Understanding The Stages Of Gum Disease

  • Zebunnisa MullaBachelor of Science - Bsc (Hons), Biomedical Science, The University of Salford
  • Lenee CastelynBachelor of Dental Surgery. - University of the Western Cape
  • Ellen Rogers MSc in Advanced Biological Sciences, University of Exeter

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Introduction

Gum disease is an extremely common condition in the UK and most adults suffer from it to some degree.1 The main cause of gum disease is the buildup of plaque on the surface of the teeth. Plaque contains large numbers of bacteria and can harden if not removed by regular and thorough cleaning. Whilst everyone is susceptible to plaque, some people can be genetically predisposed to enhanced plaque formation and gum disease, although this is quite rare.5


Besides genetics, risk factors which can contribute to gum disease include:2

  • Poor oral hygiene
  • Autoimmune diseases such as Lupus or Crohn’s disease
  • Smoking 
  • Diabetes
  • HIV
  • Heart disease
  • Hormone changes (such as during puberty, pregnancy or menopause)
  • Use of certain medications
  • Poor nutrition

Ensuring good oral hygiene and regular plaque removal is the number one way to prevent gum disease. Nonetheless, it is important to understand the different stages of gum disease and the severity of your condition, so you can seek the correct medical attention. 

The stages of gum disease

Stage 1: gingivitis 

Gingivitis is the earliest stage of gum disease. It is the mildest and most common form of gum disease, and around 70% of adults suffer from it to some degree. In gingivitis, the gingiva (the part of the gum around the base of the teeth) becomes swollen, and can bleed easily. Plaque buildup can be observed in areas that are not kept clean. 

Symptoms of gingivitis include:

  • Swollen gums
  • Gums which bleed easily when you brush or floss
  • Bright red and tender gums
  • Bad breath

Gingivitis is most commonly caused by poor dental care, of both the teeth and gums. This allows plaque to build up on the teeth, which overtime can harden and form tartar (or calculus) under your gum line. Tartar collects bacteria and creates a protective barrier around it, meaning that it can only be removed by getting your teeth professionally cleaned by an oral hygienist or dentist. During a professional clean, your hygienist or dentist uses a tool called an ultrasonic scaler to remove tartar from the surface of your teeth. This process is not painful. 

If you do not get your teeth cleaned and plaque and tartar remain on your teeth, your gums will eventually become irritated and infected, causing them to become swollen and bleed easily (gingivitis).

Luckily, gingivitis is not as serious as the later stages of gum disease. It is reversible with professional dental treatment and at-home oral treatments, including proper brushing methods and using antibacterial mouthwash.

Stage 2: mild periodontitis 

Stage 2 gum disease is marked by the bacteria from the plaque/ tartar spreading beneath the gums, where they begin to affect the supporting bones. At this stage, your gums can pull away from your teeth, creating pockets where plaque, bacteria and tartar can hide.

These areas cannot be cleaned with regular brushing and flossing - and again, only an oral hygienist or dentist will be able to assist with plaque removal. Tooth surfaces may need to be scraped clean of all deposits to prevent the bacteria from coming back.2

Stage 3: moderate periodontitis 

This stage of gum disease occurs when the build up of calculus is left untreated. Bacteria on the teeth will start to erode the ligaments, bones and soft tissues which hold your teeth in place. Bacteria start to erode the bone around the teeth, leading to loss of the supporting bone and tooth mobility. Your gums may start to become infected at this stage.2 

Some signs of stage 3 gum disease include:

  • Bad breath
  • Pus around the gum line
  • Pain

Stage 4: advanced periodontitis

This is the most severe form of gum disease. In stage 4, bone loss continues, which can cause your teeth to become loose and fall out. More gum tissue and bones are destroyed, and pockets can deepen. Recession of the gum line can be seen as the supporting bone becomes eroded away.2

Diagnosing gum disease

If you think you may have any of the signs or symptoms of gum disease, you should see a dental professional as soon as possible. A dentist will be able to tell if you have gum disease during a routine exam by looking for plaque buildup on the teeth, evaluating the health of the soft tissue, and asking you questions about your symptoms. 

Dentists can also perform a more detailed examination of the teeth and gums by measuring the pockets around your teeth with a dental probe. In healthy gums, these pockets should be no deeper than 1mm. As such, deeper pockets indicate how much bone has been lost and how loose your teeth are. X-rays can also be used to show your dentist the severity of bone loss in greater detail.3,4 

The precise diagnosis of gum disease varies by its grade and stage. Your dentist will conduct a thorough assessment of your teeth and gums, and assign a stage (initial to severe) and grade (which reflects the rate of disease progression and your predicted response to possible treatments).3,4 

Treating gum disease

Gingivitis is the least severe form of gum disease, and is also the easiest to reverse via early intervention and active treatment. It can be reversed with good oral hygiene, using antibacterial mouthwash, and regular dental cleanings. 

