Periodontal (Gum) Disease
Causes, Symptoms, and Treatments

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of HealthPeriodontal (Gum) Disease

If you have been told you have periodontal (gum) disease,
you’re not alone. Many adults in the U.S. currently havesome form of the disease. Periodontal diseases range from
simple gum inflammation to serious disease that results inmajor damage to the soft tissue and bone that support theteeth. In the worst cases, teeth are lost.
Whether your gum disease is stopped, slowed, or gets worsedepends a great deal on how well you care for your teeth
and gums every day, from this point forward.

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Periodontal (Gum) Disease

What causes gum disease?
Our mouths are full of bacteria. These bacteria, along withmucus and other particles, constantly form a sticky, colorless“plaque” on teeth. Brushing and flossing help get rid ofplaque. Plaque that is not removed can harden and form
“tartar” that brushing doesn’t clean. Only a professional
cleaning by a dentist or dental hygienist can remove tartar.

2 |Gingivitis
The longer plaque andtartar are on teeth, the more
harmful they become. The
bacteria cause inflammationof the gums that is called“gingivitis.” In gingivitis,the gums become red,swollen and can bleed easily.
Gingivitis is a mild form of
gum disease that can usually
be reversed with daily
brushing and flossing, andregular cleaning by a dentist ordental hygienist. This form of
gum disease does not include
any loss of bone and tissue
that hold teeth in place.

Periodontitis
When gingivitis is nottreated, it can advance to“periodontitis” (which means“inflammation around thetooth”). In periodontitis, gums
pull away from the teeth andform spaces (called “pockets”)
that become infected. The
body’s immune system fights
the bacteria as the plaquespreads and grows below thegum line. Bacterial toxins andthe body’s natural response toinfection start to break down
the bone and connective tissue
that hold teeth in place. If nottreated, the bones, gums, andtissue that support the teeth
are destroyed. The teeth may
eventually become loose andhave to be removed.

| 3Risk Factors• Smoking. Need another reason to quit smoking?
Smoking is one of the most significant risk factors
associated with the development of gum disease.
Additionally, smoking can lower the chances for
successful treatment.
• Hormonal changes in girls/women. Thesechanges can make gums more sensitive andmake it easier for gingivitis to develop.
• Diabetes. People with diabetes are at higher riskfor developing infections, including gum disease.
• Other illnesses and their treatments. Diseases suchas AIDS and its treatments can negatively affect thehealth of gums, as can treatments for cancer.
• Medications. There are hundreds of prescription
and over the counter medications that can reduce theflow of saliva, which has a protective effect on themouth. Without enough saliva, the mouth is vulnerable
to infections such as gum disease. And some medicines
can cause abnormal overgrowth of the gum tissue; thiscan make it difficult to keep teeth and gums clean.
• Genetic susceptibility. Some people are more
prone to severe gum disease than others.
4 |Who gets gum disease?
People usually don’t show signsof gum disease until they are in
their 30s or 40s. Men are more
likely to have gum disease thanwomen. Although teenagers
rarely develop periodontitis,
they can develop gingivitis, themilder form of gum disease.
Most commonly, gum diseasedevelops when plaque isallowed to build up along andunder the gum line.

How do I know if I
have gum disease?
Symptoms of gum
disease include:• Bad breath that
won’t go away
• Red or swollen gums
• Tender or bleeding gums

• Painful chewing• Loose teeth• Sensitive teeth• Receding gums orlonger appearing teeth
Any of these symptoms may
be a sign of a serious problem,
which should be checked by adentist. At your dental visit thedentist or hygienist should:• Ask about your medical
history to identify underlying
conditions or risk factors(such as smoking) that may
contribute to gum disease.
• Examine your gums
and note any signsof inflammation.

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The dentist or
hygienist may also:• Take an x-ray to see whether
there is any bone loss.
• Refer you to a periodontist.
Periodontists are experts inthe diagnosis and treatmentof gum disease and may
provide you with treatment
options that are not offeredby your dentist.
• Use a tiny ruler called a“probe” to check for andmeasure any pockets.
In a healthy mouth, thedepth of these pockets
is usually between 1 and3 millimeters. This testfor pocket depth isusually painless.

6 |How is gum
disease treated?
The main goal of treatment is
to control the infection. The
number and types of treatment
will vary, depending on theextent of the gum disease. Anytype of treatment requires thatthe patient keep up good dailycare at home. The doctor may
also suggest changing certain
behaviors, such as quitting
smoking, as a way to improvetreatment outcome.

Deep Cleaning (Scaling and Root Planing)
The dentist, periodontist, or dental hygienist removes the plaquethrough a deep-cleaning method called scaling and root planing.
Scaling means scraping off the tartar from above and below thegum line. Root planing gets rid of rough spots on the tooth root
where the germs gather, and helps remove bacteria that contributeto the disease. In some cases a laser may be used to remove plaqueand tartar. This procedure can result in less bleeding, swelling,
and discomfort compared to traditional deep cleaning methods.
Medications
Medications may be used with treatment that includes scaling androot planning, but they cannot always take the place of surgery.
Depending on how far the disease has progressed, the dentist
or periodontist may still suggest surgical treatment. Long-term
studies are needed to find out if using medications reduces theneed for surgery and whether they are effective over a long periodof time. Listed on the next page are some medications that are
currently used.
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Medications

What is it?

