The most common cause of tooth loss in adults is not decay but gum disease. What is more, it often progresses quietly, without pain.
What do healthy gums look like?
The gum is the firm, pink tissue that surrounds the tooth. Healthy gum hugs the neck of the tooth tightly, does not bleed when you brush and has a slightly stippled surface like orange peel. If the gums are not properly cared for they become diseased and painful, and can even lead to tooth loss.
What causes gum disease?
The main cause is bacterial plaque that builds up on the teeth and along the gum line. If plaque is not cleaned away every day, within a few days it hardens into tartar. Tartar cannot be brushed off; its rough surface lets more bacteria attach and constantly irritates the gum.
Smoking, diabetes, pregnancy, stress, certain medications and genetic predisposition make the disease start more easily and progress faster.
Two stages: gingivitis and periodontitis
Gingivitis
The first stage of the disease. The gums become red and swollen and bleed when brushed. At this stage the inflammation is only in the gum. It heals completely with professional cleaning and regular oral care.
Periodontitis
If gingivitis is not treated, the inflammation spreads to the bone and fibres that hold the tooth. The gum separates from the tooth and a pocket forms between them. As bone is lost the gums recede, the teeth look longer and they start to loosen. Bone loss at this stage is permanent; treatment aims to stop the disease.
Which symptoms should you take seriously?
- Bleeding when brushing or flossing
- Red, swollen, shiny-looking gums
- Persistent bad breath
- Receding gums, black triangles opening between the teeth
- Teeth that loosen or shift
- Pus at the gum line
How is it treated?
The first step is professional removal of plaque and tartar. If pockets have formed, the root surfaces below the gum are also cleaned under local anaesthesia; this is called curettage or deep cleaning. Surgical treatment may be needed in advanced cases. For details see our gum treatment page.
How long the results last depends on care at home. Cleaning in the clinic resets the bacterial load; but plaque forms again every day.
What can you do to protect yourself?
- Brush twice a day with a soft brush, covering the gum line as well.
- Use floss or an interdental brush every day.
- Stop smoking; it both worsens the disease and masks its symptoms by suppressing bleeding.
- If you have diabetes, keep your blood sugar under control.
- Have a check-up every six months and scaling if needed.
Frequently asked questions
Are bleeding gums normal?
No. Healthy gums do not bleed. Bleeding when you brush or floss is usually the first sign of gum inflammation.
Does gum disease affect general health?
Research shows a link between advanced gum disease and diabetes and cardiovascular disease. Gum treatment can also help blood sugar control in people with diabetes.
Does mouthwash treat gum disease?
Mouthwash does not replace brushing and flossing, nor does it remove tartar. It can be used to support treatment when, and for as long as, your dentist recommends.
This article is for general information and is not a substitute for diagnosis or treatment. If you have a complaint, please see your dentist.