Whether you have gum disease or not, it is important to brush your teeth twice a day so that the bacteria in your mouth are removed from the tooth surfaces before they can form plaque or tartar. If plaque is present, a dentist will be able to clean this off your teeth. As long as you stick to a rigid oral routine, your gingivitis should reverse spontaneously.

In the later stages of gum disease, the damage is not easily reversed, and active management options have to be considered. These may include:2

  • Pocket reduction surgery: this approach looks to remove plaque and tartar under the gumline which is hard to reach through routine brushing. Your dentist will make an incision in the gums and create a flap. This allows them to deep clean all the tartar and bacteria from the root surfaces. After this, they reposition the gums and stitch up the incisions
  • Bone grafting: bone grafting replaces bone that has been lost due to gum disease. After the infection has been cleaned out, bone grafting material is placed into the areas where the bone has been eroded by bacteria. This essentially acts as scaffolding and allows your body to regenerate its own bone over time
  • Gum or tissue grafting: this approach aims to add thickness back to eroded gum lines and make the teeth appear longer. This is achieved by adding gum tissue to the areas where gum recession and/or erosion has occurred. This tissue usually comes from the palatal tissue in the roof of the mouth

Preventing gum disease

The most effective way to prevent gum disease is maintaining consistent oral hygiene, which includes brushing your teeth twice a day and flossing. This helps remove bacteria from the tooth surface and ensures your teeth and gums stay healthy.3

Regular dental visits are also an effective way to monitor and prevent gum disease. Dentists are able to clean your teeth and gums more thoroughly than you can at home. They can remove build up of plaque and tartar, leaving you with healthier gums.3

Lifestyle choices also play a part in preventing gum disease. Factors such as smoking or eating foods that are high in sugar significantly increase your likelihood of developing gum disease. Therefore, it is important to follow a balanced, healthy diet. Always brush your teeth before bed to ensure you remove all the bacteria that have collected in your mouth throughout the day.5

FAQs

What is gingivitis?

Gingivitis is a common condition which causes inflammation and pain in the gums. It presents as easy bleeding upon brushing, swelling and redness.

Can gingivitis be reversed?

Yes, gingivitis can be reversed by removing plaque from tooth surfaces and maintaining good oral hygiene. Proper brushing techniques, regular flossing and using antibacterial mouthwash are very effective in treating gingivitis.

What is periodontitis?

Periodontitis is the progression of gingivitis (gum disease) to the point where the underlying bone is eroded, leading to teeth becoming loose.

What is calculus?

Calculus is a hard, yellow, tartar-like substance that forms on teeth when plaque is not removed from tooth surfaces. Calculus can only be removed from the teeth via professional cleaning using an ultrasonic scaler. This can be done by a dentist or oral hygienist.

Summary

Gum disease is a common disease that affects most adults in the UK. Early gum disease (gingivitis) is not serious and can be easily reversed with proper care and treatment. However, more severe cases of gum disease cannot reverse spontaneously and requires professional intervention and management.

It is important to see your dentist regularly, as they will be able to detect and treat gum disease early. Healthy gums provide vital support to your teeth, and can play a huge role in maintaining your self esteem and ability to enjoy a healthy diet over your entire life.

References 

  1. NHS. Gum disease symptoms and treatments [Internet]. [Updated 2022 Feb 18; cited 2024 Mar 1]. Available from: https://www.nhs.uk/conditions/gum-disease/
  2. Trombelli L, Farina R, Silva CO, Tatakis DN. Plaque-induced gingivitis: Case definition and diagnostic considerations. J. Periodontol. [Internet] 2018 [cited 2024 May 19];89(Suppl 1): S46–S73. Available from: https://aap.onlinelibrary.wiley.com/doi/10.1002/JPER.17-0576
  3. Cleveland Clinic. Periodontal (gum) disease: How serious is it? [Internet]. [Updated 2023 Oct 4; cited 2024 Mar 1]. Available from:https://my.clevelandclinic.org/health/diseases/21482-gum-periodontal-disease 
  4. Mayo Foundation for Medical Education and Research. Periodontitis. [Internet] [Updated 2023 Feb 24; cited 2024 Mar 1]. Available from: https://www.mayoclinic.org/diseases-conditions/periodontitis/symptoms-causes/syc-20354473
  5. Lang N, Bartold PM. Periodontal Health. J. Periodontol. [Internet] 2018 [cited 2024 May 19];89,(S1),9-16. Available from: https://aap.onlinelibrary.wiley.com/doi/10.1002/JPER.16-0517

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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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