Prescription antimicrobial
mouthrinse

A prescription mouthrinse
containing an antimicrobial
called chlorhexidine

Antiseptic chip

A tiny piece of gelatin filledwith the medicine chlorhexidine

Antibiotic gel

A gel that contains theantibiotic doxycycline

Antibiotic microspheres

Tiny, round particles that containthe antibiotic minocycline

Enzyme suppressant

A low dose of the medication
doxycycline that keeps destructive
enzymes in check

Oral antibiotics

Antibiotic tablets or capsules

8 |Why is it used?

How is it used?

To control bacteria when treating
gingivitis and after gum surgery

It’s used like aregular mouthwash.

To control bacteria and reduce
the size of periodontal pockets

After root planing, it’s placed in
the pockets where the medicine
is slowly released over time.

To control bacteria and reduce
the size of periodontal pockets

The periodontist puts it in thepockets after scaling and root
planing. The antibiotic isreleased slowly over a period
of about seven days.

To control bacteria and reduce
the size of periodontal pockets

The periodontist puts themicrospheres into the pockets
after scaling and root planing.
The particles release minocycline
slowly over time.

To hold back the body’s enzyme
response — If not controlled,certain enzymes can break
down gum tissue

This medication is in tablet form.
It is used in combination withscaling and root planing.

For the short term treatmentof an acute or locally persistent
periodontal infection

These come as tablets or capsules
and are taken by mouth.

| 9Periodontal (Gum) Disease
Surgical Treatments(Gum) andDisease
Flap Surgery. Surgery mightPeriodontal
be necessary if inflammation
deep pockets remain following treatment with deep cleaning andmedications. A dentist or periodontist may perform flap surgery toremove tartar deposits in deep pockets or to reduce the periodontal
pocket and make it easier for the patient, dentist, and hygienist to
keep the area clean. This common surgery involves lifting back thegums and removing the tartar. The gums are then sutured backin place so that the tissue fits snugly around the tooth again. After
surgery the gums will heal and fit more tightly around the tooth.
This sometimes results in the teeth appearing longer.
Bone and Tissue Grafts. In addition to flap surgery, yourperiodontist or dentist may suggest procedures to help regenerate
any bone or gum tissue lost to periodontitis. Bone grafting, inwhich natural or synthetic bone is placed in the area of bone loss,
can help promote bone growth. A technique that can be used withbone grafting is called guided tissue regeneration. In this procedure,a small piece of mesh-like material is inserted between the boneand gum tissue. This keeps the gum tissue from growing into thearea where the bone should be, allowing the bone and connective
tissue to regrow. Growth factors – proteins that can help your bodynaturally regrow bone – may also be used. In cases where gum
tissue has been lost, your dentist or periodontist may suggest asoft tissue graft, in which synthetic material or tissue taken fromanother area of your mouth is used to cover exposed
tooth roots.

10 |Second Opinion
When considering any extensive dental or medical
treatment options, you should think about getting
a second opinion. To find a dentist or periodontist
for a second opinion, call your local dental society.
They can provide you with names of practitioners
in your area. Additionally, dental schools may
sometimes be able to offer a second opinion.
Call the dental school in your area to find out
whether it offers this service.
Since each case is different, it is not possible to predict withcertainty which grafts will be successful over the long-term.
Treatment results depend on many things, including how far
the disease has progressed, how well the patient keeps up withoral care at home, and certain risk factors, such as smoking, which
may lower the chances of success. Ask your periodontist what thelevel of success might be in your particular case.

How can I keep my teeth and gums healthy?
• Brush your teeth twice a day (with a fluoride toothpaste).
• Floss regularly to remove plaque from between teeth. Or use
a device such as a special brush or wooden or plastic pickrecommended by a dental professional.
• Visit the dentist routinely for a check-up and professional cleaning.
• Don’t smoke| 11Can gum disease cause healthproblems beyond the mouth?
In some studies, researchers haveobserved that people with gum
disease (when compared to people
without gum disease) were more
likely to develop heart disease or
have difficulty controlling blood
sugar. Other studies showed thatwomen with gum disease weremore likely than those withhealthy gums to deliver preterm,
low birth weight babies. But so far,it has not been determined whether
gum disease is the cause of these
conditions.
There may be other reasons people
with gum disease sometimes
develop additional health problems.

For example, something else may
be causing both the gum disease
and the other condition, or it could
be a coincidence that gum disease
and other health problems arepresent together.
More research is needed to clarify
whether gum disease actuallycauses health problems beyond
the mouth, and whether treating
gum disease can keep other healthconditions from developing.
In the meantime, it’s a factthat controlling gum disease cansave your teeth – a very goodreason to take care of your teethand gums.

Clinical Trials
Clinical trials are research studies of new and promising ways toprevent, diagnose, or treat disease. If you want to take part in a clinical
trial about periodontal disease, visit http://www.clinicaltrials.gov. In thebox under “Search Clinical Trials,” type in: periodontal diseases. This
will give you a list of clinical trials on gum disease
for which you might be eligible.
12 |For additional copies of this booklet contact:
National Institute of Dental and Craniofacial Research
National Oral Health Information Clearinghouse
1 NOHIC Way
Bethesda, MD 20892–3500
1–866–232–4528
http://www.nidcr.nih.gov
This publication is not copyrighted.
Make as many photocopies as you need.

NIH Publication No. 13-1142
September 2013
NIH…Turning Discovery Into Health®