Periodontal Disease: Good Oral Hygiene vs. Gingivitis and Periodontitis
7 min read
Periodontal disease is an inflammatory disease that affects the supporting structures of a tooth, including the gums and underlying bone. The first stage of periodontitis is called “gingivitis”, a commonly seen gum inflammation. Over time, however, untreated gingivitis can develop into periodontitis, which may result in wobbly teeth or even tooth loss! Periodontal disease is primarily caused by a build-up of bacteria called “dental plaque” around the teeth and gums. The result is bad breath, red gums which bleed easily and soreness. Good oral hygiene can reduce the bacteria accumulation on the teeth and gum, reducing the chances of developing gingivitis and periodontitis. 🦷
What are Periodontal Disease, Gingivitis and Periodontitis?
Gingivitis and periodontitis are different stages of periodontal disease, caused by bacterial infection leading to inflammation. The mouth is a host to multiple different types of bacteria, most of them are beneficial and contribute to a healthy oral environment. However, if the host’s oral hygiene is inadequate, this can lead to an unhealthy buildup of bacteria on the teeth and gum called dental plaque. The balance in mature plaque can shift from good to bad bacteria, which can then lead to dental problems like periodontal disease.
Did you know that plaque starts accumulating on your tooth surface almost immediately after you brush? However, if you brush your teeth twice a day, this is sufficient to prevent plaque from building up. If enough plaque is built up on the teeth and gums, then over time this could cause the gums to become inflamed, otherwise known as gingivitis. With gingivitis, our gums become red, swollen and can bleed during brushing and flossing. There might also be associated bad breath (halitosis) and yellow-grey discoloration on your teeth.
Over time, long standing gingivitis can deteriorate into periodontitis. During periodontitis, bacteria not only has an effect on the gums, but the supporting structures as well (called the periodontium). The periodontium includes the gums, underlying bone and the attachment the bone has with the roots of the teeth (called the periodontal fibers). During periodontitis, long standing infection will start to cause a gradual loss of this periodontium. When more and more support is eroded away, eventually the teeth will become loose causing difficulty in chewing. If the infection is not treated, then this might eventually lead to tooth loss.
Luckily, gingivitis and periodontitis are both preventable diseases. Brushing your teeth twice a day, flossing daily and having regular dental checkups can significantly lower your risk of developing periodontal disease and can improve your recovery from gingivitis and periodontitis.
Causes of Periodontal Disease (Gingivitis and Periodontitis)
Your risk of developing periodontal disease can be influenced by a number of factors, the most common one being poor oral hygiene. Different types of bacteria are naturally present inside the oral cavity. Some of these bacteria can interact with sugar and starches in food, forming a thin, sticky and yellowish film called plaque on your teeth and gums. If you do not clean your teeth properly, plaque will continue to build up. Over time, plaque may mineralize and harden into tartar (also known as calculus), which cannot be removed by brushing and flossing. It then requires professional dental cleaning in order to remove tartar from the teeth.
The longer plaque and tartar remain on your teeth, the more potential damage there could be to your teeth, gums and supporting periodontal structures. Moreover, ongoing gum inflammation can strain the immune system, leading to immunity-related complications.
Risk Factors of Periodontal Disease (Gingivitis and Periodontitis)
Aside from poor oral hygiene, a number of risk factors can increase your risk of developing periodontal diseases (gingivitis and periodontitis):
- Crooked teeth, or dentures that no longer fit properly: Gaps between teeth are difficult to clean by brushing and flossing, and are ideal places for bacteria to hide, populate and develop into plaques.
- Smoking or chewing tobacco: Smokers can be 5 times more likely to develop periodontal diseases compared to non-smokers.
- Medications that cause dry mouth or gum changes, including antidepressants, antihistamines and certain antihypertensive drugs.
- Immunodeficiency: Certain conditions like HIV/AIDS, leukemia or treatments like chemotherapy can suppress your immunity, leading to a higher risk of gum infection and inflammation.
- Diabetes: Uncontrolled diabetes can result in compromised immune systems which can increase your risk of developing periodontitis.
- Recreational drug use and drug abuse, such as smoking marijuana or vaping.
- Stress: Our immune system does not function well when we are under stress.
- Overweight and obesity: People who are overweight tend to have compromised immune systems and chronic low-grade inflammation, which increases the risk of gum inflammation.
- Malnutrition: Gum infection can occur more readily during malnutrition. In particular, those deficient in vitamin C.
- Family history: If you have a family history of periodontal diseases, you are more likely to have gum problems.
- Age: Periodontal disease becomes more common as you get older.
- Pregnancy, the use of oral contraceptives, or hormonal imbalances can result in a higher risk of gum diseases.
