The ‘Quiet Disease’ Lingering in Our Mouths

Nearly half of U.S. adults over 30 show signs of gum disease, which can cause tooth loss. Here’s how to recognize and treat it.

If your spit is sometimes tinged pink at least a couple of times a week after you brush or floss, it’s possible you have early-stage gum disease. But the troublesome condition can also have other surprising symptoms — or none at all.

“It’s a very, very quiet disease,” said Dr. Rodrigo Neiva, chairman of periodontics at Penn Dental Medicine.

According to the U.S. Centers for Disease Control and Prevention, nearly half of U.S. adults over the age of 30 show signs of gum disease, and nine percent have severe gum disease, known as periodontal disease.

When left untreated, gum disease can become more difficult to remedy. “Patients may eventually end up losing their teeth,” Dr. Neiva said. And some research has connected periodontal disease with other undesirable 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, as well as how to prevent it and what dentists can do to manage it.

Understanding the Causes

Early gum disease is called gingivitis and it is characterized by inflammation of the gums (also known as gingiva).

“It is caused by bacteria on teeth — plaque — that release products that irritate the gums,” said Dr. Deborah Foyle, interim department head of periodontics at the Texas A&M University School of Dentistry.

Good oral hygiene is key to preventing gum disease, because it removes plaque from the teeth before bacteria can harm the gums. Often, people develop gingivitis because they aren’t brushing and flossing adequately. Sometimes, only parts of the gums become affected — especially the gums around the backs of the teeth where people often don’t brush as well, Dr. Neiva said.

Dentists can diagnose gingivitis by using a special instrument that measures the distance between gums and teeth, said Dr. Y. Natalie Jeong, professor and chair of the department of periodontology at Tufts University School of Dental Medicine. Larger spaces are indicative of the condition.

When gingivitis is left untreated, the bacteria can invade and destroy the tissues under the gums, causing advanced gum disease, or periodontal disease. “The bone supporting the teeth starts 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 get loose.”

People who smoke, have diabetes or grind their teeth have an increased chance for developing gum disease, Dr. Jeong said. Some medications, such as steroids, and certain epilepsy and cancer drugs, can also increase the risk. Genetics can also make people more or less susceptible, she noted.

People who rarely get cavities may be more likely than other people to get gum disease, too, Dr. Neiva said. That’s because the bacteria that cause gum disease outcompete and suppress the bacteria that cause cavities.

“It’s very common to see patients with very, very advanced periodontal disease not having a single cavity,” he said.

The Warning Signs, and What to Do

Gingivitis often goes unnoticed because it doesn’t cause pain. But people with gingivitis may notice that their gums bleed when they brush or floss their teeth, Dr. Neiva said. The part of the gums adjacent to their teeth may also look red rather than pink.

That said, smokers with gingivitis may not experience any gum bleeding or other symptoms, Dr. Jeong said. “People tend to think, ‘OK, my gums never bleed, I should be just fine,’” she said — but that’s a misconception.

Regular brushing and flossing can help prevent gum disease, but once gingivitis has set in, good oral hygiene at home can’t always fix the problem. That’s because the bacteria may have started to accumulate 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 into more advanced periodontal disease, people may notice that their gums start to recede, causing their teeth to look longer, Dr. Jeong said. They may also experience increased sensitivity around the gums. Their teeth may not fit together the same way when they bite because they have shifted, and they might have chronic bad breath. Eventually, their teeth may start to become loose and even fall out.

Advanced periodontal disease can be incurable. Dentists and periodontists can, however, recommend treatments that slow down 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 frequently as suggested, Dr. Neiva said.

“The sooner we detect it,” he said, “the more we can do.”

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