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The Causes of Periodontal Disease and How You Can Prevent It

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Have you experienced tender or bleeding gums? Periodontal disease is the infection and inflammation of the gums, ligaments and bone surrounding your teeth. Know the causes, treatments and steps to preventing gum disease so you can protect your oral and overall health.

If you've ever experienced inflamed or bleeding gums, you're not alone. In fact, an estimated 42 percent of U.S. adults ages 30 years and over have periodontal disease, also known as gum disease. But that doesn't mean bleeding gums are normal or should be ignored. If left untreated, periodontal disease can lead to some serious oral health problems.

Learning the causes of periodontal disease, what conditions or habits put you at risk, and how you can prevent gum disease is a great first step toward healthy and happy gums.

What Is Periodontal Disease?

Periodontal literally means "around the tooth," so periodontal disease refers to the infection and inflammation of the gums, ligaments, or bone that surround your teeth, and can vary in severity. Early stages include gingivitis, where the infection is found only in your gums, and they become inflamed, red, and may even bleed. Gingivitis is treatable, and the effects can be reversed if caught early enough.

However, as the infection spreads, it can also affect the surrounding tissue and bone that support your teeth. This is called periodontitis, and it can result in the gums pulling away from tooth, bone loss, and eventually, the potential for tooth loss or removal. The effects of periodontitis are more serious and can be irreversible, with treatment often requiring surgery.

What Causes Periodontal Disease?

Poor oral hygiene or uncontrolled bacteria from dental plaque and the toxins produced by that bacteria cause periodontal disease. If not removed, the American Academy of Periodontology (AAP) states that plaque can spread below the gumline. Those toxins can irritate the gums and even cause your body to break down and destroy the tissues and bone that support your teeth. Next, your gums begin to pull away from the teeth, forming periodontal pockets, or spaces between the teeth and gums. When these pockets become infected and deepen, more gum tissue and bone are destroyed. Eventually, this destruction will cause your teeth to become loose, and you may even have to remove them. Symptoms can be varied across the spectrum — from extreme pain to some experiencing no symptoms at all.

Symptoms of Periodontal Disease

You can be vigilant about your oral health by looking out for these warning signs of periodontal disease:

  • Red, swollen, tender, or bleeding gums
  • Gums receding or pulling away from the tooth
  • Abnormal tooth sensitivity, especially around the gumline
  • Loose teeth or painful chewing
  • Bad breath or a bad taste in the mouth

If you recognize any of these symptoms, make an appointment with your dentist for an evaluation. They will examine your gums with a dental probe to look for infection. They also may take new X-rays to compare with older X-rays and identify any changes to your teeth or bones. If a referral to a specialist is needed, your dentist will refer you to a periodontist.

Periodontal Disease Treatment

If you are diagnosed with periodontal disease, treatments may vary depending on the severity of your case. Some of these treatments include:

  • Scaling and root planing. For gingivitis or the early stages of gum disease, non-surgical treatments may be available to restore periodontal health. Scaling is a deep cleaning technique that carefully removes plaque and tartar from your teeth both above and below the gumline. Root planing removes plaque and tartar from the root surfaces, areas of rough spots that trap and hold bacteria. Once the gums are cleaned, the gum tissue can begin to heal.
  • Periodontal gum surgery. If the periodontal pockets surrounding your teeth become so deep that they are difficult to clean with regular at-home oral hygiene and a professional care routine, a pocket reduction procedure may be an option. During this procedure, the periodontist makes incisions in your gums to flap back the tissue, providing more access to the roots for more effective scaling and root planing below the gumline and cleaning out the bacterial infection. This will allow for the reattachment of the gum tissue to the bone.
  • Gum graft surgery. If periodontal disease progresses and gums begin to recede, the periodontist might recommend surgery to reshape gums or graft new tissue to cover exposed tooth roots. During this surgery, the periodontist takes gum tissue — usually from the roof of your mouth — to cover the root and protect your tooth from decay, bone loss, and further recession.
  • Regenerative procedures. When periodontitis has destroyed the bone supporting your teeth, regenerative procedures may help reverse some of the damage. After the periodontist exposes the root and removes the bacteria, he or she may graft bone to the surrounding area of the tooth to encourage your body to regenerate the lost bone and tissue. In time — if adequate bone is present — you may then be a candidate for dental implants.
  • Extraction. In the worst cases of periodontitis, bone loss is so severe that the tooth cannot be saved and must be removed.