Signs and Symptoms of Periodontal Diseases (Gingivitis and Periodontitis)
Healthy gums should be pale, pink and firm. If they bleed during brushing or flossing, it could be the first sign of gingivitis or periodontitis!
The following are some of the early signs and symptoms of gingivitis:
- Bright red, dusky red or purplish gums
- Tender, or swollen gums
- Bleeding gums
- The buildup of plaque or tartar on your teeth
- Sensitive teeth
- Pain when chewing
Gingivitis can develop into periodontitis if oral hygiene is not improved. Signs and symptoms of periodontitis include:
- Bad breath (halitosis)
- Foul taste in your mouth that won’t go away
- Pain or discomfort while chewing
- Receding gum line, exposing the roots of your teeth
- Gum abscesses: collections of pus under your gums or teeth
- Loose teeth or teeth migration, which can make eating difficult
- Loss of teeth
Complications of Periodontal Diseases (Gingivitis and Periodontitis)
If early periodontal disease is not managed early, it could lead to a variety of complications:
- Advanced periodontitis: The periodontium around your teeth may become severely reduced. This will lead to highly mobile teeth which may then require extraction; they might even fall out by themselves!
- Tooth decay: Bacteria in plaque can also produce acid from food sugar. This acid erodes your teeth and causes tooth decay.
- Increased risk for diabetes, rheumatoid arthritis, respiratory problems or heart disease: Bacteria responsible for periodontitis can enter the bloodstream through the gum tissue and blood capillaries, infecting other parts of the body such as the heart.
- Premature labor and underweight newborn: A pregnant woman with severe gum disease may develop premature labor or give birth to an underweight baby.
Diagnosis and Treatment of Periodontal Diseases (Gingivitis and Periodontitis)
If you have painful, swollen gums or if you have regular bleeding when you brush your teeth this might mean you are suffering from Periodontal disease. It is prudent to have this examined by a dentist!
Your dentist will perform a thorough dental examination to check the health of your gums and teeth. The dentist may gently insert a probe in the gap beside your teeth to measure any pockets in your gum. A deeper pocket may indicate more support or periodontium loss. Dental X-rays may also be taken to check the condition of your teeth and jawbones. Any periodontal pockets that have been detected may require teeth scaling and root debridement. Root debridement is a method of deep cleaning which aims to remove plaque and tartar from the teeth roots. You may need a local anesthetic for this procedure to numb the area before treatment. After root planning, the gums might feel sore for a couple of days afterward.
After your gum treatment, your dentist will reassess your gum condition after a couple of months. If your condition doesn’t improve, your dentist may refer you to a periodontist (a specialist in treating periodontal diseases) for further treatment.
Prevention of Periodontal Diseases (Gingivitis and Periodontitis)
Periodontal diseases can be prevented by good oral hygiene and regular professional checkup and cleaning. A good oral hygiene routine includes:
- Brushing your teeth twice a day (in the morning and before bed). Electric and manual toothbrushes are both effective tools to clean your teeth, but some people find that an electric toothbrush allows them to clean their teeth more thoroughly. Dentists generally recommend using toothpaste that contains fluoride, a mineral that protects against tooth decay.
- Flossing after meals or at least once a day. Flossing helps remove food particles and plaque in between your teeth, an area difficult to reach by tooth brushing alone.
- Use antiseptic mouthwashes that contain chlorhexidine, which is available from pharmacies. Mouthwashes cannot remove existing plaque (only regular brushing and flossing can do this), but your dentist may recommend it if it controls plaque buildup. Do not use chlorhexidine mouthwash for more than 4 weeks.
Apart from performing good oral hygiene, you should also:
- Have a dental check-up and teeth scaling at least once a year. Early-stage periodontal disease may be symptomless, needing professional examination to detect. Your dentist or dental hygienist will clean your teeth thoroughly and remove any plaque or tartar. They may also educate you on the proper way to brush and floss your teeth to prevent plaque buildup. Read our guide for a dental check-up.
- Stop smoking. Quit Smoking or Help Your Loved-ones Quit Smoking!
This article was medically reviewed by Dr. Jonathan Lui 雷威鴻醫生. Dr. Jonathan Lui is a specialist in periodontology practicing at the Gum and Implant Dental Center. He is a Fellow of both the Hong Kong Academy of Medicine and the College of Dental Surgeons of HK. He obtained his university education from King's College (GKT) London and his specialist Periodontal training from the University of Hong Kong (HKU).
If plaque is not removed from a tooth, gingivitis can start as early as 1-2 weeks. Untreated gingivitis can have the potential to lead to more serious periodontitis after some time. This period of time depends on each individual, according to their risk profile. People who smoke, suffer from uncontrolled diabetes for example may have more rapid and aggressive periodontium loss than others.
This article was independently written by Healthy Matters and is not sponsored. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.