Gum Disease: Causes, Symptoms, Treatments and Costs

Let's talk about gum disease. The bad news is that 75% of Americans will develop gum disease in their lifetime.¹ The good news is that while gum disease is common, it's also largely preventable.²

Here's a closer look at gum disease — including its causes, symptoms and treatments — to learn more about this prevalent condition.

What Is Gum Disease?

Gum disease (periodontal disease) is an infection of the gum tissues that hold your teeth in place,³ commonly caused by plaque on your teeth or gumline that has hardened into tartar.² This bacterial infection involves not just the gums, but sometimes even the bone that surrounds your teeth.⁴ Gum disease can affect one tooth or many teeth⁴ — and in advanced stages, it can lead to loss of teeth.³

Gum Disease Symptoms

Gum disease is often silent, which means you may not see symptoms until the disease has reached an advanced stage.⁵ Still, it's wise to watch for these warning signs of gum disease:

• Red, swollen, or tender gums.⁵ If your gums are healthy, they should be firm and pale pink, and fit snugly around your teeth.²
• Bleeding while brushing or flossing.⁵ If you see a pink-tinged toothbrush after brushing — or you're spitting out blood when brushing or flossing — it can be a sign of gum disease.²
• Receding gums.⁵ You may notice that when your gums pull away from your teeth, your teeth look longer than they were before.⁵
• Persistent bad breath.⁵ This is the kind of bad breath that doesn't go away with a good cleaning. You may also notice an unpleasant taste in your mouth.⁴
• Loose or shifting teeth.⁶ You may notice a change in the way your teeth fit together when you bite;⁵ you may also notice new spaces between your teeth.²
• Sensitive teeth.³ In addition to sensitivity, you may even find it painful to chew.³

If you spot any symptoms of gum disease, make an appointment with your dentist right away.² The sooner you seek care, the better your chances of reversing any damage.²

Types of Gum Disease

There are two primary types of gum disease:¹

1. Gingivitis
2. Periodontitis

1. Gingivitis

Gingivitis is irritation and inflammation of the gums (gingivae) around the base of your teeth.² This is the mildest form of gum disease, causing the gums to become red and swollen because of excess plaque on your teeth.⁴

Since gingivitis is so common — half of all American adults have it — you may not even notice the symptoms,⁴ and you may feel little or no discomfort at this early stage of gum disease.⁵

The good news: With professional treatment and good home oral care, gingivitis can be reversed.⁵

2. Periodontitis

If left untreated, gingivitis can advance to periodontitis.² Over time, the plaque on your teeth can spread and grow below the gumline.²

The bacteria in plaque produce toxins that irritate the gums, stimulating an inflammatory response in which your body attacks the toxins, breaking down and destroying the tissues and bone that support your teeth.²

With periodontitis, the gums separate from the teeth, forming pockets that can become infected.² If periodontitis progresses, the pockets deepen, filling with more plaque and bacteria.² Eventually, when enough gum tissue and bone have been destroyed, teeth can become loose and fall out — or they may need to be removed.⁵

Stages of Gum Disease

Periodontitis is usually classified by stage and grade.⁵ The stage describes the acuteness of the disease, which can range from initial to severe.⁵ The grade refers to the rate of disease progression and anticipated response to treatment.⁵

Here are three stages of periodontitis:

Chronic periodontitis

This is the most common form of periodontitis, and it occurs more often in adults than in children.⁴ Most people with this condition are older than 35.⁴ The main symptoms of chronic periodontitis include receding gums and pockets between the gums and teeth.⁴

Aggressive periodontitis

While gum diseases are rare in children, some children (and adults) develop aggressive periodontitis even if they're otherwise healthy.⁴

For example, localized juvenile periodontitis involves an over-colonization of gum bacteria in adolescents, and prepubertal periodontitis affects young children soon after their primary teeth appear.⁴ By age 20, people with especially aggressive gum diseases can lose teeth.⁴

Necrotizing periodontitis

Necrotizing periodontitis (acute necrotizing ulcerative gingivitis) may be the most severe of all gum diseases, destroying tissues, ligaments and bones in the mouth.⁴ It is most common in smokers, people who are malnourished and people who have a compromised immune system.⁴

