Periodontal (Gum) Disease

On this page

  1. Overview
  2. Ask the Expert
  3. Causes
  4. Symptoms
  5. Diagnosis
  6. Treatment
  7. Helpful Tips
  8. Additional Resources 
  9. Related Publications
  10. References
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Overview

Information on preventing and treating periodontal (gum) disease and NIDCR’s related research.

Periodontal (gum) disease is an infection that causes inflammation of the tissues that hold your teeth in place. It's typically caused by poor brushing and flossing habits that allow plaque—a sticky film of bacteria—to build up on the teeth. Plaque can harden into tartar (or calculus) which, if not removed, can lead to gum disease. Gum disease starts with swollen, red, and bleeding gums. If left untreated, it can spread to the bones supporting the teeth, making it painful to chew. In the worst cases, teeth may become loose or need to be removed.

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Ask the Expert

NIDCR Deputy Director Jennifer Webster-Cyriaque, D.D.S., Ph.D. answers all your questions about flossing. Read the interview here.

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Causes

Dental plaque, if not removed every day, can harden and form tartar. Only a professional cleaning by a dentist or dental hygienist can remove tartar. Plaque and tartar contain bacteria which can trigger inflammation that damages the gums and supporting tissues around the teeth, causing gum disease. 

There are several risk factors for gum disease, but smoking or using tobacco products is the most significant.1,2,3 Tobacco use can also delay healing and make treatment for gum disease less successful.4 Gum disease is more prevalent and severe in men compared to women.5,6,7 Other risk factors include older age, diabetes, and genetics.8 Stress, certain illnesses, such as rheumatoid arthritis, cardiovascular disease, obesity, AIDS, and the medications used to treat them; and hormonal changes in girls and women are also associated with gum disease.

Children with certain rare genetic conditions called primary immunodeficiency disorders are nearly ten times more likely to develop gum disease due to their weakened immune systems, which struggle to fight off infections that cause gum disease.9

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Symptoms

Gum disease can affect various areas of the mouth.

Affected AreaSymptoms
GumsGums may be red, swollen, or tender.
Gums may bleed easily.
The gums may pull away from the teeth, making the teeth appear longer.
TeethLoose or sensitive teeth
Pain while chewing
OtherPersistent bad breath
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Diagnosis

A dentist or dental hygienist will perform tests to diagnose gum disease:

Diagnostic TestHow it’s doneWhy it’s done
Gum ExaminationThe dentist will examine your gums for signs of inflammation, bleeding, and receding of gums away from the teeth. The dentist will use a tiny ruler called a “probe” to measure the spaces around the teeth (pockets).In a healthy mouth, the pockets around the teeth are usually between 1 and 3 millimeters. Deeper pockets can be a sign of periodontal disease.
Teeth ExaminationThe dentist will check your teeth.In advanced gum disease, the bone supporting the teeth is destroyed which may cause looseness and shifting of teeth in the mouth. 
Medical History SurveyThe dentist will ask questions about your medical history.Certain conditions or risk factors, like tobacco use or diabetes, can contribute to gum disease.
X-rayX-ray images of the teeth and mouth are taken.An x-ray can show if there is any bone loss as a result of gum disease.

Your dental professional may also refer you to a periodontist, a specialist in the diagnosis and treatment of gum disease, who may provide other treatment options not provided by your dentist.

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Treatment

The main goal of treatment is to control the infection. The number and types of treatments will vary, depending on the extent of the gum disease. 

Early gum disease, caused by plaque buildup, can often be reversed by daily brushing and flossing. People with periodontal disease will need to receive treatment from a dentist or dental hygienist. The dentist may conduct “scaling and root planing,” a deep cleaning of the affected tooth, and may discuss how best to clean your teeth and gums, including prescribing medication such as an oral rinse. In advanced cases of gum disease, surgical treatment may be required. Any type of treatment requires that the patient keep up good daily oral health care at home. The dentist may also suggest changing certain behaviors, such as quitting tobacco, as a way to improve your treatment results.

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Helpful Tips

You can keep your gums and teeth healthy by:

  • Brushing your teeth twice a day with a fluoride toothpaste.
  • Flossing regularly to remove plaque from between teeth. You can also use a device such as an interdental (between-the-teeth) brush, a wooden or plastic pick, or a “water flosser” recommended by a dental professional.
  • Visiting the dentist routinely for a check-up and professional cleaning.
  • Quitting all forms of tobacco.
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Additional Resources 

  • Periodontal (Gum) Disease
    Information from the Centers for Disease Control and Prevention (CDC) about the causes of periodontal disease, its warning signs, risk factors, and prevention and treatment.
  • MedlinePlus: Gum Disease
    The NIH National Library of Medicine's collection of links to government, professional, and nonprofit and voluntary organizations with information on periodontal disease and gingivitis.
  • How to Quit Smoking
    Information from the CDC on quitting smoking.
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Cover image for "Older Adults and Oral Health" publication.
Older Adults and Oral Health

Fact sheet on maintaining oral health for a lifetime.

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References

  1. Leite FRM, Nascimento GG, Scheutz F, López R. Effect of smoking on periodontitis: A systematic review and meta-regression. Am J Prev Med. 2018 Jun;54(6):831-841. doi: 10.1016/j.amepre.2018.02.014. Epub 2018 Apr 12.
  2. Alkattan R, Tashkandi N, Mirdad A, Ali HT, Alshibani N, Allam E. Effects of electronic cigarettes on periodontal health: A systematic review and meta-analysis. Int Dent J. 2025 Jun;75(3):2014-2024. doi: 10.1016/j.identj.2024.12.036. Epub 2025 Jan 24.
  3. Quadri MFA, Kamel AM, Nayeem M, John T, Thacheril A, Tartaglia G, et al. Smokeless tobacco and periodontitis: A systematic review with meta-analysis. J Periodontal Res. 2024 Dec;59(6):1062-1070. doi: 10.1111/jre.13274. Epub 2024 May 17.
  4. Apatzidou DA. The role of cigarette smoking in periodontal disease and treatment outcomes of dental implant therapy. Periodontol 2000. 2022 Oct;90(1):45-61. doi: 10.1111/prd.12449. Epub 2022 Aug 11.
  5. Alves T, Swanson KV, Girnary MS, Freire M, Moss K, Divaris K, et al. Inflammasome targeting for periodontitis prevention is sex dependent. Proc Natl Acad Sci U S A. 2025 Nov 4;122(44):e2507092122. doi: 10.1073/pnas.2507092122. Epub 2025 Oct 27.
  6. Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ; CDC Periodontal Disease Surveillance workgroup. Prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res. 2012 Oct;91(10):914-20. doi: 10.1177/0022034512457373. Epub 2012 Aug 30.
  7. Eke PI, Borgnakke WS, Genco RJ. Recent epidemiologic trends in periodontitis in the USA. Periodontol 2000. 2020 Feb;82(1):257-267. doi: 10.1111/prd.12323.
  8. Genco RJ, Borgnakke WS. Risk factors for periodontal disease. Periodontol 2000. 2013 Jun;62(1):59-94. doi: 10.1111/j.1600-0757.2012.00457.x.
  9. Nibali L, Bayliss-Chapman J, Halai H, Somani C, Davies J, Ancliff P, et al. Periodontal status in children with primary immunodeficiencies. J Periodontal Res. 2021 Aug;56(4):819-827. doi: 10.1111/jre.12880. Epub 2021 Apr 3.
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Periodontal (Gum) Disease Research from NIDCR

Last Reviewed
August 2026