What is gum disease?

What is scaling and root planing(deep cleanings)?


What is gum disease?

Gum disease is a bacterial infection of the tissues and bones that surround and support the teeth. It is also called periodontal disease.

Gingivitis is mild gum disease that only affects the gingiva, or gums, the tissue surrounding the teeth. Gum disease that progresses and spreads below the gum line to damage the tooth-supporting tissues and bone is called periodontitis.

  • Gingivitis causes red, swollen gums that bleed easily when brushed. Because gingivitis usually doesn't cause pain, many people don't get the treatment they need.
  • Periodontitis develops if gum disease progresses. The gums pull away from the teeth, leaving deep pockets where bacteria can grow and damage the bone that supports the teeth. Gums can also shrink back, or recede. This can make the teeth look longer. Teeth may become loose, fall out, or have to be removed.

What causes gum disease?

Your mouth constantly produces a clear, sticky substance called plaque that contains bacteria. The bacteria in plaque make poisons, or toxins, that irritate the gums and cause the tissues to break down. If you don't do a good job of removing plaque from your teeth, it can spread below the gum line and damage the bone that supports the teeth. With time, plaque hardens into a substance called tartar that has to be removed by a dentist or dental hygienist.

You are more likely to get gum disease if you:

  • Do not clean your teeth well.
  • Smoke or use spit tobacco.
  • Have gum disease in your family.
  • Have a condition that makes it harder for your body to fight infection, such as:
    • Uncontrolled diabetes, AIDS, or leukemia.
    • A high level of stress.
    • A diet low in nutrients.

What are the symptoms?

Healthy gums are pink and firm, fit snugly around the teeth, and do not bleed easily. Early-stage gum disease (gingivitis) causes:

  • Gums that are red, swollen, and tender.
  • Gums that bleed easily during brushing or flossing.

As gum disease advances, it causes more noticeable symptoms, such as:

  • Gums that pull away or recede from the teeth.
  • Persistent bad breath.
  • Pus coming from the gums.
  • A change in how your teeth fit together when you bite.
  • Loose teeth.

How is gum disease diagnosed?

To diagnose gum disease, your dentist will do an exam to look for:

  • Bleeding gums.
  • Hard deposits (calculus or tartar) above and below the gum line.
  • Areas where your gums are pulling away or receding from your teeth.
  • Pockets that have formed between your teeth and gums.

Your dentist or dental hygienist may take X-rays of your teeth to look for bone damage and other problems.

How is it treated?

If you have gingivitis, you will probably be able to reverse it with daily brushing and flossing and regular cleanings at your dentist's office.

If your gum disease has advanced to periodontitis, your dentist or dental hygienist will clean your teeth using a method called root planing and scaling. This removes the plaque and tartar buildup both above and below the gum line. You may also need to take antibiotics to help get rid of the infection in your mouth. If your gum disease is severe, you may need to have surgery.

How can I prevent gum disease?

While gum disease is most common in adults, it can affect anyone, even children, so good dental habits are important throughout your life:

  • Brush your teeth twice a day, in the morning and before bedtime, with a fluoride toothpaste.
  • Floss once a day.
  • Visit your dentist for regular checkups and teeth cleaning.
  • Don't use tobacco products.

Having gum disease may increase a pregnant woman's risk of having a premature, low-birth-weight baby.1 Also, a recent study of older adults found a direct link between heart disease and the bacteria that cause gum disease.2 So taking good care of your teeth and gums may have benefits beyond keeping your mouth healthy.

What Increases Your Risk

You are more likely to have gum disease if you don't brush and floss your teeth regularly or well enough to remove plaque.