What Causes Gum Disease

Gum disease is usually caused by poor brushing and flossing habits.³ Here's how it can happen:

1. Plaque forms on your teeth.² Your mouth is full of bacteria that are constantly forming a sticky, colorless film (plaque) on your teeth.³ You can remove plaque by brushing and flossing your teeth, but plaque re-forms quickly.²
2. Plaque hardens under your gumline into tartar.² If plaque stays on your teeth, it can harden into calculus (aka tartar), which is filled with bacteria and more difficult to remove than plaque.² The longer tartar stays on your teeth, the more damage it can do.² While you can't get rid of tartar on your own, a professional dental cleaning can remove it.²
3. Plaque can cause gingivitis, which can lead to periodontitis.² Without proper oral care, the persistence of plaque and tartar can lead to gum disease.² And since periodontitis is a severe form of gum disease, you can't treat it on your own.⁴

Risk Factors for Gum Disease

While plaque is the primary cause of gum disease,⁶ a variety of risk factors can contribute to its development or progression.⁷ And since many symptoms don't appear until gum disease is well underway, it's important to know the risk factors.⁴

Risk factors include:

• Tobacco use. Smoking is the most significant risk factor for gum disease³ — it may be responsible for nearly 75% of periodontal diseases among adults.⁴
• Age. Older people have the highest rates of periodontal disease — more than 70% of Americans aged 65 and older have some form of gum disease.⁷
• Genetics. Despite diligent oral care habits, up to 30% of Americans may be more likely to get gum disease because of their genes.⁶
• Hormonal changes. Changes like those occurring during puberty, menstruation, pregnancy and menopause can make gums more sensitive, which can make it easier for gum disease to develop.⁶ In fact, about 60% to 70% of pregnant people experience gum disease.¹
• Stress. Stress can make it more difficult for the body to fight off infection, including infection that leads to gum disease.⁷
• Medications. Some medications decrease the flow of saliva, which has a protective effect on teeth and gums, while others can cause abnormal growth of gum tissue.⁶
• Clenching or grinding your teeth. This can put excessive force on the tissues supporting your teeth and speed up the rate at which the tissues are destroyed.⁷
• Other systemic diseases. Other diseases that interfere with the inflammatory system — like diabetes, cardiovascular disease and rheumatoid arthritis — can worsen the condition of the gums.⁷ In fact, 95% of people who have diabetes experience some form of gum disease.¹
• Poor nutrition. A diet that's lacking in key nutrients (like vitamin C)² can compromise the immune system and make it harder for the body to ward off infection, including an infection that becomes gum disease.⁷

If you are at increased risk of gum disease, talk with your dental professional.⁸ They may recommend more frequent checkups and cleanings.⁶

How to Prevent Gum Disease

The best way to prevent gum disease is to practice good oral hygiene consistently throughout your life.² By doing this, you can prevent the development of an environment around your teeth that's favorable to the bacteria that cause gum disease.²

Try these tips to keep your teeth and gums healthy:³

• Brush your teeth twice a day with a fluoride toothpaste.³ Brushing after meals helps remove food particles and plaque.² Brush for a full two minutes² and don't forget to brush your tongue, where bacteria tend to hide.⁸
• Replace your toothbrush.⁶ Replace your toothbrush every three months (or sooner if the bristles become frayed) — worn-out brushes won't clean your teeth as well.⁶ Consider using an electric toothbrush, which may be more effective at removing plaque and tartar.⁹
• Floss at least once a day.⁸ This helps remove food particles and plaque between teeth and along the gumline.⁸ You can also use a dental pick, interdental brush or dental stick designed to clean between your teeth.⁹
• Use mouthwash.⁸ Swishing with mouthwash can help reduce plaque and remove any remaining food particles after brushing and flossing.⁸ Plus, antibacterial rinses can reduce bacteria that cause plaque and gum disease.⁶
• Get regular professional dental cleanings.² Follow your dentist's recommended schedule for regular checkups and cleanings — usually every six to 12 months.² If you have risk factors for gum disease, you may need professional cleanings more often.²
• Quit smoking.³ Not only can tobacco products cause damage to your gum tissue,⁴ but smoking can also make treatment for gum disease less successful.³
• Eat a balanced diet.⁶ Plaque forms on your teeth when the sugars and starches in the food you eat interact with the bacteria in your mouth.² Since candy and junk food have a lot of extra sugar and starch, it's wise to avoid them.⁶ Plus, proper nutrition can help your immune system fight infection.⁶

