Gum disease is the most common reason adults lose teeth, and the most commonly ignored, because in its early stages it does not hurt. If your gums bleed when you brush, that is not normal and it is not something to brush harder at. It is the first sign, and at that stage it is completely reversible.
We are at 115 Christopher Columbus Drive, Suite 200, two minutes from the Grove Street PATH. Call 201-425-8600 or request an appointment.
The two stages, and why the difference matters
Gingivitis is inflammation of the gum only. The gums are red, puffy and bleed when brushed or flossed. Nothing has been lost yet. Treat it properly and the gum returns to health completely.
Periodontitis is what gingivitis becomes if it is left. The inflammation spreads below the gum and starts destroying the bone that holds the teeth in. The gum peels away from the tooth, forming pockets that collect bacteria and cannot be cleaned with a toothbrush.
Here is the part that matters: bone that has been lost does not grow back. Treatment stops the disease and keeps what you have. It does not undo the damage. That is the whole reason for catching it early, and why we would rather see you about bleeding gums than about a loose tooth two years later.
What to look for
- Bleeding when you brush or floss, even a little, even only sometimes
- Gums that look red and swollen rather than firm and pale pink
- Persistent bad breath or a bad taste that comes back however much you brush
- Teeth that look longer, as the gum recedes
- New sensitivity at the gum line, where the root is exposed
- Gaps opening between teeth that were not there before
- Teeth that feel loose or that have shifted position
- Gums that come away from the tooth, or pus around a tooth
The later items on that list mean bone has already gone. The earlier ones mean you are still in the reversible stage.
One thing that fools people
Smokers often have less bleeding, because smoking constricts the blood vessels in the gum. It hides the main warning sign while making the disease itself worse and harder to treat. If you smoke, do not take the absence of bleeding as reassurance.
How we check
We measure. A small probe is walked gently round each tooth to record how deep the gum attaches. Healthy is one to three millimetres. Four and above is a pocket, and the deeper it goes the more support has been lost. X-rays show the bone level directly.
The result is a set of numbers rather than an opinion, which means we can show you exactly where the problem is and compare it at your next visit to see whether treatment worked.
Treatment
For gingivitis
A thorough clean to remove the hardened deposits that brushing cannot shift, and then getting your daily cleaning right. That second part does most of the work. It is unglamorous and it is genuinely what fixes it.
For periodontitis: deep cleaning
Called scaling and root planing. The deposits are removed from the root surfaces below the gum, and the roots are smoothed so the gum can reattach. It is done under local anaesthetic, usually across one or two appointments, treating half or a quarter of the mouth at a time.
Expect some tenderness for a few days afterwards, and be ready for two things people find unsettling. Sensitivity to cold often increases for a few weeks as exposed root surfaces are cleaned. And as the swelling goes down, the gums shrink slightly, so teeth can look a little longer and small gaps may appear. That is the inflammation leaving, not the treatment causing harm. It usually means it has worked.
Afterwards
We re-measure at around eight to twelve weeks to see which pockets have responded. Most do. Any that have not may need further treatment, or referral to a specialist if surgery would help.
The part that actually decides the outcome
Periodontitis is controlled, not cured. The bacteria return, and in someone who has had the disease they cause damage faster than in someone who has not.
So people who have had it move to maintenance cleanings every three to four months rather than the usual six. This is not a way of selling more appointments. Three months is roughly how long it takes the harmful bacteria to re-establish themselves below the gum. People who keep to it mostly keep their teeth. People who drift back to once a year mostly do not.
Most PPO plans cover periodontal maintenance, though many pay for only two cleanings a year, so ask us to check what yours does before you plan around it.
What makes it worse
- Smoking. The single largest risk factor after plaque. It worsens the disease, hides the symptoms, and makes treatment less effective.
- Diabetes. The relationship runs both ways: poorly controlled blood sugar worsens gum disease, and gum inflammation makes blood sugar harder to control.
- Family history. Some people are simply more susceptible. It is not a reflection on how hard you brush.
- Pregnancy and hormonal change, which make gums more reactive. Worth extra attention rather than alarm.
- Some medications, including certain blood pressure and epilepsy drugs, which can cause gum overgrowth. Bring your list.
On the links to general health
You may have read that gum disease is connected to heart disease, diabetes and other conditions. There is a genuine and well-documented association. What is not established is that treating your gums will prevent a heart attack, and anyone telling you it will is going beyond the evidence. Treat your gums to keep your teeth. That reason is good enough.
Sort this out before other treatment
Gum health comes first, before implants, before straightening, before veneers. An implant placed into unhealthy gums fails. Teeth moved through inflamed gum lose support faster. Veneers with a receding gum line look wrong within a few years.
This occasionally disappoints people who came in for something cosmetic, and we still will not skip it.
Who does the work
Dr. Singal earned her Doctorate in Dental Surgery at the New York University College of Dentistry. More about the practice.
We see patients from across downtown Jersey City, including Grove Street, Exchange Place, Journal Square and Newport. For a swollen or painful gum today, see emergency dental care.
My gums bleed when I brush. Is that serious?
It is the earliest sign of gum disease and it is not normal, but at that stage it is completely reversible. Healthy gums do not bleed. Do not brush harder or stop cleaning the area, which is the instinct and makes it worse. Have it looked at.
Can gum disease be cured?
Gingivitis, the early stage affecting only the gum, can be reversed completely. Periodontitis, where bone has been lost, can be stopped and controlled but not reversed, because lost bone does not grow back. That is why catching it early matters so much.
Does a deep cleaning hurt?
It is done under local anaesthetic, so the treatment itself should not. Expect tenderness for a few days afterwards, and sensitivity to cold for a few weeks as cleaned root surfaces settle.
Why do my teeth look longer after treatment?
Because the swelling has gone down. Inflamed gum is puffy and sits higher up the tooth. As it heals it shrinks back to its true level, so teeth can look slightly longer and small gaps may appear. It is a sign the treatment worked, not that it caused harm.
Why do I need cleanings every three months instead of six?
Because periodontitis is controlled rather than cured. Three months is roughly how long the harmful bacteria take to re-establish themselves below the gum, and someone who has had the disease suffers damage faster than someone who has not. People who keep to maintenance mostly keep their teeth.
Will my insurance cover deep cleaning?
Most PPO plans cover scaling and root planing, usually as a percentage. Ongoing periodontal maintenance is often covered too, though many plans pay for only two cleanings a year even when you need four. We check your plan and tell you your share before starting.
Can I lose teeth from gum disease?
Yes. It is the most common cause of tooth loss in adults, and it usually happens without pain, which is why it progresses unnoticed. Teeth become loose once enough of the bone holding them has been destroyed.
Does smoking really make a difference?
A large one. It is the biggest risk factor after plaque itself. It also reduces bleeding by constricting blood vessels, which hides the main warning sign, and it makes treatment less effective. Do not read an absence of bleeding as good news if you smoke.