You are at greater risk for gum disease if:

  • You smoke cigarettes or use spit tobacco. Tobacco use is believed to be one of the biggest risks for gum disease. Tobacco decreases your ability to fight infection, interferes with healing, and makes you more likely to have serious gum disease that results in tooth loss.
  • Gum disease runs in your family. If you have a family history of gum disease, you are much more likely than normal to develop it, even if you take good care of your teeth and gums.
  • You are a woman going through the hormonal changes caused by puberty, menopause, or pregnancy.
  • You have a disease that reduces your ability to fight infection, such as uncontrolled diabetes, AIDS, or leukemia.
  • You are under a lot of stress. Stress can weaken your immune system and make you more likely to develop infections.
  • You eat a diet that is low in vitamins and minerals, which can weaken your immune system, or high in sugary foods and other carbohydrates (grains, pasta, bread), which help plaque grow.
  • You take certain medicines, such as:
    • Seizure-control drugs like phenytoin (Dilantin, Phenytek).
    • Calcium channel blockers, which are used to control high blood pressure or for people with certain heart problems.
    • Cyclosporine, a medicine that suppresses the immune system. It is used to keep the body from rejecting transplanted organs.
    • Birth-control pills.

Symptoms

Early-stage gum disease (gingivitis) causes:

  • Red, swollen, tender gums.
  • Gums that bleed easily when brushed or flossed. Healthy gums do not bleed with regular brushing and flossing.

Because gingivitis usually isn't painful, you may not notice the symptoms and may not get the treatment you need. If you don't get treated, the disease will progress.

Advanced gum disease (periodontitis) causes more noticeable symptoms, such as:

  • Gums that pull away or recede from the teeth.
  • Persistent bad breath.
  • Pus coming from the gums.
  • A change in how your teeth fit together when you bite, or a change in the fit of partial dentures.
  • Loose teeth.

Treatment Overview

Early treatment of gum disease is very important. The goals of treatment are to prevent gum disease from permanently damaging tissues, control infection, and prevent tooth loss. For treatment to be effective, you will need to:

  • Keep your teeth clean by brushing twice a day and flossing once a day.
  • See your dentist regularly for checkups and cleanings.
  • Avoid all tobacco use. Tobacco decreases your ability to fight infection, interferes with healing, and makes you more likely to have serious gum disease that results in tooth loss.

Treatment for early-stage gum disease

If you have early-stage gum disease (gingivitis), you may be able to reverse the damage to your gums:

  • Brush your teeth twice a day, in the morning and before bedtime.
  • Floss your teeth once a day.
  • Use an antiseptic mouthwash, such as Listerine, or an antiplaque mouthwash.

Your dentist will want to see you for regular checkups and cleanings. Professional cleaning can remove plaque and tartar that brushing and flossing missed. Once you have had gum disease, you may need to see your dentist every 3 or 4 months for follow-up.

Your dentist may prescribe antibiotics to help fight the infection. They can be applied directly on the gums, swallowed as pills or capsules, or swished around in your teeth as mouthwash. Your dentist may also recommend an antibacterial toothpaste that reduces plaque and gingivitis when used regularly.

Treatment for advanced gum disease

Early-stage gum disease (gingivitis) that is not treated promptly or that does not respond to treatment can progress to periodontitis. Periodontitis requires prompt treatment to get rid of the infection and stop damage to the teeth and gums, followed by long-term care to maintain the health of your mouth.

  • Your dentist or dental hygienist will remove the plaque and tartar both above and below your gum line. This procedure, called root planing and scaling, makes it harder for plaque to stick to the teeth.
  • Your dentist may give you antibiotics to kill bacteria and stop the infection. They may be applied directly on the gums, swallowed as pills or capsules, or inserted into the pockets in your gums.
  • You may need surgery if these treatments don't control the infection or if you already have severe damage to your gums or teeth. Surgery options may include:
    • Gingivectomy, which removes and reshapes loose, diseased gum tissue to get rid of the pockets between the teeth and gums where plaque can accumulate.
    • A flap procedure, which cleans the roots of a tooth and repairs bone damage.
    • Extraction, to remove loose or severely damaged teeth.
  • After surgery, you may need to take antibiotics or other medicines to aid healing and prevent infection.

After treatment, you will need to keep your mouth disease-free by preventing plaque buildup. You will need to brush carefully and thoroughly after all meals and snacks and floss daily. Your dentist will probably prescribe an antibacterial mouthwash.

