Periodontal (Gum) Disease

Causes, Symptoms, and Treatments

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health

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Periodontal (Gum) Disease

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

you’re not alone. Many adults in the U.S. 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.

Whether your gum disease 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.
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Periodontal (Gum) Disease

What causes gum 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 

“tartar” that brushing doesn’t clean. Only a professional 

cleaning by a dentist or dental hygienist can remove tartar.
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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 spaces (called “pockets”) 

that become 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 natural response to 

infection start to break down 

the bone and connective tissue 

that hold teeth in place. If not 

treated, the bones, gums, and 

tissue that support the teeth 

are destroyed. The teeth may 

eventually become loose and 

have to be removed. 
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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. 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 gum disease. 

•	 Other illnesses. Diseases like cancer or AIDS and 

their treatments can also negatively affect the 

health of gums. 

•	 Medications. There are hundreds of prescription 

and over the counter medications that can reduce the 

flow of saliva, which has a protective effect on the 

mouth. Without enough saliva, the mouth is vulnerable 

to infections such as gum disease. And some medicines 

can cause abnormal overgrowth of the gum tissue; this 

can make it difficult to keep teeth and gums clean.

•	 Genetic susceptibility. Some people are more 

prone to severe gum disease than others.
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Who gets gum disease?

People usually don’t show signs 

of gum disease until they are in 

their 30s or 40s. Men are more 

likely to have gum 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.

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 or 

longer appearing teeth

Any of these symptoms may 

be a sign of a serious problem, 

which should be checked by a 

dentist. At your dental visit the 

dentist 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 signs 

of inflammation.
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•	 Use a tiny ruler called a 

“probe” to check for and 

measure any pockets. 

In a healthy mouth, the 

depth of these pockets 

is usually between 1 and 

3 millimeters. This test 

for pocket depth is 

usually painless.

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 in 

the diagnosis and treatment 

of gum disease and may 

provide you with treatment 

options that are not offered 

by your dentist.

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 the 

extent of the gum disease. Any 

type of treatment requires that 

the patient keep up good daily 

care at home. The doctor may 

also suggest changing certain 

behaviors, such as quitting 

smoking, as a way to improve 

treatment outcome.
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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. In some cases a laser may be used to remove plaque 

and 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 and 

root 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 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.
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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 filled 

with the medicine chlorhexidine

Antibiotic gel A gel that contains the 

antibiotic doxycycline

Antibiotic microspheres Tiny, round particles that contain 

the antibiotic minocycline

Enzyme suppressant A low dose of the medication 

doxycycline that keeps destructive 

enzymes in check

Oral antibiotics Antibiotic tablets or capsules
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Why is it used? How is it used?

To control bacteria when treating 

gingivitis and after gum surgery

It’s used like a 

regular 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 the 

pockets after scaling and root 

planing. The antibiotic is 

released slowly over a period 

of about seven days. 

To control bacteria and reduce 

the size of periodontal pockets

The periodontist puts the 

microspheres 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 with 

scaling and root planing.

For the short term treatment 

of an acute or locally persistent 

periodontal infection

These come as tablets or capsules 

and are taken by mouth.
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Periodontal (Gum) Disease

Periodontal (Gum) Disease

Surgical Treatments

Flap Surgery. Surgery might be necessary if inflammation and 

deep pockets remain following treatment with deep cleaning and 

medications. A dentist or 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. 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, your 

periodontist or dentist may suggest procedures to help regenerate 

any bone or gum tissue lost to periodontitis. Bone grafting, in 

which natural or synthetic bone is placed in the area of bone loss, 

can help promote bone growth. A technique that can be used with 

bone grafting is called guided tissue regeneration. In this procedure, 

a small piece of mesh-like material 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. Growth factors – proteins that can help your body 

naturally regrow bone – may also be used. In cases where gum 

tissue has been lost, your dentist or periodontist may suggest a 

soft tissue graft, in which synthetic material or tissue taken from 

another area of your mouth is used to cover exposed 

tooth roots. 
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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 with 

certainty 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 with 

oral care 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.

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 pick 

recommended by a dental professional.

•	 Visit the dentist routinely for a check-up and professional cleaning.

•	 Don’t smoke 
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Can gum disease cause health 

problems beyond the mouth?

In some studies, researchers have 

observed 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 that 

women with gum disease were 

more likely than those with 

healthy 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 are 

present together.

More research is needed to clarify 

whether gum disease actually 

causes health problems beyond 

the mouth, and whether treating 

gum disease can keep other health 

conditions from developing.

In the meantime, it’s a fact 

that controlling gum disease can 

save your teeth – a very good 

reason to take care of your teeth 

and gums.

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 http://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.

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. 12-1142

August 2012

NIH...Turning Discovery Into Health