About Periodontal (Gum) Disease

Key points

  • Periodontal (gum) diseases, such as gingivitis and periodontitis, are largely preventable and treatable. The key is good oral hygiene, overall self-care, and regular care from a dental health care provider.
  • Periodontal disease refers to conditions that involve inflammation and infection of the tissues (gum and bone) that surround and support the teeth.

Overview

Periodontal (gum) disease is a broad term for conditions involving inflammation and infection of the tissues (gum and bone) that surround and support the teeth. 12

Gingivitis is a type of gum disease that involves inflammation of the gums. It is largely preventable and treatable with a combination of routine oral hygiene and professional cleanings. 12

Periodontitis, which also involves bone loss around teeth, is an irreversible condition that can be slowed down and managed with professional treatment.12

Periodontitis is a very common type of gum disease among US adults:

  • About 4 in 10 US adults 30 years or older had a mild, moderate, or severe level of periodontitis in 2009–2014.3
  • About 1 in 2 men and 1 in 3 women 30 years or older had some level of periodontitis.3

Periodontitis is more common as people age. About 60% of adults 65 years or older had periodontitis in 2009–2014.34

Types

Two of the most common types of gum disease are gingivitis and periodontitis.

Gingivitis

The mildest form of gum disease is gingivitis, an inflammatory condition where the gums become red, swollen, and may easily bleed. Gingivitis is a reversible condition. But if left untreated, it can lead to a gum disease called periodontitis.14

Periodontitis

Periodontitis is a chronic inflammatory condition that leads to mild, moderate, or severe destruction of the supporting tissues around teeth. A main feature of periodontitis is bone loss around the affected teeth.25 Untreated periodontitis can also make other chronic conditions, such as diabetes, worse.16

Periodontitis cannot be reversed, but it can be slowed down and managed with professional treatment. Periodontitis and cavities (tooth decay) are the two leading causes of tooth loss.7

Signs and symptoms

Gum disease can often become serious before a person notices that they have symptoms.1 A yearly dental checkup can help to detect and prevent this condition.

Signs and symptoms of gum disease may include:1

  • Red, swollen, or tender gums.
  • Bleeding gums.
  • Gums that have moved away or downward from your teeth.
  • Loose or sensitive teeth.
  • Painful chewing.
  • Any change in the way your teeth fit together when biting.
  • Any change in how well your partial denture fits.

Risk factors

Research is ongoing to learn more about the risk factors for gum disease. Some studies have indicated an association between gum disease and certain factors or characteristics, including:

  • Smoking.1348
  • Diabetes.4689
  • Poor oral hygiene.410
  • Medication with oral side effects.14
  • Stress.11
  • Genetics.148
  • Malocclusion (crooked teeth), clenching, or bruxism (grinding teeth).14
  • Underlying systemic conditions.14812
  • Hormonal changes, such as with pregnancy or menopause.148
  • Poor nutrition or obesity.1413

Who is at risk

About 62% of US adults 30 years or older who are current smokers had periodontitis in 2009–2014.3

Among US adults 30 years or older, periodontitis also disproportionately affects those who are:3

  • Living below 100% of the federal poverty level (60%).
  • Living with diabetes (60%).
  • Mexican American (60%).
  • Non-Hispanic Black (57%).

Causes

It is normal for some bacteria to live in a healthy mouth.14 Bacteria in the mouth constantly produce and dwell within a sticky, removable film on tooth surfaces called plaque.1

If plaque is left to build up on a tooth, it can lead to inflammation around the tooth and result in gingivitis. Plaque can be removed regularly with toothbrushing and flossing. If it is not removed, it will usually harden into tartar (also called calculus). Tartar buildup cannot be removed with toothbrushing. Professional treatment is needed to remove it.

Bacteria in buildup can spread below the gumline and lead to the formation of a periodontal "pocket." This pocket is an abnormal deepening of the space between tooth surfaces and gum tissues. Bacteria can release toxins in the pocket that make inflammation worse.1215

As this process continues, it contributes to the destruction of gum tissues and bone loss around the teeth, which is a main feature of periodontitis.

Prevention

Gingivitis can be largely prevented and treated with a combination of self-care and professional cleanings. More severe forms of gum disease can be managed by a dental health care provider and may include referral to a specialist called a periodontist.16

To help prevent or manage gum diseases, it is important to:

  • Brush twice daily and floss every day to remove plaque and debris.
  • Get regular professional cleanings.
  • Have a dental checkup at least once a year, or more often if recommended by your health care provider.

Treatment and recovery

Treatment for periodontitis might include:

  • A non-surgical procedure commonly known as "scaling and root planing"17 or “deep cleaning” of the affected tooth and root surfaces.
  • Prescribed medication, such as an oral rinse or medicine placed directly under the affected gums.
  • Surgical procedures.18

What CDC is doing

CDC's Division of Oral Health (DOH) works with key partners to improve and sustain the surveillance of gum disease in the US adult population. These partners have included the American Academy of Periodontology and the American Dental Association.