Your dentist will schedule follow-up appointments every 3 to 4 months for cleaning and to make sure that the disease has not returned.

Prevention

You usually can prevent gum disease by brushing and flossing regularly, having regular dental visits for exams and cleaning, and eating a balanced diet.

Practice good dental habits:

  • Brush your teeth twice a day, in the morning and before bedtime, using fluoride toothpaste. Clean all sides of your teeth, and also brush your tongue. Plaque on the tongue can cause bad breath and is an ideal environment for bacteria. If you can't brush, chew sugar-free gum, especially one with xylitol.
  • Try an electric toothbrush that has a rotating and oscillating (back-and-forth) action. This type of toothbrush is better at removing plaque than a regular toothbrush.3 Look for one that has the American Dental Association (ADA) Seal of Acceptance.
  • Use an antiseptic mouthwash, such as Listerine, or a fluoride or antiplaque mouthwash.
  • Floss once a day. Any type of floss works, so choose a type you like. Curve the floss around each tooth into a U-shape, and gently slide it under the gum line. Move the floss firmly up and down several times to scrape off the plaque.
  • Use disclosing tablets periodically so you can see if you are brushing effectively. Disclosing tablets are chewable and will color any plaque left on the teeth after brushing. They are available at most drugstores.
  • See your dentist regularly as recommended to have your teeth cleaned and checked.

If your gums bleed when you brush or floss, the bleeding should stop as your gums become healthier and tighter to your teeth. However, bleeding gums may be a symptom of gum disease and should be brought to the attention of your dentist.

Making wise food choices can help you prevent gum disease:

  • Eat a healthy diet that includes whole grains, vegetables, and fruits; is low in fat and saturated fat; and low in sodium. Good nutrition is vital for children, whose teeth are still developing, and for adults in order to maintain healthy gums and avoid tooth decay. For more information on making good food choices, see the topic Healthy Eating.
  • Mozzarella and other cheeses, peanuts, yogurt, and milk are good for your teeth. They help clear the mouth of harmful sugars and protect against plaque.
  • Avoid foods that contain a lot of sugar, especially sticky, sweet foods like taffy and raisins. The longer sugar stays in contact with the teeth, the more damage it will do.
  • Avoid bedtime snacks.

If you smoke or use spit tobacco, one of the best things you can do for yourself is to quit. Tobacco decreases your ability to fight infection and delays healing. Tobacco users are much more likely to develop gum disease--up to 6 times more likely--than nonsmokers. They also have more serious gum disease that leads to tooth loss and that doesn't respond as well to treatment.4 Quitting is difficult, but many people find success through a combination of medicine, a stop-smoking program, and counseling. For more information on how to quit, see the topic Quitting Tobacco Use.

Antibiotics

Antibiotics kill bacteria. Since plaque contains bacteria, antibiotics will reduce the amount of plaque in your mouth, reversing gum disease and allowing your gums to heal.

Dentists prescribe antibiotics in different forms to treat gum disease. They can be applied directly on the gums (topical), swallowed as pills or capsules, swished around on your teeth as mouthwash, or inserted into the pockets of advanced gum disease. Some medicated toothpastes contain an antibacterial ingredient that reduces plaque and gingivitis when used regularly. Ask your dentist if this type of product would benefit you.

Why They Are Used

  • Antibiotic mouthwash may be prescribed for use after brushing and flossing to reduce bacteria in your mouth.
  • Topical antibiotics may be prescribed to treat early-stage gum disease (gingivitis) that cannot be slowed by improving brushing and flossing habits.
  • Topical antibiotics may be prescribed to treat mild forms of advanced gum disease (periodontitis).
  • Sustained-release antibiotics may be inserted into the gum pocket for periodontitis.
  • Antibiotic pills or capsules may be prescribed to treat moderate to severe periodontitis.

How Well They Work

If antibiotic treatment is combined with proper brushing and flossing habits, gum disease can sometimes be stopped, and gums will become pink and healthy again.

