regularly (per Medical News Today). Unfortunately, neglecting these healthy habits can eventually lead to cavities and gum disease (periodontitis). Other factors can also impact the health of your gums, including genetics, smoking, and medications. There may even be a connection between gum disease and certain health conditions, such as heart disease.

When left untreated, gum disease can cause painful symptoms, require expensive treatments, and sometimes lead to tooth loss. One early sign of trouble is gum inflammation (gingivitis). Although The Family Dental Center describes gingivitis as the "uncalm before a gum disease storm," this condition is considered reversible. If you have gingivitis, we recommend focusing on proper oral hygiene and following all of your dentist's recommendations.

Some individuals may develop periodontitis despite their best efforts. As WebMD describes, "In a person with periodontitis, the inner layer of the gum and bone pull away from the teeth and form pockets. These small spaces between teeth and gums collect debris and can become infected. The body's immune system fights the bacteria as the plaque spreads and grows below the gum line." While periodontitis can't be reversed, you may be able to slow its progression. Depending on disease severity, your dentist may recommend nonsurgical and/or surgical interventions. Below, we discuss causes, symptoms, and treatments of gum disease.

According to a 2015 study in the Journal of Natural Science, Biology and Medicine, female hormones may play a role in the development of gum disease: "The periodontium shows an exaggerated inflammatory response to plaque modified by female sex hormone during puberty, pregnancy, in women taking oral contraceptives and at the postmenopausal stage." In other words, you may be at increased risk for gum problems during certain stages of your life. Even menstruation may have an impact on your oral health (per the Cleveland Clinic).

The Cleveland Clinic shares that hormone therapy, specifically estrogen therapy, may benefit the gums of some postmenopausal women. This is because reduced estrogen levels during and after menopause can place women at increased risk for osteoporosis, periodontitis, and bone loss. If you notice that your gums are receding, this may be a sign of bone loss in the jaw, which can eventually lead to tooth loss. If you or your dentist think that hormones (or a lack of hormones) may be contributing to your gum issues, talk to your doctor about potential treatment options.

It is always important to discuss medication use with your dentist. Some medications may directly impact the health of your teeth and gums; others may cause related issues like unusual bleeding, changes in your sense of taste, soft-tissue reactions (such as mouth ulcers), overgrown tissue, and dry mouth (via the American Dental Association).

Dry mouth (xerostomia) is a known risk factor for the development of gingivitis and periodontitis. According to WebMD, certain drugs can impact the amount of saliva in your mouth. When the mouth is dry, mouth tissue — including the gums — can become inflamed. This may contribute to the development of tooth decay and gum disease.

If you are on medications that impact oral health, you may wish to ask your doctor whether some changes are possible. But if that's not possible, don't panic. Even when certain medications can't be avoided, your dentist can work with you to develop an appropriate treatment plan (i.e. additional cleanings) to help manage medication side effects.

If you need one more reason to quit smoking, here it is: Smoking can increase your risk of developing gum disease (per WebMD). (Oh, and here are a few more: Smoking can also lead to bad breath, tooth discoloration, increased plaque and tartar build up, and even oral cancer). But how, exactly, does smoking impact the gums?

According to the Centers for Disease Control and Prevention (CDC), smoking can impact your body's ability to fight off infection, including infection of the gums. And once your gums have been damaged, smoking can also impede their ability to heal. If you are a smoker, you are twice as likely to develop gum disease as a nonsmoker. Additionally, the more you smoke and the longer you smoke, the higher your risk. Finally, gum disease treatment tends to not be as effective on people who smoke.

Smoking isn't the only bad habit that can affect the health of your gums. Any type of tobacco use, including chewing tobacco, raises your risk for gum disease. Recreational drug abuse is also problematic. Not only do drugs themselves impact the gums, they can also lead to addiction-related behavior that affects oral health. As American Addiction Centers describes, "People who struggle with addiction spend a great deal of their time intoxicated on drugs or trying to acquire more drugs; this means that they often neglect oral hygiene because they cannot afford a dentist or they simply stop caring about brushing their teeth."

