The Warning Signs of Gum Disease
Gum disease is often painless and without noticeable symptoms, making it hard to know if you really have it. Many symptoms may not appear until an advanced stage of the disease, called periodontitis.
We 're usually told to take care of our teeth, but what about our gums? Your gums also play an important role in oral health. This is because without proper care, periodontal (gum) disease can take hold, and cause tooth and even bone loss in the mouth.
Symptoms pointing to gum disease commonly don’t include pain, especially early on, but that doesn't mean it's not there. "It's sort of like hypertension in that way, and I use the comparison to explain to patients why they may not have experienced any symptoms before they come in," says Dr. Seema Ashrafi, a clinical associate professor and board certified periodontist at UIC. As with other chronic conditions such as hypertension, diabetes or heart disease, you may be affected by gum disease, yet feel okay.
Still, there are some warning signs you can watch for that may indicate you have some form of gum disease. Paying attention to these signs, along with proper oral hygiene and regularly consulting your dentist is a healthy strategy for avoiding a disease that affects about half of adults in the US.
What is gum disease?
Periodontal (gum) disease is an inflammatory disease that affects the tissues that surround and support your teeth, and is a major cause of tooth loss in adults. The disease is usually painless, yet, if left untreated can lead to major tissue damage, or even tooth and bone loss.
Periodontal diseases range from mild forms such as gingivitis - an inflammation of the gums caused by bacterial infection leading to plaque and tartar buildup – to more advanced and chronic forms that can result in major damage to the soft tissue and even tooth loss. Chronic periodontitis, the most advanced form of the disease, progresses relatively slowly in most people and is typically more evident in adulthood. Early detection is key to controlling and treating periodontal disease before it becomes worse.
Did you know?
Half of American adults suffer from periodontal (gum) disease.
Data from the Centers for Disease Control and Prevention show high prevalence of periodontal disease in the U.S. population.
What causes gum disease?
Every day, food can get trapped in the space between where our teeth and gums attach below the gum line. Without regular brushing and flossing to remove it, bacteria builds up as plaque on the surface of your teeth. As plaque advances, it hardens and becomes tartar. The gums may get infected when the plaque extends below the gum line. Once this happens, the gums become red, swollen and can bleed easily. Gingivitis can usually be reversed with a good brushing and flossing routine, and regular cleaning by a dentist or dental hygienist.
Un-treated gingivitis may advance to periodontitis, where the gums pull away from the teeth and form bigger spaces (called “pockets”) that become infected. As the bacterial infection increases, the plaque continues to spread below the gum line. While your body’s immune system fights the bacteria, it may also start to break down the bone and connective tissue that hold teeth in place. If left un-treated, the bones, and soft tissue that support the teeth are eventually destroyed and the teeth may eventually become loose and have to be removed.
VIDEO: Causes of Periodontal Disease
Four signs that you may have gum disease
1. Swollen, sore or bleeding gums.
Gums that are bleeding or aching may be the result of gum disease. Healthy gums generally won't bleed when you brush and floss. Without regular brushing and flossing, the dental plaque created from bacteria will continue to build up and eventually begin to irritate the gums, making them red, swollen or sensitive, and susceptible to bleeding. That bacteria film, or plaque attacks the healthy tissue around the teeth, and can eventually destroy the fibers that attach your gum tissue to your teeth. This will cause the gums to become inflamed and irritated, which may cause them to bleed when brushing or flossing. This is called gingivitis and is the first stage of gum disease.
If my gums are bleeding, should I stop flossing?
Actually no. If you don’t floss, the plaque buildup can get even worse. If you have never flossed before, your gums might bleed the first few times you use floss. Keep flossing gently and the bleeding typically stops within a week or two. However, if the bleeding doesn't stop, you should consult your dentist.
Are you a smoker? Here's something to else to know about bleeding gums: smoking restricts the normal blood flow to the gums masking the early warning signs of gum disease. Dr. Aniruddh Narvekar, Clinical Assistant Professor and Diplomate of the American Board of Periodontology and Dental Implant Surgery in UIC Department of Periodontics explains: "Bleeding gums while brushing and flossing are a common sign of gum disease. However, smoking restricts the blood flow to the gums and smokers may not experience this early warning sign."
2. Gum recession.
Have you heard the term, ‘long in the tooth?’ This phrase originated with horses, whose teeth – unless our own - continue to grow and be worn down as they age.
Rest assured, your teeth won’t grow, and should not begin to look longer as you grow older. However, with advancing gum disease, your teeth can appear to be longer because the gums that surround them are receding away. Gum recession is the loss of gum tissue from around the tooth, exposing the root. Receding gums becomes a health concern when the roots of the teeth become exposed, leaving the teeth at risk of decay, infection, and loss. The exposure of root surfaces and receding gum line causes not only aesthetic concerns, but also potentially serious tooth sensitivity issues. Healthy gums should fit snugly around each tooth, with the distance between the gum tissue and its attachment to the tooth only one to three millimeters in depth. Advancing gum disease can lead to deeper than normal spaces around the teeth called periodontal pockets. In later stage gum disease, the pockets become so deep that it becomes difficult to remove the food and debris by brushing and flossing. This causes the pockets to become progressively deeper and worsens the disease further – a virtuous cycle.
Sometimes, gum recession is related to the way you brush your teeth. "We are starting to see more patients brushing too hard or using hard-bristle toothbrushes that cause gum recession," says Dr. Kevin Wanxin Luan, Clinical Assistant Professor and Board Certified Periodontist and Dental Implant Surgeon in UIC Department of Periodontics.
"We advise our patients to use either a soft bristle toothbrush or an electric powered toothbrush with pressure sensors and then demonstrate proper and effective brushing techniques to minimize the harmful effects of gum recession and its related symptoms," added Dr. Luan.