Side Effects

Some possible side effects of antibiotic pills include:

  • Shortness of breath.
  • Puffiness or swelling around the face.
  • Rash.
  • Bad taste in the mouth.
  • Upset stomach.
  • Diarrhea.

Sometimes switching to a different medicine will reduce or eliminate these side effects.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Antibiotic mouthwashes should not be swallowed but swished around in your mouth and then spit out.

Bacteria that cause disease can become resistant to medications used to treat those diseases or illnesses. When this happens, the medications are no longer effective at killing or controlling the bacteria that cause the disease. Be sure to take antibiotics exactly as they are prescribed and for the exact amount of time prescribed, and never use leftover antibiotics for a different illness.

Flap procedure for gum disease

You may need surgery for severe gum disease (periodontitis) if it cannot be cured with antibiotics or root planing and scaling. A flap procedure cleans the roots of a tooth and repairs bone damage caused by gum disease. A gum specialist (periodontist) or an oral surgeon often performs the procedure.

Before the procedure, you will be given a local anesthetic to numb the area where the doctor will work on your gums.

The doctor will pull back a section of your gums to clean the roots of your teeth and repair damaged bone, if necessary. The gum flap will be sewn back into place and covered with gauze to stop the bleeding.

Bone may be:

  • Smoothed and reshaped so that plaque has fewer places to grow.
  • Repaired (grafted) with bone from another part of the body or with man-made materials. The doctor may place a lining on the bone graft to help the bone grow back. The lining may need to be removed later.

What To Expect After Surgery

Typically, it takes only a few days to recover from a flap procedure. Be sure to follow the home care instructions that your dentist or oral surgeon gives you. If you have questions about your instructions, call the dentist or surgeon. The following are general suggestions to help speed recovery:

  • Take painkillers as prescribed.
  • Rinse your mouth gently with warm salt water several times a day to reduce swelling and relieve pain.
  • Change gauze pads before they become soaked with blood.
  • Relax after surgery. Strenuous physical activity may increase bleeding.
  • Eat soft foods such as gelatin, pudding, or light soup. Gradually add solid foods to your diet as the area heals.
  • Do not lie flat. This may prolong bleeding. Prop up your head with pillows.
  • Continue to carefully brush your teeth and tongue.
  • Apply an ice or cold pack to the outside of your mouth to help relieve pain and swelling.
  • Do not use sucking motions, such as when using a straw to drink.
  • Do not smoke.

A few days after the procedure, your dentist will remove the stitches.

Why It Is Done

The flap procedure is necessary when severe gum disease (periodontitis) has damaged the bones that support your teeth.

How Well It Works

If you maintain good dental care after the surgery, the flap procedure should help stop your gum disease. Your gums should become pink and healthy again.

Risks

The roots of your teeth may become more sensitive.

The contour or shape of your gums may change.

Gum surgery can introduce harmful bacteria into the bloodstream. Gum tissue is also at risk of infection. You may need to take antibiotics before and after surgery if you have a condition that puts you at high risk for developing a severe infection, such as:

  • Damaged or artificial heart valves.
  • A congenital heart defect.
  • An impaired immune system.
  • Liver disease (cirrhosis).
  • Artificial joints, such as a hip replacement.
  • A history of bacterial endocarditis.

What To Think About

  • A flap procedure is often needed to save teeth that are supported by a bone damaged by gum disease.
  • Gum disease usually will come back if you do not brush and floss regularly after surgery.
  • To promote healing, stop all use of tobacco. Smoking or using spit tobacco decreases your ability to fight infection of your gums and delays healing. For more information, see the topic Quitting Tobacco Use.
  • You will need to see your dentist regularly so that he or she can follow your progress. If your gum disease spreads, you may lose teeth.

Gingivectomy for gum disease

You may need surgery for severe gum disease (periodontitis) if it cannot be cured with antibiotics or root planing and scaling. A gingivectomy removes and reshapes loose, diseased gum tissue to get rid of pockets between the teeth and gums. A gum specialist (periodontist) or oral surgeon often will do the procedure.

