Periodontal Disease (Gum Disease): Causes, Symptoms & Treatment

What Is Periodontal Disease?

Periodontal diseases affect between 30 and 50 percent of the world’s population (x). Periodontal disease, also called gum disease, is a fairly common condition that results from an infection in the mouth. Even though it is common, it can be very severe. It attacks the gums, teeth and surrounding tissues in the mouth, which weakens the teeth.

While gum disease is generally more common in adults, children with poor oral hygiene can also develop the condition. The risk factors include smoking, hormonal imbalance, underlying health conditions, heredity and poor nutrition (x). Treatment may require medication, routine oral cleaning or surgery. With early and well-timed treatment, the prognosis is good. However, if the condition is not treated early, gum disease can cause tooth loss. Maintaining good oral hygiene and prompt treatment for any early signs may help prevent periodontal disease.

Symptoms of Periodontal Disease

The signs of periodontal disease include (x, x):

  • Bleeding gums while eating or brushing the teeth
  • Unusual tenderness in the gums
  • Swollen and red or purple gums
  • Receding gums
  • Pus between the teeth
  • Bad breath
  • Sensitive teeth
  • Unusual taste in the mouth
  • Loose teeth
  • Changes in how the teeth fit together

Stages of Periodontal Disease

There are three major stages of periodontal disease that range in severity and require different forms of treatment (x, x).

Stage 1: Gingivitis

Gingivitis is the first and most mild stage of gum disease. Plaque — a colorless sticky membrane that forms over the teeth — builds up around the gums, causing swelling, inflammation and even bleeding. A deeper space also forms between the gum and the tooth. The patient may not experience any symptoms or it may progress further.

Stage 2: Periodontitis

If gingivitis is not treated, it may get worse and lead to periodontal disease. The inflammation threatens the surrounding bones that support the teeth. The patient may notice the space between the teeth and the gum deepening. The infection begins to destroy the bone and the teeth begin to feel loose.

Stage 3: Advanced Periodontitis

When periodontal disease progresses to the third stage, the patient is at a greater risk of losing teeth and the fibers and bones that prop them up. The pocket between the teeth and gums deepens even more and it can fill with pus. Bone loss continues and the patient’s teeth may hurt to brush and they may also feel sensitive to cold or heat. Sometimes, a dentist must remove the teeth to prevent the disease from spreading.

Symptoms/Stages of Periodontal Disease

What Causes Periodontal Disease?

Periodontal disease develops from bacteria that infect the tissue in the mouth. If the bacteria stay in the mouth long enough, it can cause plaque buildup on the gums and teeth. Plaque development can cause periodontal disease in several stages. First, the sugars and starches in food interact with the natural bacteria in the mouth. This causes plaque to form on the teeth. If the patient does not treat it, the gum line may toughen into tartar, which is harder to remove with brushing or flossing. Removing tartar requires a visit to the dentist (x).

Then, untreated tartar and plaque buildup causes gingivitis. This marks the start of periodontal disease, which can cause inflammation and irritation in the gums surrounding the bottom of the teeth. Without treatment, gingivitis develops into periodontal disease, which creates pockets in between the gums and teeth that typically contain bacteria, plaque and tartar (x).

Risk Factors for Periodontal Disease

There are different factors that may increase the risk of getting periodontal disease (x).


Some individuals are more likely to develop periodontal disease than others due to their genes. However, genes don’t make periodontal disease inevitable. Patients who are highly susceptible to periodontal disease can control or prevent it with excellent oral care (x).


Patients who smoke regularly are more likely to have gum issues. Smoking weakens the immune system and the body is unable to fight off an infection in the gums. Smoking also weakens the effectiveness of treatment and patients may not respond to it (x).

Crooked or Crowded Teeth

Crooked or crowded teeth can make it more difficult to brush or floss, as well as fillings, crowns or dentures. Because the patient may not have easy access to these areas, plaque can accumulate much easier. A periodontist or a dentist can come up with the best ways to keep the teeth clean in these cases (x).


Different types of medicines might cause dry mouth and this may increase the risk for gum disease (x). For example, certain medications for high blood pressure and depression may cause dry mouth. If a patient does not produce enough saliva, they are more likely to develop plaque. This may result in tooth decay and cavities. Some medicines may also make the gums swell, making them more likely to catch plaque, including calcium channel blockers (for chest pain, high blood pressure or heart arrhythmias), immunosuppressants or medications to control seizures.

Underlying Diseases 

Patients with certain medical conditions may have a greater risk of developing periodontal disease. For instance, patients with diabetes are at a higher risk of getting periodontal disease than those without it (x). Other conditions that increase the risk of periodontal disease include inflammation disorders like rheumatoid arthritis (x).

Poor Nutrition 

Nutrition is essential for good overall health, including a healthy mouth and gums and a functional immune system. Researchers associate key nutrient intake with periodontal health. For example, excessive sugar intake is a major contributing factor in plaque formation. On the contrary, major vitamins like vitamin A, vitamin C, vitamin D, vitamin E and vitamin B complex — thiamine, riboflavin, niacin, biotin and folic acid — all play a role in supporting oral health and immune function (x).


According to research, stress can interfere with communications between the immune system and the central nervous system, affecting immune function. Researchers have not identified a specific connection between the two, but it may affect the way the patient’s body responds to bacteria (x).

