Overview 

Gum disease, also known as periodontitis, is a prevalent oral health condition affecting 45% of the UK adult population.¹ It is a dental disease characterised by inflammation and infection of the gums and soft tissue surrounding the teeth. If left untreated, it can irreversibly destroy the bone which supports your teeth, leading to serious complications like tooth loss and systemic health issues.

Although prevalent, gum disease can usually be prevented. Recognising the signs and symptoms of gum disease is vital for early detection, to prevent further damage and preserve oral health. 

This article will explore the signs and symptoms of gum disease, as well as its risk factors and complications that can arise if left untreated. Read on to find out what you can do to prevent developing the disease to safeguard your smile and overall well-being.

What is gum disease? 

Gum disease is an accelerating bacterial infection that can be caused by poor oral hygiene. However, some people are more prone to this disease than others despite proper brushing and flossing, due to factors such as:

• Genetics
• Low-nutrient diet
• Smoking
• Autoimmune diseases
• Diabetes
• Hormones

What causes gum disease?

The primary cause of gum disease is the accumulation of dental plaque. Dental plaque is a sticky film which forms when bacteria in the mouth combine with saliva. The bacteria in plaque produces acids after eating and drinking which destroys the teeth, causing gingivitis or periodontitis. Generally, gum disease isn’t painful, so many people are not aware that they have it.

Types of gum disease

Types of gum disease can be classified by their stages of progression:²

Gingivitis

This is the earliest and mildest form of gum disease. Gingivitis means inflammation of the gums. At this stage, there is no bone loss and can be reversed with good oral hygiene and proper treatment.

Slight periodontal disease

Bacteria have spread beneath the gums causing them to pull away from your teeth and create pockets around them, trapping plaque.

Moderate periodontal disease

When gum disease is left untreated, bacteria begin to erode the soft tissue and bone holding your teeth in place.

Advanced periodontal disease

Worsened bone loss, gaps between the teeth, recession of gums and eventually teeth fall out. This last stage is irreversible and requires periodontal surgery for treatment.

Signs and symptoms of gum disease 

Healthy gums are characterised by being pale pink, firm to the touch, fitting tightly around the teeth and don’t bleed or swell. 

Early signs of gum disease

Symptoms of early signs of gum disease are attributed to gingivitis. Inflammation occurs when there is an increased blood flow to the gums due to the body's response to local or systemic factors, such as oral hygiene, immunity and diet.³ If identified and treated quickly, gingivitis can easily be treated by your dentist by removal of dental plaque, and the condition is reversible. 

It’s possible not to have any symptoms, leaving people unaware that they have gingivitis. Below are good indications of the first stage of gum disease.

Appearance and texture of gums

Gingivitis is associated with having red, swollen, or tender gums, particularly along the gum line, and can also feel sensitive to the touch. The texture may feel different, becoming smooth, shiny, or puffy and enlarged in comparison to normal gum texture.

Bleeding

Bleeding is known to be one of the earliest signs of gum disease.⁴ Your red and swollen gums may bleed easily during brushing, flossing, and eating. Poor oral hygiene causes plaque to build up and irritate the gums. Sometimes, spontaneous gum bleeding can happen.³ Pain can also be felt when chewing. 

Persistent bad breath

Due to continuous bacterial growth with plaque build-up, persistent bad breath can develop without improvement, even after brushing your teeth. It’s caused by plaque microorganisms that release volatile chemicals, particularly sulphide compounds.⁵ Some people may also notice a bad taste in their mouth that doesn’t go away.³ 

Advanced signs of gum disease

Advanced stages of gum disease can occur if gingivitis is not treated. When plaque is not properly removed, it turns into tartar, causing irritation and inflammation to the gums and progresses into periodontitis.³ Managing gingivitis is a primary preventative strategy for periodontitis.⁶

Receding gums

This happens due to the loss of gum tissue as a result of bacterial growth. It causes the roots to become exposed, leading to increased:

• Inflammation
• Sensitivity
• Infection
• Tooth decay

Plaque accumulates more rapidly at inflamed sites than at non-inflamed sites, progressing to periodontitis.⁶

Formation of periodontal pockets 

Advancing periodontitis can lead to deeper than normal spaces around the teeth and the formation of periodontal pockets between the teeth and gums. These pockets allow for food particles and debris to get trapped away and multiply, thus making it difficult for removal as these sites cannot be reached.⁷ Instead, plaque continues to build up and cause further irreversible damage. 

