Gum Disease

Gum disease, also called periodontitis or periodontal disease, is a dental disease that happens when the gum becomes red, inflamed, and swollen. It begins with bacterial growth in the mouth, and if left untreated may lead to tooth loss.

Causes and Risk factors

There are many causes and contributing risk factors for periodontal disease, such as:

Dental Plaque

Plaque is the primary cause of gum disease. It’s a sticky film of bacteria that forms on the teeth constantly. The bacteria in it produce acids after eating or drinking, destroying the teeth and causing gingivitis (gum inflammation) or periodontitis (gum disease).


Some medications can affect oral health in various ways; one of these ways is reducing the salivary flow that protects the teeth and washing any food debris away from them. Another way is by causing gum overgrowths, such as the anticonvulsant medication Dilantin and the anti-angina drug Procardia.

Hormonal Changes

Gums becomes sensitive and more susceptible to developing gum disease during periods of hormonal changes such as pregnancy, monthly menstruation, menopause, and puberty.


Some diseases can affect the condition of the gum such as diabetes, which affects the body’s level of blood sugar, and increases the risk of gum disease. Also, conditions that interfere with the body’s immune system, such as cancer and HIV, can also make gum disease more likely.

  • Poor oral hygiene habits: such as neglecting daily teeth brushing and flossing.
  • Family history of dental disease
  • Smoking

Signs and Symptoms

Unlike healthy gums, which look firm and pink, periodontal disease has some signs and symptoms such as:

  • Puffy or swollen gums
  • Red, dusky red, or purplish gums
  • Tender gums when touched
  • Bleeding on touch or after brushing teeth
  • Bad breath
  • Pus between the teeth and the gums
  • Loose teeth or even loss of them
  • Longer teeth due to the recession of gums away from the surfaces of teeth
  • Spaces between teeth


A visit to the dentist becomes necessary if you experience any of these symptoms. The dentist should take a look to see if there are any of these signs:

  • Gum firmness, bleeding, pockets (the spaces between the teeth and the gum), and bone loss around the teeth in the radiograph
  • Teeth mobility and improper teeth alignment.

Stages of periodontal disease

Periodontal disease can pass with 4 stages according to severity: gingivitis, slight periodontal disease, moderate periodontal disease, and advanced periodontal disease.


It’s the first stage of the periodontal disease and it’s the only stage that is considered reversible, as it doesn’t have the time to cause bone resorption and damage.

Most of the signs and symptoms of this stage are painless, and this is what makes periodontal disease dangerous; it’s a silent disease until its fourth and fifth stages.

This stage is characterised by swelling of the gums, bad breath, and bleeding on brushing or flossing. Gingivitis can be reversed by maintaining good oral hygiene and having regular checkups.

Slight Periodontal Disease

It’s the second stage of periodontal disease and, while it is not reversible, it can be managed. Once the patients reach this second stage, the bacteria become more aggressive. The infection spreads to the bone and begins to destroy it. Signs of this stage are: increased swelling and redness of the gums, bleeding on brushing or flossing, and pocket depth between teeth ranging from 4 to 5 mm. In the second stage, good oral hygiene won’t reverse the signs and symptoms.

Moderate Periodontal Disease

This stage also can’t be reversed. Signs and symptoms in this stage are like those of stage two but with greater pocket depth at six to seven millimetres, which allows more bacteria to attack and destroy the bone.

Treatment in the second and third stages requires scaling and root planing.

If left untreated, these stages can progress to bone and tooth loss, gum sensitivity, increased bleeding, and the shifting of teeth.

Advanced periodontal disease

This is the final stage of periodontal disease which occurs when the infection deepens even further and the bacteria evolves into disease-causing bacteria.

During this stage, there’s a 50-90% risk of bone loss, red, swollen gums that ooze pus, cold sensitivity, further loosening of teeth, pain when chewing, and severe halitosis.

Treatment of the final stage of periodontal disease requires periodontal laser or periodontal surgery treatment to clean the deep pockets filled with bacteria.

If left untreated, stage four periodontal disease leads to spacing or gaps between the teeth, gum recession, patients needing dentures, and other overall health problems that can be serious.


The goals of treatment for periodontal disease are to regain the attachment of a healthy gum to the teeth, stop disease progression, and to reduce swelling, the risk of infection, and the depth of pockets.

The type of treatment depends on the stage of periodontal disease, the overall health, and the patient’s response to the treatment.

Treatments range from nonsurgical therapies that control bacterial growth to surgery to restore supportive tissues.

Non-surgical treatment

·   Professional dental cleaning: the dentist can remove the plaque from above and below the gum line during regular checkups.

·   Scaling and root planing: this is a deep cleaning procedure, done under local anaesthesia, to remove all the plaque from above and below the gum line and scrub the root, resulting in a clean root and tooth surface which allows for the reattachment of the healthy gum again.

Surgical treatment

  • Flap surgery/pocket reduction surgery
  • Bone grafts
  • Soft tissue grafts
  • Guided tissue regeneration
  • Bone surgery


Proper plaque management and maintaining good oral hygiene are the keys to keeping you safe from gum diseases.

Brushing your teeth twice a day with a soft-bristled brush and fluoride toothpaste is a must. The brush should be replaced every 3 months or with the bristles becoming frayed.

Flossing must be a routine daily, as flossing removes food particles and plaque from between the teeth and under the gum line, and reaches the areas that can’t be reached with a brush. Using interdental cleaners, picks, or small brushes that fit in between teeth is also useful. You should ask the dentist how to use them to avoid damaging your gum.

Rinsing your mouth with antibacterial mouthwash doesn’t only fight periodontal disease, but prevents the bad odour of the mouth.

You have to change some of your lifestyles to avoid periodontal disease such as: stopping smoking, reducing stress, and maintaining a balanced diet.

If it's been 6 months since you last saw the dentist, set up cleaning to remove tartar and plaque buildup from your teeth.

This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Nessma Adel

Bachelor's degree, Dentistry, Cairo University, Egypt

Nessma is a Qualified General Dentist with a bachelor degree from Cairo University (Al-Kasr Al-Aini) with very good experience in working for private clinics. Also a passoinate dental content writer.

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