Gum Diseases: Types, Causes & Symptoms

by Dr. Maneka Vig (BDS) last updated -

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Healthy gums play a major role not only for your dental health but for your overall health as well. Gum diseases may cause irritation, redness, and inflammation of the gums, which is very painful for individuals experiencing it. It is important to take care of your gums and teeth regularly.

Types of Gum Diseases

The cause of most gum diseases is the presence of bacterial plaque. This plaque is a sticky and colorless film that easily attaches itself to the teeth. If left untreated for a long time, these may cause major damage to the bones and soft tissues that support our teeth and may even cause tooth loss. According to an updated classification system developed by the American Academy of Periodontology (AAP) and European Federation of Periodontology (EFP), gum or periodontal diseases can be classified into three major categories which are further sub-divided as follows.

Gum diseases

A. Periodontal health, gingival diseases and conditions

  • Periodontal health and gingival health
  • Gingivitis: Dental Biofilm induced
  • Gingivitis: Non-dental Biofilm induced

B. Periodontitis

  • Necrotizing periodontal disease
  • Periodontitis
  • Periodontitis as a manifestation of systemic disease

C. Other conditions affecting the periodontium

  • Systemic diseases affecting periodontium
  • Periodontal abscess and Endodontic periodontal lesions
  • Mucogingival deformities and conditions
  • Traumatic occlusal forces
  • Tooth and prosthesis-related factors

Any inherited or acquired disorder of the tissues surrounding and supporting the teeth (periodontium) can be defined as periodontal disease. We will limit our discussion to the two most commonly known gum diseases – gingivitis and periodontitis.

Simply put, gingivitis is as follows:

  • The mildest form of gum disease
  • It is caused by the bacterial biofilm (dental plaque) that accumulates on teeth
  • It is reversible if regular oral hygiene is maintained and
  • It does not affect the underlying supporting structures of the teeth

Whereas, periodontitis is as follows:

  • It is not reversible
  • Affects the underlying supporting structures of the teeth and results in the loss of tissue and bone around the teeth leading to tooth loss

Prevalence of Gum Diseases in the United States

Gingivitis is prevalent worldwide and epidemiological studies state that more than 82% of adolescents in the United States suffer from gingivitis and bleeding gums. Periodontitis is widespread among adults in the United States and a study titled “Predicting Periodontitis at State and Local Levels in the United States,” claims that the estimated prevalence of periodontitis in New Mexico is as high as 52.8% and that the overall prevalence for periodontitis is highest in the southeastern and southwestern states and for geographic areas in the Southeast along the Mississippi Delta, as well as along the US and Mexico border.

Causes of Gum Diseases

Gum diseases can occur for many reasons, bacterial infections being the most common. Some of the other reasons include the following.

Poor Oral Hygiene

In case brushing and flossing are not done regularly, gum disease can find a perfect place to develop. According to Dr. Bruce L Pihlstrom (DDS), bacterial biofilm begins to develop on teeth surfaces 24 hours after tooth brushing, flossing is stopped and leads to gingivitis in 10-21 days following cessation of brushing. It is also mentioned that proper tooth cleaning and maintenance of oral hygiene return the gums to a healthy condition in approximately a week.

Wrong Brushing Techniques

In the quest to keep their teeth healthy, people sometimes overdo the brushing of their teeth. Overly vigorous brushing of teeth might actually cause damage to the gums since they are very soft and sensitive. There are many people among us who use the back and forth styles of brushing, which can irritate and damage the gums, causing a recession in the gum line, as well as increasing the frequency of bleeding gums.

Chemotherapy

Swollen and painful, bleeding gums could be an unpleasant side effect of chemotherapy. People undergoing chemotherapy may suffer from stomatitis which gives rise to painful sores and ulcers in the mouth and on the gums. National Institute of Dental and Craniofacial Research (NIDCR) recommends a visit to the dentist before and during chemotherapy to minimize possible side-effects from chemotherapy.

Hormones

Gum problems are experienced by some women during puberty, menstruation, menopause, and pregnancy. Pubertal gingivitis usually peaks when a child is 9 to 14 years old and then decreases after puberty. A review paper published in the Journal of Clinical Periodontology states that increased levels of estrogen and progesterone during pregnancy, puberty, or in patients consuming oral contraceptive pills are responsible for increased blood flow to the gums causing them to become sensitive, red, and swollen. Gingivitis is likely to happen in the second trimester of pregnancy and if left untreated can develop into periodontitis. During this phase, the gums become red, swollen, and might even bleed.

Stress

Several clinical studies have documented a positive relationship between stress and the existence of gum disease. Though all of us experience stress in our day to day lives, it does not mean that all kinds of stress invariably lead to gum problems. It should be kept in mind that long-term stress which happens to be beyond our control (financial stress, stress due to loss of a loved one) is the type of stress that leads to gum diseases. Emotional stress tends to interfere with the normal immune functioning and thus leads to periodontal diseases. Miller et al, in a study of 50 periodontitis patients, chosen at random from a dental clinic, established a positive correlation between a state of anxiety and periodontal disease.

Gingivitis due to Medications and Diseases

Certain medications such as anticonvulsant drugs or drugs used to control blood pressure may cause inflammation in gums. Some blood disorders such as leukemia lead to reduced immunity of gum tissues and such patients may experience swollen, spongy, bleeding gums.

Smoking and Tobacco

Using cigarette and tobacco products is extremely bad for your gums. A study in the Swedish army revealed that soldiers who smoked were more susceptible to oral diseases such as gingivitis and periodontitis than those who did not. Smoking in this study was also associated with bone loss. Another study designed to estimate the proportion of periodontitis in the United States adult population concluded that amongst people who are currently in the habit of smoking in the U.S, 74.8% of their periodontitis was attributable to smoking.

Other

Gum disease may also develop due to certain illnesses such as diabetes or a family history of dental diseases. Results from several studies have been consistent in reporting that people with Type 1 and Type 2 diabetes suffer from more widespread gum diseases as compared to people without diabetes. Also, people with poorly controlled diabetes are at a higher risk of periodontal problems.

Signs and Symptoms

Look for signs and symptoms before the gum disease becomes highly troublesome or medically serious. Some of the noticeable signs of progressive gum disease include:

  • Swollen, red, or tender gums
  • Gums that bleed easily on brushing, flossing etc.
  • Receding gums
  • Bad breath
  • Acute pain caused while chewing
  • The teeth may appear to be long and can become loose and sensitive to heat and cold

The earlier gum diseases are detected; the sooner they can be managed. Make sure you visit your dentist whenever you see any of these symptoms. Symptoms that persist for a long time will require serious attention.

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About the Author

Dr. Maneka Vig, Bachelor of Dental Surgery, is a certified dental surgeon from Maharashtra University of Health Sciences, India with 8 years of experience. Spearheaded the operations for a branch of one of India’s largest dental chains. She is passionate about evidence-based medical writing and its practical applications.

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