Blood just doesn't belong on a toothbrush, and seeing it there after brushing is more than a little unsettling. Having bad breath not long after brushing your teeth is another discouraging situation. Soreness, sensitivity and loose teeth? Nothing feel-good there, either. All these signs point to gingivitis or periodontitis, two types of gum disease, and no matter whether the symptoms started today or months ago, it's time to take action both offensively and defensively. Teeth and gums are codependent; they have to be all over each other in order to have a healthy relationship. Anything that gets in the way of this bond can be toxic, literally, and a falling out can lead to a real loss -- of the relationship and even the teeth.
Gum disease is just that, a disease, which means that the gum tissues are not working the way they're supposed to within the design of the body; they're in a state of decline. Normal gums are typically pink, smooth and moist, with seamless connections to teeth. Vessels and nerves supply blood flow and sensations to the entire mouth and this circulation allows gums to remain firmly committed to holding tight to the teeth, keeping them straight, immobile and ready to do the work of chewing necessary for digesting food.
When gums suffer neglect or attack from plaque left on or between teeth or from sickness or hormonal changes in the body, gingivitis starts to settle in. Gingivitis is an early form of gum disease that starts to impair the relationship between the teeth and gums. Technically, gingivitis is gum inflammation. Periodontitis is a much more serious form of gum disease involving inflammation around the entire tooth and it can lead to the breakdown of gums, their supporting tissues and even the bones beneath [source: NIH]
Both periodontitis and gingivitis are gum disease, but they are different in the degree of damage they do. Advanced gum disease leads to increased bacteria and toxins, along with active infections, and the body's immune system kicks in to fight them. Unfortunately, it also turns on itself by annihilating gum tissues and bone in the process: To fight the disease, the body defends itself by attacking infection, and the connecting tissues and bone around the teeth get "taken out" in the process. It is this loss of support that can lead to tooth loss [source: NIH].
How can you tell when your gums, teeth and immune system are at odds with each other and disease has set in? Sometimes you can't, but we'll look at some obvious rifts in the relationship, next.
Gum Disease Symptoms
Early stages of mild gum disease, or gingivitis, are invisible. By the time a person can see the effects and has some symptoms, it's likely that the gums have been in some state of decline for a while. Tasting or seeing blood on a toothbrush during or after eating, and just out of the blue, is a big indicator that gums need attention. Other signs and symptoms of gum disease include:
- Sensitive, swollen and red gums
- Bad breath -- or halitosis -- that persists and comes back soon after brushing
- Swollen tissues around the base of gums
- Gaps or loose areas in the gum line where teeth and gums are starting to separate
- Yellowish or white discharge, or pus, between the gums and teeth
- Pain or soreness at the base and roots of teeth when eating, brushing or flossing
- A bad taste in the mouth that comes and goes throughout the day
- Loose teeth or a feeling that your bite or alignment is shifting [source: Mayo Clinic]
Sometimes even these symptoms are absent but you can feel a buildup or ridge of gunk where the teeth and gums meet or there are spots where floss "catches" on the sides of teeth. Those chunks and deposits are hardened plaque, the calculus or tartar that sticks like glue to teeth and irritates gum tissue until it's inflamed. (It's no coincidence that gingivitis and periodontitis end in "-itis," which is a medical word ending for "inflammation.")
Often, when there are no signs of trouble and our teeth look and feel good, it's easy to put off dental appointments. Why have a checkup every six months or so when our mouths look so healthy? A big reason is to stay on top of the tartar buildup before it stays on top of teeth too long and accumulates enough to inflame and irritate the gums.
If you're seeing, feeling or tasting a problem related to gingivitis symptoms, getting to a dentist right away can stop early gum disease in its tracks and prevent it from worsening. And the really good news is that gingivitis is reversible, so gum health can return to pre-disease and pre-symptomatic condition. Periodontitis, though not reversible, is treatable.
Next, we'll look at some causes of gum disease and how to stop it before it starts.
Gum Disease Causes
Poor or inconsistent dental hygiene is considered the most common cause of gingivitis and its progression to more serious gum disease. When brushing, flossing and routine dental checkups are neglected, plaque builds up and hardens into tartar on teeth and down around the roots of teeth below the gum line. This buildup coats teeth, making it harder for gums to attach to tooth surfaces. As the space between the teeth and gums grows, more bacteria gets below the gum line and multiplies. Every time food and debris are left on the teeth and in the mouth, bacteria have an opportunity to grow and spread, and they run with it, multiplying rapidly and seeping into every available opening in the spaces between teeth and the pockets between teeth and gums. These pockets grow as gums lose their attachment to teeth, and when the gingivitis advances for too long without treatment, gum tissues then start to break down or degenerate and the advancing gum disease becomes irreversible.
