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 | 1

If you have been told you have periodontal (gum) disease, 

you’re not alone. An estimated 80 percent of American 

adults currently have some form of the disease.

Periodontal diseases range from simple gum inflammation 

to serious disease that results in major damage to the soft 

tissue and bone that support the teeth. In the worst cases, 

teeth are lost.

Gum disease is a threat to your oral health. Research is 

also pointing to possible health effects of periodontal 

diseases that go well beyond your mouth (more about 

this later). Whether it is stopped, slowed, or gets worse 

depends a great deal on how well you care for your teeth 

and gums every day, from this point forward.

Periodontal (Gum) Disease
2 | 

What causes periodontal disease?

Our mouths are full of bacteria. These bacteria, along with 

mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid 

of plaque. Plaque that is not removed can harden and form 

bacteria-harboring “tartar” that brushing doesn’t clean. 

Only a professional cleaning by a dentist or dental hygienist can remove tartar. 

Periodontal (Gum) Disease
Gingivitis

The longer plaque and tartar 

are on teeth, the more harmful they become. The bacteria 

cause inflammation of 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, 

and regular cleaning by a dentist or dental hygienist. This 

form of gum disease does not 

include any loss of bone and 

tissue that hold teeth in place. 

Periodontitis

When gingivitis is not treated, 

it can advance to “periodontitis” (which means “inflammation around the tooth.”) 

In periodontitis, gums pull 

away from the teeth and form 

“pockets” that are infected. 

The body’s immune system 

fights the bacteria as the 

plaque spreads and grows 

below the gum line. Bacterial 

toxins and the body’s enzymes 

fighting the infection actually start to break down the 

bone and connective tissue 

that hold teeth in place. If not 

treated, the bones, gums, and 

connective tissue that support 

the teeth are destroyed. The 

teeth may eventually become 

loose and have to be removed. 

 | 3
4 | 

Risk Factors

• Smoking. Need another reason to quit smoking? 

Smoking is one of the most significant risk factors 

associated with the development of periodontitis. 

Additionally, smoking can lower the chances of 

success of some treatments.

• Hormonal changes in girls/women. These changes 

can make gums more sensitive and make it easier 

for gingivitis to develop.

• Diabetes. People with diabetes are at higher risk for 

developing infections, including periodontal disease. 

• Stress. Research shows that stress can make it more 

difficult for our bodies to fight infection, including 

periodontal disease.

• Medications. Some drugs, such as antidepressants 

and some heart medicines, can affect oral health 

because they lessen the flow of saliva. (Saliva has a 

protective effect on teeth and gums.)

• Illnesses. Diseases like cancer or AIDS and their 

treatments can also affect the health of gums.

• Genetic susceptibility. Some people are more prone 

to severe periodontal disease than others.
Who gets periodontal 

disease?

People usually don’t show 

signs of gum disease until they 

are in their 30s or 40s. Men are 

more likely to have periodontal 

disease than women. Although 

teenagers rarely develop periodontitis, they can develop 

gingivitis, the milder form of 

gum disease. Most commonly, 

gum disease develops when 

plaque is allowed to build up 

along and under the gum line.

What can I do to prevent 

gum disease?

• Brush your teeth twice a day 

(with a fluoride toothpaste)

• Floss every day

• Visit the dentist routinely 

for a check-up and professional cleaning

• Don’t use tobacco products

How do I know if I have 

periodontal disease?

Symptoms are often not 

noticeable until the disease 

is advanced. They include:

• Bad breath that won’t 

go away

• Red or swollen gums

• Tender or bleeding gums

• Painful chewing

• Loose teeth

• Sensitive teeth

Any of these symptoms may 

signal a serious problem, 

which should be checked by 

a dentist. At your dental visit:

• The dentist will ask about 

your medical history to 

identify underlying conditions or risk factors (such 

as smoking) that may contribute to periodontal 

disease.

 | 5
• The dentist or hygienist will 

examine your gums and note 

any signs of inflammation.

• The dentist or hygienist 

will use a tiny ruler called 

a ‘probe’ to check for periodontal pockets and to 

measure any pockets. In a 

healthy mouth, the depth 

of these pockets is usually 

between 1 and 3 millimeters.

• The dentist or hygienist may 

take an x-ray to see whether 

there is any bone loss.

• The dentist may refer you 

to a periodontist, a specialist 

who treats gum diseases.