DOH efforts to monitor and address gum disease include:

  • Developing and testing the validity of measures that can be used to track gum disease at national, state, and local levels.
  • Updating methods to simplify how data on gum disease are collected from National Health and Nutrition Examination Survey participants.
  • Developing simple gum disease screening tools for use in clinical settings.
  • Working to integrate medical and dental care.

Resources

How to Find Low-Cost Dental Care

Information on how to find low-cost dental care through community health centers, dental schools, and other resources can be found at:

More Information About Periodontal Disease

Podcasts About Periodontal Disease and Diabetes

Listen to Summary: Periodontal Disease and Diabetes Podcast. Information on the impact of periodontal disease and its link to diabetes (Length 1:36). View transcript.

Listen to Periodontal Disease and Diabetes Podcast. Interview with two dental professionals about periodontal disease, diabetes complications, and the influence of poor oral health on blood glucose control (Length 5:33). View transcript.

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Content Source:
National Center for Chronic Disease Prevention and Health Promotion; CDC Division of Oral Health
  1. American Academy of Periodontology. Gum Disease Information. Accessed December 18, 2023. https://www.perio.org/for-patients/gum-disease-information/
  2. Page RC, Eke PI. Case definitions for use in population-based surveillance of periodontitis. J Periodontol. 2007;78(7 suppl):1387–1399. https://doi.org/10.1902/jop.2007.060264
  3. Eke PI, Thornton-Evans GO, Wei L, Borgnakke WS, Dye BA, Genco RJ. Periodontitis in US adults: National Health and Nutrition Examination Survey 2009–2014. J Am Dent Assoc. 2018;149(7):576–588. https://doi.org/10.1016/j.adaj.2018.04.023
  4. National Institutes of Health. Oral Health in America: Advances and Challenges. US Dept of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research; 2021. Accessed January 3, 2024. https://www.nidcr.nih.gov/sites/default/files/2021-12/Oral-Health-in-America-Advances-and-Challenges.pdf
  5. Eke PI, Page RC, Wei L, Thornton-Evans G, Genco RJ. Update of the case definitions for population-based surveillance of periodontitis. J Periodontol. 2012;83(12):1449–1454. doi:10.1902/jop.2012.110664
  6. Simpson TC, Clarkson JE, Worthington HV, et al. Treatment of periodontitis for glycaemic control in people with diabetes mellitus. Cochrane Database Syst Rev. 2022;4(4):CD004714. https://doi.org/10.1002/14651858.CD004714.pub4
  7. Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W. Global burden of severe tooth loss: a systematic review and meta-analysis. J Dent Res. 2014;93(7 Suppl):20S–28S. doi:10.1177/0022034514537828
  8. Page RC, Beck JD. Risk assessment for periodontal diseases. Int Dent J. 1997;47(2):61–87. doi:10.1111/j.1875-595x.1997.tb00680.x
  9. Sanz M, Ceriello A, Buysschaert M, et al. Scientific evidence on the links between periodontal diseases and diabetes: consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International Diabetes Federation and the European Federation of Periodontology. J Clin Periodontol. 2018;45(2):138–149. doi:10.1111/jcpe.12808
  10. Theilade E, Wright WH, Jensen SB, Löe H. Experimental gingivitis in man. II. A longitudinal clinical and bacteriological investigation. J Periodontal Res. 1966;1:1–13. doi:10.1111/j.1600-0765.1966.tb01842.x
  11. Peruzzo DC, Benatti BB, Ambrosano GM, et al. A systematic review of stress and psychological factors as possible risk factors for periodontal disease. J Periodontol. 2007;78(8):1491–1504. doi:10.1902/jop.2007.060371
  12. Parker ML, Thornton-Evans GO, Wei L, Griffin SO. Prevalence of and changes in tooth loss among adults aged ≥50 years with selected chronic conditions — United States, 1999–2004 and 2011–2016. MMWR Morb Mortal Wkly Rep. 2020;69:641–646.
  13. Keller A, Rohde JF, Raymond K, Heitmann BL. Association between periodontal disease and overweight and obesity: a systematic review. J Periodontol. 2015;86(6):766–776. doi:10.1902/jop.2015.140589
  14. Fu Y, Rubio AH, Gscheider C, et al. Oral and Dental Infections: Bacteria. In Encyclopedia of Infection and Immunity. 2022;3:346–362. Accessed December 18, 2023. https://doi.org/10.1016/B978-0-12-818731-9.00207-X
  15. Newman MG, Takei HH, Klokkevold PR, Carranza FA. Carranza's Clinical Periodontology. 10th ed. Saunders Elsevier; 2006.
  16. American Academy of Periodontology. What is a periodontist? Accessed December 18, 2023. https://www.perio.org/for-patients/what-is-a-periodontist/
  17. American Academy of Periodontology. Non-Surgical Treatments. Accessed December 18, 2023 https://www.perio.org/for-patients/periodontal-treatments-and-procedures/non-surgical-treatments/
  18. American Academy of Periodontology. Surgical Procedures. Accessed January 16, 2023. https://www.perio.org/for-patients/periodontal-treatments-and-procedures/surgical-procedures/