Sometimes great oral hygiene isn't enough to prevent and stop gingivitis, though, and it's time to get aggressive. Life changes such as puberty, pregnancy and menopause bring hormone changes, and these cause either an increase or a decrease in hormonal balance. Increased progesterone in pregnant women, for example, leads to increased blood flow in the mouth and teeth and gums swell and can get sore. Gum tissues become vulnerable to bacteria as they pull away from teeth, and simple brushing may even be painful. This condition is known as pregnancy gingivitis, and not only does it cause discomfort and possible long-term damage to gum health, but it also may lead to low-weight babies or early births.
Studies show a connection, though not a proven link, between the oral health of the mother and a healthy full-term delivery, as well as an infant's birth weight. Pregnancy gingivitis is very common, so extra precautions against gum disease need to be taken. Women also experience changes in hormones and gum health due to dry mouth during menopause, as well as through the hormonal changes brought on when taking oral contraceptives [sources: AAP; ADA; March of Dimes].
Men and women of all ages can also experience gingivitis and periodontitis due to illness or disease. Some short-term viruses attack the body and, in turn, increase the bacteria levels in the mouth, and chronic conditions do the same but for many years. Diabetics often have increased risk for infections and need to fight bacteria in their bodies and mouths. People with heart disease have increased risk of infections reaching the bloodstream, and links between gum disease and coronary issues are common though not definitive.
Individuals with compromised immune systems from malnutrition or HIV, for example, also have increased risk for gum disease as their bodies have less immunity against disease-causing microbes and infection. Genetics can play a role as well, and some people are predisposed to having gum problems. Even being in overall good health but eating a poor diet lacking in vitamins and nutrients increases the risk of gum disease [source: AAP]. Smoking also greatly increases the likelihood of gum disease and makes it harder to treat [source: NIH].
Just reading about the risk factors may make your mouth hurt a little bit, so let's look at some options for treatment and relief, next.
Gum Disease Treatment
Before getting into the ins and outs of treating periodontitis, or advanced gum disease, let's repeat the really, really good news about gingivitis again: It is treatable and reversible. If you have the telltale symptoms mentioned earlier in this article, it's best to get to a dentist as soon as possible and start taking care of the problem. Once plaque has hardened, whether below or above the gum line, it has to be removed by professional cleaning.
A dentist and hygienist can use ultrasonic devices and good old fashioned dental picks to chip off the calculus or tartar and return teeth to their smooth-sided selves. Gums can then cling and cozy up next to the tooth surfaces as inflammation subsides, and with follow-up care, gingivitis has less of a chance of rearing its swollen head until plaque builds again.
If gingivitis has been left untreated and periodontitis is advancing, a dentist may start by checking the depth of the problem, literally. Periodontal probes, the kind many dread to see coming at their open mouths, do a lot to assess the gum damage and course of treatment needed. These probes are marked with grooves that measure the depth of pockets between the gums and teeth. Sliding the probe gently into the gum line and noting where the tip stops helps determine how much the gum disease has progressed. Healthy gums have about 1 and 3 millimeters of space, while larger and deeper pockets show diseased tissues and areas where teeth need to be deep cleaned [source: NIH].
Treatment for gum disease involves the whole mouth and not just the gums. Because gingivitis starts first with plaque and tartar buildup on the teeth, which irritates gum tissues and keeps them from clinging tightly to tooth surfaces, cleaning the teeth is an important part of treatment. Battling the toxins and infections within the pockets is essential. When deep pockets have developed, the dentist or periodontist will likely perform one or several procedures:
- Scaling -- Removing tartar buildup from teeth both above and below the gum line
- Root planing -- Forcing off remaining buildup and smoothing rough spots deep along the sides of teeth and at roots
- Killing bacteria -- Using medications either on the teeth topically, such as rinses and gels, or through oral antibiotics to kill and repress bacteria in the mouth and/or body
- Surgery and grafts -- Pulling back the gums to get inside for thorough cleaning and grafting new tissues or bones to rebuild recessed areas of tissue and bone. Some interventions attempt to restart bone growth.
Probes and visual exams are two tools a dental professional will use to assess damage and make a care plan. X-rays will be used to check for bone loss between the roots, gums and jaw bones. Sometimes too much damage and bone loss have occurred and teeth have to be extracted or will fall out, but dentists are trained first and foremost to save teeth, so gum disease interventions will likely be aggressive treatments to kill bacteria, repair tissues, and establish root and bone health to save teeth. Although it isn't reversible, gum disease is very treatable [sources: NIH; Mayo Clinic; AAP].