Gum recession is a common oral health problem, especially in the 40+ age group (via California Dental Association). It can be caused by aging, vigorous brushing, or periodontal disease. No matter the cause, gum recession will likely require some changes, starting at home. One of the first things to consider are your daily brushing habits. The California Dental Association provides some helpful brushing tips for those with receding gums: Choose a soft toothbrush, use mild to moderate pressure, and brush with circular or very small back and forth strokes. Do not use hard bristles, excessive pressure, or long horizontal brush movements. 

For mild gum recession, your dentist may suggest deep cleanings (via Santa Monica Periodontics & Implant Surgery). During a deep cleaning procedure, also sometimes called root planing or tooth scaling, the gums are drawn away from the teeth so that the tooth roots can be smoothened, making it more difficult for bacteria to latch onto them. In some cases, medications are applied directly to the area, or prescribed afterward to prevent or address infection. If you are experiencing more significant gum recession, your dentist may suggest surgery. This could involve grafting gum tissue to cover exposed roots. Another possibility is bone regeneration surgery, in which medication to stimulate new growth of bone and tissue is applied to the roots of the teeth.

Periodontal pockets are spaces that develop around the teeth, below the gum line. While there are normally small spaces present even in a healthy mouth, these can usually be kept clean with regular brushing, flossing, and professional cleaning. However, most toothbrushes are unable to reach beyond 2-3 mm beneath the gum line, according to Dear Doctor Dentistry & Oral Health. In other words, when deeper periodontal pockets develop, food and bacteria can begin to collect and cause problems: "Pockets provide an ideal environment for bacteria to grow, and may spread infection to the structures that keep teeth anchored in the mouth."

So, how do you know if you have deep pockets? While you won't be able to see them on your own, a dentist can probe your gums and measure these spaces during an oral health exam. Healthline explains that measurements for healthy gums should fall within the 1-3 mm range. If you have mild periodontitis, 3-5 mm; for moderate disease, 5-7 mm. Anything over 7 mm is considered severe periodontal disease. While mild disease can often be treated with improved oral hygiene, moderate to severe disease may require more aggressive treatments.

We understand that a diagnosis of gum disease can be overwhelming. Fortunately, treatments are available. If your gum disease isn't too severe, your dentist may recommend non-surgical treatment (per WebMD). For some, this is as straightforward as improving oral hygiene and getting more frequent dental cleanings than usual. Although professional cleaning is normally recommended twice a year, people with gum disease may benefit from keeping plaque and tartar buildup to a minimum.

Another treatment option is called scaling and root planing, more commonly known as deep cleaning. Scaling removes plaque buildup under the gum line; root planing smooths down the root of the tooth so that your gum can (hopefully) reattach itself. If that sounds uncomfortable, rest assured that deep cleaning is performed under local anesthesia (per the American Dental Association).

Medications can also be used to treat gum disease, according to the Cleveland Clinic. Some medications, including antibiotics, are applied between the tooth and gum, within the periodontal pocket. These are administered through a gelatin-filled chip that releases its contents gradually over a period of seven days. Your dentist may also prescribe specialized toothpaste or mouth rinses.

Let's face it: Gum disease is no party. The good news is that it is largely preventable. To avoid unnecessary pain, discomfort, and possible tooth loss (along with massive dental bills!), Listerine recommends brushing, flossing, and rinsing with antiseptic mouthwash twice daily. They also encourage patients to see their dental provider at least every six months, as well as anytime they experience symptoms of gum disease. Finally, consider eating a healthy, balanced diet and avoiding smoking.

If you do develop gum disease, we want you to know that you're not alone. The CDC provides the following statistics: Almost half (47.2%) of adults aged 30 and older experience some form of periodontal disease. You are even more likely to develop periodontitis as you age, with about 70% of adults 65 years and older suffering from the condition. Periodontal disease is more likely to occur in men than in women (56.4% versus 38.4%), as well as in those living in poverty (65.4%). Also at an elevated risk are people who smoke (64.2%). If you can't afford to visit a dentist, there may be help available. The CDC provides resources on finding affordable dental care.