Gum disease

Causes of gum disease

Gum disease is usually caused by a build-up of plaque on teeth and along the gum line. Plaque is a sticky coating containing bacteria. The immune system tries to get rid of plaque with an inflammation response. This is seen as redness and swelling of the gum around the tooth.

Everybody has a range of bacteria in their mouth. Plaque is constantly being formed by some of these bacteria when they feed on the sugars in the foods and drinks you consume. Plaque provides the perfect environment for the bacteria that can cause gum disease and tooth decay to live and multiply.

Stages of gum disease

The two main stages of gum disease are:

• gingivitis
• periodontitis.

Gingivitis

Gingivitis is early gum disease. It affects the surface layers of the gum, particularly where the gum meets the tooth. At this stage, there is no damage to the deeper parts of the gums, teeth or bone.

The signs of gingivitis are:

• bleeding gums, especially when brushing or eating
• redness and swelling of the gum.

The good news is that gingivitis can be reversed.

Do not stop brushing if your gums are red or puffy. Try to keep brushing with a soft toothbrush, as this will get rid of the bacteria and plaque that are causing the problem. Soon the gums should look and feel better. If your gums do not improve or keep bleeding, after four weeks, see your oral health professional.

Periodontitis

The job of the gum is to provide a protective covering for the bone that holds your teeth in place. The periodontium is the name given to the group of gum and bone structures that surround and support the teeth, keeping them in place. The gum protects the periodontium by forming a seal that runs around the neck of the tooth.

Periodontitis is the inflammation of the periodontium, caused by the bacteria in plaque and the body’s immune response to it.

Periodontitis is an advanced stage of gum disease that may occur if gingivitis is not treated.

The structures affected by periodontitis include the covering of the tooth root (cementum), the bone and the fibres that connect the tooth root to the bone (periodontal ligament).

When the seal of the gum is damaged by gum disease, spaces can form between the tooth root and the gum. These spaces are called ‘periodontal pockets’. Bacteria get trapped in these pockets and cause even more damage to the periodontium. Over time, bone is damaged and lost, and larger spaces begin to form between the tooth and the gum. These gaps can look like black triangles between the teeth, which an oral health professional cannot “fill”.

If periodontitis is not treated, the structures that hold the tooth firmly into the gum can become so damaged that teeth become loose, painful and may need to be removed.

Smoking and poorly managed diabetes are risk factors for periodontitis.

Signs of periodontitis include:

• bleeding gums
• red/swollen gums
• receding gums (the gum line shrinks away from the tooth making teeth look longer)
• bad breath
• a bad taste in the mouth
• tenderness when biting
• loose teeth, or teeth that have moved

Make an appointment with your oral health professional if you think you have any of these signs. They can talk with you about how to care for your teeth. They can also professionally remove plaque and hardened plaque (calculus). This helps the gums to attach back to the tooth. Early treatment of periodontitis can save affected teeth.

If gum disease is not under control it can impact your health and have negative effects on heart health, and worsen diabetes. Keeping your gums clean and healthy, helps keep your heart and other systems healthy too.

Prevention of gum disease

Regular tooth brushing helps to prevent gum disease by removing the plaque that causes it. Remember to:

• Brush your teeth and along the gum line twice a day – in the morning and before going to bed.
• Use a toothbrush with a small head and soft bristles, and a fluoride toothpaste from the age of 18 months.
• Use floss, interdental brushes, or another tool recommended by an oral health professional to clean in between teeth.
• Clean dentures every day. Plaque can easily build up on dentures, increasing the risk of gum disease around your natural teeth. Read more about caring for your dentures and your mouth.

Other things that can help to prevent gum disease:

• Quitting smoking. Information about how to quit is available from Quitline tel. 13 78 48
• for people with diabetes, keeping blood sugar levels well-controlled will help to reduce the risk of gum disease
• avoiding sugary foods and drinks, especially between meals
• drinking plenty of water (fluoridated where possible)

Have a dental check-up

See your oral health professional if you have swollen or bleeding gums, or you are worried about anything to do with your mouth. Getting treatment early can help save teeth affected by gum disease.

Ask your oral health professional how often you should visit for a check-up.

Where to get help

• Your oral health professional (dentist)
• Dental Health Services Victoria provides public dental services through the Royal Dental Hospital of Melbourne and community dental clinics, for eligible people. For information about public dental services call (03) 9341 1000 or 1800 833 039 (outside Melbourne metro)
• Australian Dental Association 'Find a Dentist' or Tel. (03) 8825 4600
• Periodontist