If your spit is sometimes pinkish at least twice a week after brushing or flossing, you may have early gingivitis. But the troublesome condition can also have other surprising symptoms — or none at all.
“It’s a very, very silent disease,” said Dr. Rodrigo Neiva, chair of periodontics at Penn Dental Medicine.
According to the US Centers for Disease Control and Prevention, almost half of US adults over the age of 30 show signs of gingivitis, and nine percent have severe gingivitis, known as periodontal disease.
When left untreated, gingivitis can become more difficult to treat. “Patients can eventually lose their teeth,” Dr. Neiva said. And some research has linked periodontal disease to other adverse health conditions, such as dementia, diabetes and heart disease.
Here’s everything you need to know about gum disease, including its causes and early symptoms, how to prevent it, and what dentists can do to treat it.
Understanding the Causes
Early gingivitis is called gingivitis and is characterized by inflammation of the gums (also known as gingiva).
“It’s caused by bacteria on the teeth — plaque — that release products that irritate the gums,” said Dr. Deborah Foyle, interim chief of periodontics at Texas A&M University School of Dentistry.
Good oral hygiene is key to preventing gingivitis because it removes plaque from the teeth before bacteria can damage the gums. Often, people develop gingivitis because they don’t brush and floss enough. Sometimes, only parts of the gums are affected — especially the gums around the back of the teeth where people often don’t brush as well, Dr. Neiva said.
Dentists can diagnose gingivitis using a special instrument that measures the distance between the gums and teeth, said Dr. Y. Natalie Jeong, professor and chair of the department of periodontics at Tufts University School of Dental Medicine. Larger spaces are indicative of the situation.
When gingivitis is left untreated, bacteria can invade and destroy the tissues beneath the gums, causing advanced gingivitis or periodontal disease. “The bone that supports the teeth begins to break down, leaving the roots of the teeth exposed and sensitive in some cases,” Dr. Foyle said. “Spaces develop between the teeth and the teeth start to loosen.”
People who smoke have Diabetes or grind their teeth have an increased chance of developing gum disease, Dr. Jeong said. Certain medications, such as steroids and some epilepsy and cancer drugs, can also increase your risk. Genetics can also make people more or less sensitive, he noted.
People who rarely get cavities may be more likely than other people to get gingivitis, too, Dr. Neiva said. This is because the bacteria that cause gum disease compete with and suppress the bacteria that cause tooth decay.
“It’s very common to see patients with very, very advanced periodontal disease not have a single cavity,” he said.
The warning signs and what to do
Gingivitis often goes unnoticed because it does not cause pain. But people with gingivitis may notice that their gums bleed when they brush or floss, Dr. Neiva said. The part of the gums next to their teeth may also appear red rather than pink.
That said, smokers with gingivitis may not experience bleeding gums or other symptoms, Dr. Jeong said. “People tend to think, ‘OK, my gums never bleed, I should be fine,'” she said — but that’s a misconception.
Regular brushing and flossing can help prevent gum disease, but once gingivitis has occurred, good oral hygiene at home can’t always fix the problem. That’s because bacteria may have started to build up below the gum level, Dr. Neiva said. In these cases, a professional cleaning and, sometimes, antibiotics can treat — and cure — gingivitis.
Once gingivitis has progressed to more advanced periodontal disease, people may notice that their gums begin to recede, making their teeth appear longer, Dr. Jeong said. They may also experience increased sensitivity around the gums. Their teeth may not fit the same way when they bite down because they have shifted, and they may have chronic bad breath. Eventually, their teeth may start to loosen and even fall out.
Advanced periodontal disease may be incurable. Dentists and periodontists can, however, recommend treatments that slow or prevent further gum and bone loss. They may also deep clean the roots of affected teeth and recommend gum surgery.
Keeping your gums healthy is ultimately simple: Brush twice a day, floss once a day and see your dentist for cleanings every six months or as often as recommended, Dr. Neiva said.
“The sooner we detect it,” he said, “the more we can do.”