How is periodontal disease 

treated?

The main goal of treatment is 

to control the infection. The 

number and types of treatment 

will vary, depending on the 

extent of the gum disease. Any 

type of treatment requires that 

the patient keep up good daily 

care at home. Additionally, 

modifying certain behaviors, 

such as quitting tobacco use, 

might also be suggested as 

a way to improve treatment 

outcome. 

6 | 
 | 7

Deep Cleaning (Scaling and Root Planing)

The dentist, periodontist, or dental hygienist removes the plaque 

through a deep-cleaning method called scaling and root planing. 

Scaling means scraping off the tartar from above and below the 

gum line. Root planing gets rid of rough spots on the tooth root 

where the germs gather, and helps remove bacteria that contribute to the disease. 

Medications

Medications may be used with treatment that includes scaling 

and root planning, but they cannot always take the place of surgery. Depending on the severity of gum disease, the dentist or 

periodontist may still suggest surgical treatment. Long-term 

studies will be needed to determine whether using medications 

reduces the need for surgery and whether they are effective over 

a long period of time. Listed on the next page are some medications that are currently used.
8 | 

Medications What is it?

Prescription antimicrobial 

mouthrinse

Antiseptic “chip”

Antibiotic gel

Antibiotic micro-spheres

Enzyme suppressant

A prescription mouthrinse containing an antimicrobial called 

chlorhexidine

A tiny piece of gelatin filled with 

the medicine chlorhexidine

A gel that contains the antibiotic 

doxycycline

Tiny, round particles that contain the antibiotic minocycline

A low dose of the medication 

doxycycline that keeps destructive enzymes in check
 | 9

To control bacteria when treating gingivitis and after gum 

surgery

To control bacteria and reduce 

the size of periodontal pockets

To control bacteria and reduce 

the size of periodontal pockets

To control bacteria and reduce 

the size of periodontal pockets

To hold back the body’s enzyme 

response — If not controlled, 

certain enzymes can break down 

gum tissue

It’s used like a regular mouthwash

After root planing, it’s placed in 

the pockets where the medicine 

is slowly released over time.

The periodontist puts it in 

the pockets after scaling and 

root planing. The antibiotic is 

released slowly over a period of 

about seven days. 

The periodontist puts the microspheres into the pockets after 

scaling and root planing. The 

particles release minocycline 

slowly over time.

This medication is in pill form. 

It is used in combination with 

scaling and root planing.

Why is it used? How is it used?
10 | 

Surgical Treatments

Flap Surgery. Surgery might be necessary if inflammation and 

deep pockets remain following treatment with deep cleaning and 

medications. A periodontist may perform flap surgery to remove 

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 

the gums and removing the tartar. The gums are then sutured 

back in place so that the tissue fits snugly around the tooth again. 

Bone and Tissue Grafts. In addition to flap surgery, your periodontist may suggest bone or tissue grafts. Grafting is a way to 

replace or encourage new growth of bone or gum tissue destroyed 

by periodontitis. A technique that can be used with bone grafting 

is called guided regeneration, in which a small piece of mesh-like 

fabric is inserted between the bone and gum tissue. This keeps 

the gum tissue from growing into the area where the bone should 

be, allowing the bone and connective tissue to regrow. 

Since each case is different, it is not possible to predict with 

certainty which grafts will be successful over the long-term. 
 | 11

Treatment results depend on many things, including severity of 

the disease, ability to maintain oral hygiene at home, and certain 

risk factors, such as smoking, which may lower the chances of 

success. Ask your periodontist what the level of success might be 

in your particular case. 

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. 

Periodontal (Gum) Disease
12 | 

• an increased risk of delivering preterm, low birth 

weight babies, 

• difficulty controlling blood 

sugar levels in people with 

diabetes.

In the meantime, it’s a fact 

that controlling periodontal 

disease can save your teeth 

— a very good reason to take 

care of your teeth and gums.

Can periodontal disease 

cause health problems 

beyond the mouth? 

Maybe. But so far the research 

is inconclusive. Studies are 

ongoing to try to determine 

whether there is a cause-andeffect relationship between 

periodontal disease and:

• an increased risk of heart 

attack or stroke, 

Clinical Trials 

Clinical trials are research studies of new and 

promising ways to prevent, diagnose, or treat 

disease. If you want to take part in a clinical 

trial about periodontal disease, visit 

www.clinicaltrials.gov. In the box 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.

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