There are two main stages of gum disease: gingivitis, when the gums are inflamed and begin to bleed when you brush or floss; and periodontitis/periodontal disease, a more advanced form that affects the tissues supporting the teeth and can lead to tooth loss.
In the UK, more than 45 per cent of people are affected by gum disease, and around 10 per cent have the more serious periodontal form – but both are preventable by practising good dental hygiene and can be treated by a dentist or hygienist.
Gum disease is caused by the gradual build-up of plaque on the teeth, which is a sticky, colourless, film of bacteria. Most of the bacteria in the mouth is harmless, but some have been shown to be the main cause of gum disease.
If plaque isn't removed it can start to irritate the gums and they become red, swollen and bleed, which is the first sign of gingivitis. The plaque that isn't removed by brushing and flossing will harden and form tartar (calculus), which will irritate and inflame the gums further, and can only be removed by a dentist or a hygienist.
If gingivitis isn't treated, the inflammation may spread to the bones that support the structure of teeth, known as periodontitis (which literally means inflammation around the tooth). The gums will begin to recede, leaving a tiny gap (pocket) between the tooth and the gum where plaque will get trapped, leading to teeth loosening and falling out or having to be removed by the dentist. As the disease worsens the bone supporting the teeth may be lost.
In rare cases, acute necrotising ulcerative gingivitis (ANUG), a severe type of gum disease, may develop.
Symptoms of gingivitis include red, swollen, uncomfortable gums and bleeding after brushing and flossing.
Periodontitis signs include bad breath, a permanent, unpleasant taste in the mouth, gum abscesses (where pus builds up under the gums), loose teeth and gum recession and sensitivity.
ANUG symptoms are more severe and include: receding gums between your teeth; bleeding, painful gums; painful ulcers; bad breath; a metallic taste; difficulty swallowing and talking; excess saliva; and a high temperature.
Make an appointment with your dentist if you suspect gum disease. They will identify any risk factors and look at your gums for signs of swelling. They may also use a periodontal probe to measure any pockets that have developed. An x-ray may be needed to identify if there has been any bone lost.
Who gets periodontal disease?
Most adults will experience some degree of periodontal disease at least once, although symptoms don't usually appear until people reach their 30s and 40s, and it's more common in men than in women.
There's a higher risk if you don't brush or floss your teeth regularly. Other risk factors include: smoking; genetic factors; diabetes; stress; position of the teeth; a weakened immune system because of conditions such as HIV and AIDS; using medications that dry the mouth; poor diet; and pregnancy.
It's important to adopt good dental hygiene to prevent the condition from getting worse, which consists of brushing your teeth for two minutes twice a day; flossing; using fluoride toothpaste; and having regular dental check-ups. Your dentist may suggest an antiseptic mouthwash to prevent plaque from building up, as well as the use of an electric toothbrush. Any toothbrush used should have medium bristles, a small head and be replaced regularly.
A hygienist will be able to scale and polish teeth, which removes all plaque and tartar. A deeper clean, called root planing, may be required in some cases to clean under the gums and to remove the bacteria form the roots of the teeth. This is given with a local anaesthetic.
If you're having treatment for ANUG, your dentist may prescribe antibiotics, such as metronidazole or amoxicillin; recommend that you take painkillers, such as paracetamol and ibuprofen; or mouthwash that contains chlorhexidine or hydrogen peroxide. If the condition is severe, your dentist may refer you to a periodontist who may have to perform surgery or bone grafts.
It's important to make lifestyle changes, such as giving up smoking and eating a healthy, well-balanced diet including vitamin C-rich foods (such as peppers, broccoli and kiwi). Signs of vitamin C deficiency include gingivitis and bleeding gums. To keep teeth strong, consume good sources of calcium, for example, milk and cheese. Also consider taking a supplement. A 2017 study, published in the Journal of Clinical Periodontology, suggested that micronutrient deficiencies in vitamin C, vitamin D or vitamin B12 may be related to the progression and onset of the condition.