Gum disease guide

Stages of gum disease

Cleveland Clinic describes four stages: gingivitis, the earliest, with red puffy gums that may bleed and no bone loss; mild periodontitis, when bacteria reach below the gumline and affect supporting bone and gums pull away, forming pockets where plaque collects; moderate periodontitis, when bacteria erode ligaments, soft tissue and bone, with bad breath, pus and sometimes pain; and advanced periodontitis, when continued bone loss can make teeth loose and lead to tooth loss.

Symptoms and causes

Cleveland Clinic lists reddish or purplish gums, bleeding, soreness, bad breath, an unpleasant taste, pain when chewing, gum recession, loose teeth and changes in how teeth fit together. Plaque build-up is the main cause, and genes can affect how the immune system responds to bacteria. NIDCR says plaque can harden into tartar, which only a professional cleaning removes, and that the bacteria trigger inflammation that damages the gums and supporting tissues.

Risk factors

NIDCR says smoking or tobacco use is the most significant risk factor, with older age, diabetes, genetics, male sex, stress, hormonal changes and obesity also listed, and certain illnesses such as rheumatoid arthritis and cardiovascular disease linked. Cleveland Clinic lists smoking, poor oral hygiene, diabetes, autoimmune diseases, hormonal changes, stress, family history and heart disease.

Is periodontitis reversible?

No. Cleveland Clinic says periodontitis is not curable, though it is manageable, and that bone already lost generally is not regained, but treatment can reduce infection and rebuild some tissue. The same applies to periodontal disease generally: is periodontal disease reversible? Only the gingivitis stage is, as our guide on reversing gum disease explains.

Is gingivitis hereditary, and is gum disease contagious?

Genetics partly influence susceptibility, according to Cleveland Clinic, so risk is higher with a family history and some people are more prone even with good hygiene. Cleveland Clinic says the bacteria can spread between people, but brief casual contact is unlikely to transmit it and repeated, long-term saliva contact, such as through kissing, may raise the risk.

Treatment

Cleveland Clinic lists a dental cleaning and improved hygiene for gingivitis; scaling and root planing for mild disease, usually over at least two visits under local anesthesia; pocket reduction surgery for moderate to advanced disease, in which the periodontist lifts the gums, cleans the roots and repositions the gums; and other procedures such as bone grafts, gum grafts and guided tissue regeneration. NIDCR says the main goal is controlling infection, with a periodontist, a gum specialist, sometimes recommended. We found no source in our reading that defines a gingivectomy, so our gingivectomy cost guide explains what a quote covers.

Can gum disease kill you?

Cleveland Clinic says periodontal disease is not life-threatening by itself, but it can contribute to other conditions: untreated disease can lead to tooth loss and an ongoing infection cycle, and it is linked to heart disease, stroke and diabetes. Gingivitis, the early stage, is reversible. The sources we read do not describe gum disease as a cause of death on its own.

Prevention

Cleveland Clinic advises brushing two to three times daily, flossing daily, considering an antibacterial mouthwash, avoiding smoking and tobacco, and keeping up with regular exams and cleanings. NIDCR says brush twice daily with fluoride toothpaste, clean between teeth, see the dentist regularly and quit all tobacco.

Questions to ask your dentist

A few questions help you understand where you are and what to do next.

• What stage of gum disease do I have, and has it affected the bone?
• Do I need a deep cleaning or a referral to a periodontist?
• How often should I come for cleanings from now on?
• Which cleaning tools suit my teeth and gums?
• Do my other health conditions or medicines affect my gums?

Guides in this topic

Frequently asked questions