Grinding, Clenching or Gritting the Teeth

Bruxism is a condition in which a patient grinds, clenches or grinds their teeth. These habits don’t cause periodontal disease. However, they can cause more serious disease if the patient already has inflamed gums. These habits put excessive pressure on the teeth that appears to accelerate damage in the periodontal bone and ligament (x).

Treatment for Periodontal Disease 

In most cases, the condition requires a periodontist to treat it. Treatment mainly aims to thoroughly clean the gaps around the teeth and prevent further damage to nearby bone and tissue. To achieve the best results, patients need to maintain a proper oral care routine as well.

Early Treatment

Early periodontal disease may not require surgical treatment. Patients may receive less invasive medical interventions. For example, oral and topical antibiotics may help keep bacterial infections under control. The patient may also need a procedure called root planing and scaling that smooths down the surfaces of the roots of the teeth to remove plaque from the surface of the teeth and under the gums. It also attempts to prevent it from accumulating further (x).

Advanced Treatment

More severe cases may require may require surgical treatment (x). First, a patient may require regenerative procedures that can support the teeth and potentially reverse some of the damage. For example, a periodontist may use bone grafts, soft tissue grafts, filters or tissue-stimulating proteins to encourage the body to repair and reverse damage (x).

If other treatment methods are not successful, the patient may need pocket reduction surgery to save the teeth. First, the periodontist lifts the gum and rolls it back, removing tartar, bacteria and diseased tissue from the root. Then, they may smooth and reshape the bone if necessary (x, x).


Patients may be able to prevent periodontal disease by using good oral hygiene and visiting a doctor for frequent checkups and treatment. This is also an important part of treatment if an infection occurs. Patients should brush and floss their teeth daily to remove bacteria and visit a dentist at least once a year for checkups, more frequently if the patient shows warning signs of gum disease.

Supplements for Periodontal Disease

Several different supplements may be useful for supporting oral health. However, they are not designed to treat periodontal disease or any other condition. Always consult a doctor before taking any supplements.


Calcium is present in living and nonliving things and it’s the most abundant mineral in the body. However, the body cannot make it on its own, so it’s important to get it from food sources. One of the main benefits of calcium is that it supports strong bones and teeth. As a dietary supplement, take 2,400 mg of calcium citrate supplements with food once or twice a day after confirming the dosage with a doctor.

Vitamin D

Vitamin D is a very important nutrient that regulates calcium, contributing to healthy cartilage, bones and teeth. It also helps support the immune system so that the body can get rid of harmful bacteria that may cause disease, such as periodontitis. The recommended dosage for vitamin D3 (cholecalciferol) supplements is 50 mg per day, using an accurate milligram scale to measure the dosage. Consult a doctor before using this supplement.


Rich in vitamin A, lycopene contributes to skin, eye and heart health. It may also lessen the impact of aging. Lycopene is also an antioxidant, which helps fight off free radicals that play a role in health conditions like cancer, diabetes, heart disease and Alzheimer’s disease. As a dietary supplement, take 200 mg of lycopene powder once or twice a day, or according to a doctor’s instructions.

Cranberry Extract

Cranberry extract is mainly used to maintain and promote good bladder health. It contains lots of useful phytonutrients and antioxidants. But it may also support dental health with flavonoids that can stop dental plaque from accumulating. Research states that it may also help treat gum disease (x). The recommended dosage for cranberry extract powder is 400 mg one to three times a day with lots of water, or as instructed by a physician.

Beta Glucan 

Beta glucan is a type of soluble fiber from plants, oats, barley, algae, bacteria, fungi and yeast. As opposed to insoluble fiber, soluble fiber absorbs water to slow digestion and control blood sugar and cholesterol. While beta-glucan can provide various benefits for weight loss and heart health, it can also support the immune system, which may help the body fend off bacteria that can cause periodontal disease. As a dietary supplement, take 250 mg of beta glucan powder supplements once a day with food, after consulting a physician.


Zinc is the second most abundant mineral in the body behind iron. However, the body cannot produce it on its own, so patients need to get it from diet or from supplements. Zinc plays a key role in immune system defense, possibly combating inflammation and autoimmune diseases. It may help strengthen patients’ immune systems so that they can fight bacteria. Additionally, it is present in saliva, dental plaque and tooth enamel. Manufacturers also include zinc in toothpaste to support oral health. As a dietary supplement, take between 225 and 450 mg of zinc gluconate powder daily. Do not exceed 450 mg under any circumstances and consult a doctor before taking the supplement.

The Bottom Line

Periodontal disease, also known as gum disease, destroys the bone and soft tissue that supports the teeth. Left untreated, it damages the teeth and gums so much that the patient can lose their teeth. It results from bacteria that accumulate in the mouth and form plaque, a sticky membrane that forms over the teeth (x). If plaque isn’t removed, it may toughen and turn into tartar. Signs include swollen gums, an unusual taste in the mouth, bleeding, pain and receding gums.

Treatment usually involves a periodontist thoroughly cleaning the area below the gums to remove plaque and prevent the infection from spreading. In advanced cases, the periodontist may need to perform surgery to regenerate the bones and tissue in the mouth. Without treatment, periodontal disease can eventually cause tooth loss. However, patients can prevent periodontal diseases with proper dental and oral hygiene. There are also supplements that may help support oral and immune health that patients may try. However, they are not a proper treatment for periodontitis or any other condition. Always consult a doctor before adding any supplement to a health regimen.

Author: James D