Gum disease is one of the most common chronic health conditions in adults. For those 40 and older, it’s also the leading cause of premature tooth loss. Unlike cavities, which often cause sensitivity or pain, gum disease is silent. Because the infection starts under the gums, you may not notice symptoms right away.

There are two types of gum disease: gingivitis and periodontitis. Gingivitis is an early, reversible infection of the gums caused by bacteria and hardened plaque (calculus). Once the bacteria and calculus are removed, the gums can return to their healthy state. Think of it like a sliver in your skin: once it’s out, the redness and swelling go away.

Periodontitis is irreversible and develops when the infection reaches deeper structures: the gum tissue, the ligament holding the tooth, and the bone beneath. Over time, this leads to gum recession, loose teeth, and tooth loss if untreated. Signs include gum recession, teeth appearing longer, shifting teeth, or changes in your bite. These symptoms reflect permanent damage to the tooth’s support system.

Because gum infections are deeper in the gingival pocket, they can go unnoticed. Signs of both gingivitis and periodontitis include red, swollen gums and bleeding when brushing or flossing. This is often called “pink in the sink.” Other symptoms may include bad breath, a bad taste in the mouth, or irritated or “itchy” gums. If you notice these, it may be time to get your gums professionally evaluated. Most dental hygienists recommend a cleaning every six months, as that’s when gingivitis commonly returns.

When periodontitis is diagnosed in a dental office, the first step is usually nonsurgical periodontal therapy. This involves scaling and root planing; a thorough cleaning to remove bacteria, plaque, and calculus. Dental hygienists will use special instruments, including ultrasonic scalers, to clean the roots of the teeth and allow the gums to heal. For advanced cases, they may even recommend laser treatment, localized antibiotics, and other adjuncts individualized for your needs. Patients with advanced disease may be referred to a specialist called a periodontist for surgical options to repair the damage that the infection has caused. This might include flap surgeries or bone grafting. 

Home care is an essential part of managing both forms of gum diseases. Brushing twice a day with a soft-bristled toothbrush and cleaning between teeth is not just about preventing cavities, it’s about the gums too. The infection starts in the gum pocket, so cleaning under the gumline is key. Interdental brushes and water flossers often outperform traditional floss at removing bacteria from the gingival pocket around the tooth.

Gum disease may be silent, but its effects are not. Periodontitis has lasting consequences not only for your smile but for your overall health. Fortunately, with early recognition and consistent care it can be managed effectively. If your gums bleed, your breath smells bad, or it’s been more than a year since your last dental visit, now is the time to act. A healthy mouth is a vital part of a healthy body.

Sources: National Institutes of Health. Oral Health in America: Advances and Challenges. U.S. Dept of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research; 2021. 

Richard P. Holm, MD passed away in March 2020 after a battle with pancreatic cancer. He is founder of The Prairie Doc®. For free and easy access to the entire Prairie Doc® ® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook. Katie Pudwill, RDH, PhD, is a registered dental hygienist and educator in South Dakota.