Toxins, root cleaning, antibiotics and surgery! Can all of this be prevented? In most cases, yes, it can. Take a look at some ways to tighten up you oral care and gums, next.
Gum Disease Prevention
If your gums are healthy, pink and clinging beautifully to your teeth, great, get to a dentist, anyway. Routine checkups every six months or so, as recommended by your dentist, will help prevent and demolish gingivitis. If you beat gingivitis, you won't have to fight periodontitis. If your gums are sore, red and not so healthy looking, get to a dentist right away. It likely won't be as bad as you think and it can save you considerable cost and chair-time later.
In either case, whether you have no symptoms or a lot of them, starting with clean teeth can get you back on track with daily oral hygiene. And before leaving the dentist's office, it may be a good idea to review hygiene 101. Many of us learn to brush our teeth and floss when so young that it's a wonder we had the attention span to take in all the details. No matter your age, having a hygienist or dentist show you the right way to brush and floss and to suggest products that will work best with your mouth specifically can reveal some surprising do's and don'ts or things you may just be doing all wrong.
Brushing at least twice a day -- or after each meal -- and flossing daily are generally the minimum interventions. Avoid brushing too hard, which can actually do more damage to gums than good by making them recede. Having a healthy diet of vitamin-rich foods also feeds directly into overall tissue well-being from the top down. Consulting a dentist as soon as any red flags or red gums appear can stop infection and keep it localized. Sometimes illness, medications and family history will trump preventative care and gingivitis and gum disease will be inevitable, but partnering with a dental professional and being extra diligent can prevent the worsening of symptoms and tissue and bone loss. And if tooth loss has already occurred, it's also important to stay in the battle and keep gums healthy enough to support dentures and other tooth restorations.
Taking several minutes two or more times a day for brushing, fiddling with floss for another few minutes once a day, and keeping those twice-a-year appointments for tartar removal can keep the relationship between your teeth and gums close, often for life.
More Great Links
- American Academy of Periodontology (AAP). "Gum Disease and Diabetes." Perio.org. 2011. (Nov. 4, 2011) http://www.perio.org/consumer/mbc.diabetes.htm
- American Academy of Periodontology (AAP). "Protecting Oral Health Throughout Your Life." Perio.org. 2011. (Nov. 2, 2011) http://www.perio.org/consumer/women.htm
- American Academy of Periodontology (AAP). "Types of Gum Disease." Perio.org. 2011. (Nov. 3, 2011) http://www.perio.org/consumer/2a.html
- American Dental Association (ADA). "Disease, Gum (Periodontal Disease)." ADA.org. 2011. (Nov. 2, 2011) http://ada.org/3063.aspx
- March of Dimes. "Your Pregnant Body: Gum and Teeth Change." MarchofDimes.com. 2011. (Nov. 3, 2011) http://www.marchofdimes.com/pregnancy/yourbody_teeth.html
- Mayo Clinic. "Gingivitis." MayoClinic.com. Nov. 8, 2010. (Nov. 2, 2011) http://www.mayoclinic.com/health/gingivitis/DS00363
- Mayo Clinic. "Oral Health: A Window to Your Overall Health." MayoClinic.com. Feb. 5, 2011. (Nov. 2, 2011) http://www.mayoclinic.com/health/dental/DE00001
- Mayo Clinic. "Periodontitis." MayoClinic.com. Nov. 23, 2010. (Nov. 2, 2011) http://www.mayoclinic.com/health/periodontitis/DS00369
- National Institute of Dental and Craniofacial Research (NIDCR). "Periodontal (Gum) Disease: Causes, Symptoms and Treatments." NIH.gov. July 2011. (Nov. 2, 2011) http://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/PeriodontalGumDisease.htm
- National Institutes of Health (NIH). "Gingivitis." NIH.gov. 2011. (Nov. 2, 2011) http://www.nlm.nih.gov/medlineplus/ency/article/001056.htm
- Nemours Foundation. "Gum Disease." KidsHealth.org. 2011. (Nov. 2, 2011) http://kidshealth.org/teen/diseases_conditions/mouth/gum_disease.html
- University of Maryland Medical Center (UMMC). "Periodontal Disease: Risk Factors." UMM.edu. Jan. 22, 2009. (Nov. 4, 2011) http://www.umm.edu/patiented/articles/who_gets_periodontal_disease_000024_4.htm