Gum disease

Gum disease also known as periodontal disease is a chronic bacterial infection affecting gums and bone supporting the teeth. It may be in the form of simple gum inflammation to serious disease that can cause major harm to gums and supporting bone. Gum disease is highly prevalent and affect up to 90% of the population worldwide, and it is a major cause of tooth loss in adults. It is caused by accumulation of plaque (bacterial biofilm) which convert into calculus (tartar) along the gum line, when oral hygiene is not maintained. Gum diseases may sometimes be neglected as these are usually painless.


Gingivitis:  Early stage of gum disease  

Periodontitis: Advanced gum disease



SIGNS & SYMPTOMS:                                                             

  • Red, swollen, tender gums
  • Bleeding from gums
  • Persistent bad breath
  • Receded gums
  • Loose or separating teeth
  • Change in the way teeth fit together while biting
  • Change in the fitting of partial dentures



  • Poor oral hygiene
  • Smoking or chewing tobacco
  • Diabetes
  • Crooked teeth that are hard to keep clean
  • Pregnancy
  • Genetic predisposition
  • Certain drugs such as steroids, certain anti-epilepsy drugs, cancer therapy drugs, some calcium channel blockers and oral contraceptives

Gum diseases are easily preventable and reversible at early stages.


Regular dental check-ups are required to identify gum diseases at the earliest; by looking for the signs such as bleeding or receding gums, and loose teeth. Further examinations may be necessary like x-rays, to find out how much of the bone, if any, has been lost.


Good oral care at home is necessary to prevent gum disease and its progression. This includes brushing twice a day regularly, cleaning in between the teeth, eating a balanced diet, and scheduling regular dental check-ups.

Maintaining good oral hygiene helps to remove plaque that forms very quickly. Plaque, if not removed harden to form tartar (calculus), further promoting bacterial growth. Calculus (tartar) can be removed by the dentist.



It is the mildest form of periodontal (gum) disease, caused by the bacterial plaque accumulation on teeth adjacent to the gums. Gingivitis is inflammation of gums and it does not affect the underlying supporting structures of the teeth. It is reversible, if treated early, but if ignored, it may spread to the supporting tissues causing damage there. Reddened or swollen gums and bleeding while brushing or at other times are the main signs of gingivitis. It usually does not cause pain or any other symptoms, so may remain undetected for quite some time.



If gingivitis is neglected, it may progress to periodontitis- advanced form of gum disease. Periodontitis damage gums as well as supporting tissues and bone. As the infection reaches alveolar bone, gums are pulled away from teeth (receded gums), forming spaces known as pockets. It is the major cause of teeth becoming loose and teeth may have to be removed.

 Causes of periodontitis includes calculus accumulation, tobacco use, genetic and environmental factors. Many disorders such as dermatological, haematological, granulomatous, immunosuppressive, genetic, and neoplastic disorders may also have periodontal manifestations. Periodontal disease has been found to be associated with adverse pregnancy outcomes, cardiovascular disease, stroke, pulmonary disease, and diabetes.

According to the American Academy of Periodontology, types of periodontitis are:


  • Chronic periodontitis: most common, characterized by pocket formation and gum recession. It can occur at any age but is most common in adults.


  • Aggressive periodontitis: It is a highly destructive form of periodontal disease causing rapid gums and bone destruction and occurs in otherwise healthy patients.


  • Periodontitis as a manifestation of systemic diseases is associated with heart diseases, diabetes and respiratory diseases.


  • Necrotizing periodontal disease is characterized by necrosis (death) of gum tissue, periodontal ligaments and alveolar bones, which cause lesions. It is most common in people with systemic conditions like HIV, malnutrition and immunosuppression.


The earlier gum disease is detected; the sooner it can be managed. Treatment aims to stop the disease from progressing to advanced stages.

Depending on severity of gum disease, treatment can be non-surgical or surgical.

Non-surgical treatment includes:

  • Scaling: Removal of tartar from teeth and beneath gums, usually done by dentist or dental hygienist.
  • Root planing: Smoothing the root surfaces to prevent further build-up of calculus and bacterial toxins.
  • Antibiotics: May include topical antibiotics like mouth rinses and gels, or oral antibiotics. 


Surgical treatment includes:


  • Flap surgery (pocket reduction surgery)
  • Soft tissue grafts: Bone grafting
  • Guided tissue regeneration
  • Enamel matrix derivative application


  • PUBLISHED DATE : Apr 23, 2019
  • CREATED / VALIDATED BY : Dr Rida Ziaul
  • LAST UPDATED ON : Apr 23, 2019


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