The doctor will start by numbing your gums with a local anesthetic. He or she may use a laser to remove loose gum tissue.

After removing the gum tissue, the doctor will put a temporary putty over your gum line. This will protect your gums while they heal. You can eat soft foods and drink cool or slightly warm liquids while the putty is in place and your gums are healing.

What To Expect After Surgery

You can return to your normal activities once the anesthetic wears off. It usually takes a few days or weeks for the gums to heal.

Most gum surgeries are fairly simple and are not too uncomfortable. You can take aspirin, ibuprofen (such as Advil or Motrin), or acetaminophen (such as Tylenol) to reduce pain. After a gingivectomy, it will be easier for you to keep your teeth and gums clean.

The contour or shape of your gums may change.

Why It Is Done

A gingivectomy is necessary when the gums have pulled away from the teeth, creating deep pockets. The pockets make it hard to clean away plaque. Gingivectomy is usually done before gum disease has damaged the bone supporting your teeth.

How Well It Works

If you maintain good dental care after surgery, a gingivectomy is likely to help stop gum disease. Your gums should become pink and healthy again.

Risks

Gum surgery can introduce harmful bacteria into the bloodstream. Gum tissue is also at risk of infection. You may need to take antibiotics before and after surgery if you have a condition that puts you at high risk for developing a severe infection, such as:

  • Damaged or artificial heart valves.
  • A congenital heart defect.
  • An impaired immune system.
  • Liver disease (cirrhosis).
  • Artificial joints, such as a hip replacement.
  • A history of bacterial endocarditis.

What To Think About

  • Gingivectomy may help keep gum disease from further damaging your gum tissue, teeth, and bones by helping you to clean better around and between your teeth. If bones are damaged, it is more likely that you will lose your teeth.
  • Gum disease usually will progress if you do not brush and floss regularly after surgery or if you continue to use tobacco.
  • To promote healing, stop all use of tobacco. It decreases your ability to fight infection of your gums and delays healing. For more information, see the topic Quitting Tobacco Use.
  • Regular follow-up with your dentist is important. If your gum disease gets worse, you may need a different type of surgery.

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What is scaling and root planing(deep cleanings)?

Root planing and scaling is one of the most effective ways to treat gum disease before it becomes severe. For more information on gum disease please see the question above. Root planing and scaling cleans between the gums and the teeth down to the roots. Your dentist may need to use a local anesthetic to numb your gums and the roots of your teeth.

Some dentists will use an ultrasound tool for the planing and scaling. It is less uncomfortable than a standard scraping tool, but not all dentists have this type of tool.

Your dentist may place antibiotic fibers into the pockets between your teeth and gums. The antibiotic will help speed healing and prevent infection. The dentist will remove the fibers about 1 week after the procedure.

What To Expect After Treatment

If anesthesia is used, your lips and gums may remain numb for a few hours. Planing and scaling causes little or no discomfort.

Why It Is Done

Root planing and scaling is done when gums have either started to pull away from the teeth or the roots of the teeth have hard mineral deposits (tartar) on them.

How Well It Works

If you maintain good dental care after the procedure, the progression of gum disease should stop, and your gums will heal and become firm and pink again.

Risks

Root planing and scaling can introduce harmful bacteria into the bloodstream. Gum tissue is also at risk of infection. You may need to take antibiotics before and after surgery if you have a condition that puts you at high risk for developing a severe infection, such as:

  • Damaged or artificial heart valves.
  • A congenital heart defect.
  • An impaired immune system.
  • Liver disease (cirrhosis).
  • An artificial joint, such as a hip replacement.
  • A history of bacterial endocarditis.

What To Think About

  • Root planing and scaling is a simple procedure that can be very effective in stopping gum disease.
  • Brush and floss regularly afterward. Without proper dental care, your gum disease may progress.

To promote healing, stop all use of tobacco. It decreases your ability to fight infection of your gums and delays healing.

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