Loose or shifting teeth

Progression of periodontitis causes the supporting alveolar bone to deteriorate, resulting in changes in the bite or the way teeth fit together. Increased inflammation eventually leads to bone loss around the base of your teeth. At this stage of periodontitis, over 50% of the supporting bone has disintegrated, with fibres that attach teeth to the bone also destroyed.⁴ This results in instability and movement, leaving you with gaps between your teeth and can lead to tooth loss.^5,7 

Pus between teeth and gums

With the accumulation of tartar and loss of structural support, dental abscesses can form. This is the growth of pus in periodontal pockets which can cause bad breath. Signs of dental abscesses include:

• Intense toothache or pain in your gums
• Redness and swelling inside the mouth or on your face or jaw
• Sensitivity to hot or cold food and drink in the affected area
• Difficulty chewing food and opening your mouth

Risk factors for gum disease 

Poor oral hygiene habits 

Poor oral hygiene is directly associated with periodontitis. Inadequate brushing and flossing allows plaque and tartar build-up, resulting in inflammation and disease. 

Smoking and tobacco use 

Tobacco use negatively impacts periodontal health as it weakens the immune system, reducing blood flow to the gums and making it more difficult for your body to fight off infections. Periodontal treatment has also been reported to be less successful in smokers than in non-smokers.⁸

Genetics

Some individuals may be genetically predisposed to developing periodontitis despite good oral hygiene. Some people with severe periodontitis may have genetic factors that affect the immunity of a cytokine involved in the inflammatory response.

Diabetes 

Those with diabetes have an increased risk of developing periodontitis. Increased blood glucose levels cause damage to the blood vessels. This reduces oxygen and nutrient levels in the gums, making patients more susceptible to infection by plaque bacteria. Insufficiently controlled blood glucose levels increase glucose in the saliva, allowing bacteria to grow and plaque to form.¹

Hormonal changes 

Hormonal changes during pregnancy can make your gums more prone to plaque and therefore increase your risk of developing gingivitis and periodontitis. 

Complications of untreated gum disease 

Tooth loss 

As gingivitis progresses to advanced periodontitis, the supporting structures of the teeth, including the gums and bone, become damaged and destroyed, resulting in tooth loss. The prognosis of gingivitis was reported to improve with treatment, showing that decreased tooth mobility and loss have the potential to be avoided.⁵

Jawbone deterioration 

Infection can spread through gum tissue, towards the jawbone and other supporting tissues of the teeth, inducing jawbone loss and triggering the loss of other teeth. This causes difficulty in speaking, eating and moving your jaw. Additionally, it may result in serious damage to the strength and stability of your jaw. 

Increased risk of systemic health problems 

Untreated gum disease facilitates the entry of plaque bacteria into the bloodstream, potentially causing systemic infections in other parts of the body. Chronic inflammation has been associated with an increased risk of developing systemic health conditions. These include:^9,10

• Cardiovascular diseases (CVD), such as heart disease, heart attack, atherosclerosis, and thrombosis.
• Respiratory diseases, such as pneumonia, decreased lung function, and chronic obstructive pulmonary disease (COPD).
• Musculoskeletal conditions (e.g., rheumatoid arthritis).
• Pregnancy complications, such as poor pregnancy outcome, premature delivery, and low birth weight. Those who are pregnant with periodontitis are more likely to develop gestational diabetes.
• Type 2 diabetes mellitus (T2DM) can be induced when bacteria activate immune cells to produce cytokines that have a destructive effect on the body.

Prevention and treatment 

Early detection and intervention are key to effective prevention and treatment of gum disease to reduce the risk of further complications. These include:¹¹

• Good oral hygiene practices, such as brushing twice a day with fluoride toothpaste, flossing, having regular dental check-ups, and cleaning can prevent plaque build-up and infection.
• Lifestyle changes, including quitting smoking, limiting alcohol consumption and maintaining a balanced diet to support overall health.
• Dental treatments. Infection may be treated with antibiotics. Scaling and root planing by your dentist can remove plaque build-up above and below the gum line and smooth your teeth roots to prevent further infection.
• Severe and advanced cases of periodontitis may require surgery such as flap surgery, bone grafting or soft tissue grafting to repair damaged gum and bone tissues.

Summary

Gum disease is typically caused by poor oral hygiene allowing plaque to build up on the teeth. It begins with gingivitis, where symptoms can include swelling, redness, and bleeding of gums accompanied by bad breath. If left untreated, gingivitis develops into advanced periodontitis characterised by receding gums, formation of periodontal pockets, loose teeth and pus between the gums. Complications of periodontitis include tooth loss, jawbone and an increased risk of developing systemic health conditions. If you fear you may have signs of gum disease, you must consult your dentist as soon as possible.