Gum recession occurs gradually over time and can be a more serious problem for patients if not appropriately addressed early during regular visits with the periodontist and dentist. To help assess gum health changes over time, your dentist takes measurements along the outer surface of the tooth to gauge how much gum has recessed or migrated over time. As the measurement varies from the normal range, your dentist can make recommendations and may suggest consulting a periodontist, (a specialist in diagnosing and treating gum disease) involved if needed.
If the recession and pocket formation is severe, then various treatments are available. These include deep cleaning, sometimes called scaling and root planing. By removing all of the tartar and plaque from your teeth and underneath your gums, the gums can heal and tighten around the tooth again. If you have no significant bone loss, this may be the only treatment you need. However, in cases where deep periodontal pockets still remain, surgical treatments may be recommended to stabilize the advance of the disease.
Some people are more prone to the inflammatory causes of receding gums due to having more delicate tissue. Thinner gum tissue makes it more likely than plaque will cause inflammation.
3. Tooth sensitivity.
Do you experience uncomfortable sensations in your teeth when you consume hot or cold drinks, crunch on ice, or expose them to the cold air? Dentin hypersensitivity, commonly referred as tooth sensitivity, can be caused by exposed teeth roots and thin tooth enamel (the hard covering that protects teeth). And in some cases, gum recession or pocketing can lead to unusually sensitive teeth. The gums cover the tooth roots, which have no enamel to protect them. When those roots are exposed it can be quite uncomfortable and even painful because the dentin has tiny tunnels that transmit the information directly to the nerves inside your teeth.
If the sensitivity becomes progressively worse, consult your dentist - it may be due to gum disease.
4. Persistent bad breath.
All of us have had bad breath at one time or another, and it is usually easy to get rid with breath mints, mouth wash or brushing. However, having bad breath all the time may be a sign of poor oral health due to excessive bacteria, tooth decay, or even gum disease. Persistent bad breath is usually caused by the smelly gases released by the bacteria that coat your teeth, gums and tongue. As with the other warning signs, a dental consultation and treatment can help with persistently smelly breath and it’s causes.
Risk factors associated with gum disease
In addition to knowing the warning systems, it is also important to know that there are several factors that can increase your risk of gum disease. Here are some of the biggest associated risk factors:
- Smoking. Smoking is one of the most significant risk factors associated with the development of periodontal disease. Additionally, smoking can lower the chances for successful treatment.
- Diabetes. People with diabetes are at higher risk for developing infections for many diseases.
- Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.
- Other illnesses and their treatments. Diseases such as AIDS and its treatments can also negatively affect the health of gums, as can treatments for cancer.
- 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.
One of the biggest risk factors: Smoking
According to the Centers for Disease Control and Prevention (CDC), smokers are twice as likely to have periodontal disease as non-smokers, and the longer you smoke, the higher the risk becomes.
Here are the facts:
- If you are a smoker, you have twice the risk for periodontal disease compared with a nonsmoker.
- The more cigarettes you smoke – and the longer you smoke - the greater your risk becomes.
- Tobacco use in any form—cigarettes, pipes, and smokeless (spit) tobacco—raises your risk for periodontal disease.
The link between periodontal disease and your overall health
There are many factors that lead to or increase the risk of periodontal disease. Genetics, unhealthy diet, unhealthy habits such as smoking, and poor oral hygiene all play a part in creating the conditions that may lead to periodontal disease.
Genetics, and other health related factors also play a part in influencing how our bodies respond to the disease and treatment methods. For instance, research studies have identified an association between periodontitis, obesity and type 2 diabetes. And, we know that obesity is a risk factor for several chronic diseases, most notably hypertension, type 2 diabetes, dyslipidemia and coronary heart disease.
American Academy of Periodontology (Perio.org)
National Institutes of Health - Obsesity and periodontal disease
What should I do if I have any of these signs?
The most important thing to remember about all of these warning signs is early detection. The earlier the problems are found, the more effective the correction will be. If you feel you are at risk of gum disease, consult your dentist for an assessment.
Periodontists at UIC are experts in treating periodontal disease.
We provide a full range of periodontal care from non-invasive therapies such as deep cleaning (scaling and root planing) to more advanced surgery procedures such as pocket reduction, grafting, crown lengthening, dental implants, and regenerative procedures to manage periodontal and implant disease. Our approach is personalized and focuses on educating patients about the scientific link between periodontal disease and systemic disorders such diabetes, cardiovascular disease and complication during pregnancy.
Why UIC is a great choice for periodontal therapy
World-Class Expertise. As an educational and research institution based here in Chicago, UIC is uniquely positioned to lead the way in periodontal disease care and research. Our periodontics team has an average tenor of 15+ years, and many of our periodontists are board certified.
Team of Specialists in One Location. The great thing about getting your dental care at UIC is that we have all the dental specialties – including periodontists – working closely together to coordinate dental care when needed. Our general dentists can refer you to our internal specialists as with general dentists anywhere in Chicago.
Highest Standards of Care. Our general dentists and specialists are familiar with and apply the latest approaches based on scientific evidence that gives the highest levels of confidence in what is the best ways to deliver care. Patients get the advantage of being able to get consultation from a number of experts for the most optimal overall care plan.
Care Options to Fit Your Budget. We offer three care options to fit different budgets and time commitments. Our student dentistry is great for patients on a budget (or without insurance) and have some extra time for general dental care. Our advanced specialty residents, who are training to become specialists (such as periodontists), are another option to get more specialized and advanced care, like treatment for advanced periodontitis. And, our faculty also see patients. Either way, you get a team of dental professionals dedicated to our mission of changing the future of oral health in Chicago, and around the world.