Healthy gums

Healthy gums do not bleed, are light pink, firm, resistant to movement and have a smooth appearance. The gums normally form a 'ditchʼ or 'sulcus' that goes completely around the tooth; this is a shallow groove 1-3mm deep at the edge of the gum where the gum is not attached to the tooth.

In a healthy condition, the gums have a strong attachment to the root and underlying bone. The roots of all teeth are sturdily attached to the bone and the gums by many tiny, but very strong ligaments called the periodontal ligaments. They allow minimal movement of the teeth in any direction. 

In a healthy person there are many different microorganisms in the mouth. The bacteria are not destructive to our tissues, but live in harmony with us and actually help our digestive processes.

Periodontal gum disease

Periodontal gum disease is an infection of the periodontal tissues around the tooth: the gums, the ligaments, and the bone. This happens when the balance between the ‘good’ bacteria and the destructive bacteria is disturbed. Pockets of infection form between the teeth and gums, out of reach of normal dental hygiene. They accumulate and form plaque and tartar. Buried deep under the gums, aggressive bacteria produce chemical toxins. They initiate an immune response and erode the connection between the gum and the roots of teeth. The aggressive bacteria involved are mostly ʻanaerobicʼ, meaning they live in low-oxygen environments away from air. The immune systems try to attack these bacteria, but are not always able to fight back completely. As the gums' ligaments detach from the teeth and bone is lost, the infection can spread and go deeper, creating more pockets and worsening the condition. Toxins can spread to the rest of the body causing issues elsewhere. As time passes the pockets deepen, bacteria levels increase, and chemicals contaminate the bone and the root surface. The gum disease then spreads into the underlying bone supporting the teeth causing them to loosen. If the gum disease is not treated early enough, the patient can lose their teeth.

Risk factors for gum disease

Considerations which can modify the onset or aggressiveness of the disease are called ʻrisk factors'. Periodontal gum disease starts when bacteria encounter a weak immune response from an individual (the host). The general state of the immune systems are therefore an important factor in the onset of periodontal disease. The immune systems efficiency is linked to a number of factors. These factors include a person’s level of stress, fatigue, hormonal changes, general health and a number of life-style factors such as diet, exercise, and smoking. Diabetics for example tend to have a higher risk of periodontal disease. Often gum disease progresses silently and flares up in times of stress or other circumstances that suppress the immune systems. 

Besides this, the type of pathogens present in a patient’s mouth, and how many, brings another risk factor. There are pathogenic bacteria, candida, etc associated with periodontitis.

Genetics can also play a role in making some people more susceptible than others. Studies have provided evidence that hormones, heredity, and other host factors influence periodontal disease incidence and severity, we can also test the genetic involvement with gum disease.

Symptoms of gum disease:

  • Bleeding while brushing, flossing, or eating hard food

  • Soft, puffy, swollen gums. Gums can be pink to bright / deep red

  • Sensitivity

  • Receding gums (gingival recession) resulting in apparent lengthening of teeth. (Heavy handed brushing, using a toothbrush that is too hard / too often / non-tapered bristles or other trauma, orthodontics, position of teeth and the bite, thin gum type etc may also cause recessions)

  • Painful or tender gums

  • Occasional gum swellings

  • Loose teeth / moving teeth

  • Pain when chewing

  • Deep pockets between the teeth and the gums, where the attachment has been lost

  • Pus between your gums and teeth. Pus appears when you put pressure on the tooth

  • Toothache when the bacteria reach the nerve at the tip/apex of the root of the tooth

  • Sores in your mouth

  • Bad breath that is not related to food and does not go away

  • Persistent metallic / bad taste in the mouth

  • A change in the way your teeth fit together when you bite

  • A change in the fit of partial dentures

  • Lost teeth

Periodontal disease is often silent, this means that symptoms may not appear until an advanced stage of the disease.

Gum disease & general health concerns

Medical research has linked periodontal disease strongly to other issues in the body. This is because oral pathogens (not only bacteria but also their toxins and other oral pathogens like candida etc) can travel from the mouth to other parts of the body. Links have been found between gum disease and:

  • Heart disease

  • Stroke

  • Respiratory and sinus infections

  • Digestive problems (leaky gut, pancreatic cancer)

  • Alzheimer's disease

  • Arthritis

  • Ulcers

  • Infertility

  • Premature birth

  • Osteoporosis

  • Diabetes (two way relationship)

  • Covid-19

Therefore it is advisable to have a gum check and microbiome test done to see if there are any pathogens lurking in the gums.

(See microbiome testing)