How to Prevent Gum Disease

  • Because the effects of periodontitis and severe stages of periodontal disease cannot be completely reversed, it's important to identify and address symptoms of gum disease as early as possible and establish a preventative care routine before the disease progresses. 
  • Practice good oral hygiene by brushing and flossing your teeth daily. Done correctly, this will remove the plaque from your teeth and prevent build-up. Also, visit your dentist every six months for a professional cleaning to remove plaque and tartar in places that are harder to reach. If you already have periodontal disease, your dentist or periodontist may recommend more frequent visits and put a more aggressive treatment plan in place.
  • The AAP recognizes some other factors that put you at risk for gum disease. These include:
  • Genetics. Some people are genetically prone to periodontal disease than others, but that does not make it inevitable. With proper oral care, periodontal disease may be prevented or controlled.
  • Crooked or crowded teeth, braces, and bridges. These make it more difficult to brush or floss your teeth, increasing the likelihood of plaque build-up. Your dentist or dental hygienist can show you the best way to clean your teeth and even provide special tools to floss around braces or bridgework. For crooked or crowded teeth, they might also recommend orthodontic treatment.
  • Grinding, gritting, or clenching teeth. These habits can exacerbate existing periodontal disease symptoms by placing excess force on your teeth and speeding up the breakdown of supporting gum tissue and bones. Your dentist can create a custom guard appliance to reduce the pressure placed upon the teeth, supporting structures, and joints.
  • Tobacco use. Smoking makes it harder for your immune system to fight off infection, making those that use tobacco both at a higher risk for gum disease and more resistant to treatment. Smokers collect more tartar on their teeth, develop deeper pockets to catch bacteria, and lose more bone as the disease worsens. Stopping tobacco use is an important step in periodontal disease prevention and treatment.
  • Medications. Several types of medications cause dry mouth, and the lack of saliva makes it more likely for plaque to adhere to teeth. Some medicines can enlarge the gums, making them more likely to trap plaque. Check the side effects of your medications, and be diligent about your oral care routine to prevent plaque build-up.
  • Diseases. Certain diseases can put individuals at higher risk for periodontal disease. Whether that's a disease like diabetes that decreases the immune response or an inflammatory condition such as rheumatoid arthritis, the prevention, and treatment of gum disease could be more difficult. Your dentist can help guide you on the best way to maintain your oral health.
  • Poor nutrition. Proper nutrition is essential for a functioning immune system and a healthy mouth. If you have a severe Vitamin C deficiency — commonly known as scurvy — it can cause bleeding gums.
  • Stress. Stress weakens your immune system, making it more difficult to fight off the infection associated with gum disease and decreasing the effectiveness of treatment.
  • Hormones. Fluctuating hormones cause the environment of your mouth to change, so events like puberty, pregnancy, and menopause temporarily increase the risk of periodontal disease.

Other Health Implications of Periodontal Disease

Unfortunately, the impact of periodontal disease goes beyond your mouth, and researchers are finding more and more links between gum disease and your overall health. Some of these health problems include:

  • Heart disease. Infection in your gums may increase the risk of clogged arteries and even worsen existing heart conditions.
  • Stroke. Likewise, periodontal disease may increase the risk of stroke caused by blocked arteries.
  • Respiratory disease. Bacteria from the mouth may spread to the lungs, causing lung infections or worsening existing lung conditions. Immunocompromised adults with gum disease may be at increased risk for severe pneumonia.
  • Premature birth. Gum disease during pregnancy for those who are immunocompromised may increase the likelihood of delivering the baby too early, and the possibility of low birth weight.
  • Diabetes. Periodontal disease may make it more difficult for diabetic patients to control their blood sugar than those with healthy gums.

Don't ignore those tender or bleeding gums. The sooner periodontal disease gets diagnosed and treated, the more damage you can prevent to your gums and teeth.

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This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

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