Diagnosing Gum Disease

To diagnose gum disease, your dentist may:

• Examine your gums for inflammation.³ They also look for plaque and tartar buildup, as well as easy bleeding.⁹
• Use a dental probe to measure any pockets around the teeth.³ Pocket depth refers to the space between the gums and the teeth — the larger and deeper the pocket, the more severe the disease.⁶ In a healthy mouth, the pocket depth is typically between 1 and 3 millimeters.³ Pockets deeper than 4 millimeters may indicate periodontitis.⁹
• Review your medical history to identify risk factors for gum disease.³ Talk with your dentist about any potential risk factors so they can classify your disease and establish the right treatment plan.⁷
• Take dental X-rays to check for bone loss.³ They do this in areas where they observe deeper pocket depths.⁹
• Refer you to a periodontist for evaluation and treatment.³ Periodontists are experts in the diagnosis and treatment of gum disease.³

Non-Surgical Gum Disease Treatments

Types of treatment vary depending on the extent of the gum disease.³ Non-surgical treatment options include:

Scaling and root planing

If you have plaque and tartar under your gums, you may be a candidate for this deep-cleaning procedure, which is done under a local anesthetic.¹⁰ Your dental professional will scrape away plaque and tartar above and below the gumline (scaling) and smooth rough spots on the tooth root (root planing).¹⁰ This provides a clean surface for your gums to reattach to your teeth.¹⁰

Antibiotics

Your periodontist may prescribe topical or oral antibiotics to help control and eliminate the bacterial infection causing gum disease.⁹ Topical antibiotics may include antibiotic mouth rinses or antibiotic gels that are inserted into periodontal pockets after deep cleaning.⁹ Antibiotic treatments can be used alone or in combination with other therapies.¹⁰

Laser treatment

Lasers have different wavelengths and power levels that can safely treat gum disease¹¹ by removing bacteria from periodontal pockets.¹² In fact, similar results have been found with laser treatment compared to other non-surgical treatment options like scaling and root planing.¹¹

Tray delivery system

This consists of a custom-fit tray made from impressions of your mouth.¹¹ You use the tray at home to deliver medications prescribed by your periodontist.¹¹ These FDA-cleared trays have a custom inner seal that allows medication to penetrate periodontal pockets up to 9 millimeters deep.¹³

Surgical Gum Disease Treatments

If you have advanced periodontitis, you may need gum surgery.⁹ Surgical treatment options include:

Gum graft surgery (soft tissue grafts)

If gum recession has exposed your tooth roots, gum graft surgery can help.¹⁴ Your periodontist will take gum tissue from your palate or another donor source to cover the exposed roots and help prevent additional gum recession and bone loss.¹⁴ Gum graft surgery can be performed on one tooth or multiple teeth, and it can help reduce tooth sensitivity.¹⁴

Dental crown lengthening

If you have an overgrowth of gum tissue causing a “gummy" smile, this procedure can correct the problem.¹⁴ Your periodontist will reshape excess gum and bone tissue to expose more of the natural tooth and even out your gumline.¹⁴ This can be done to one tooth or several teeth,¹⁴ making them appear longer.¹⁵

Gingival flap surgery (pocket reduction)

During this procedure your periodontist will fold back the gum tissue and remove the bacteria from periodontal pockets.¹⁵ If you have bone loss, they may also recontour the bone to limit the areas where bacteria can hide.¹⁴ Then, they will secure the gum tissue snugly against your teeth to decrease the space where bacteria can grow.¹⁰

Dental bone grafting

If periodontitis has destroyed the bone surrounding your tooth root, your periodontist may recommend a bone graft.⁹ This involves grafting fragments of your own bone, synthetic bone or donated bone into the affected area.⁹ The graft can help prevent tooth loss⁹ and encourage your body's natural ability to regenerate bone.¹⁴ Other regenerative procedures may include the use of membranes or tissue-stimulating proteins.¹⁴

Gum Disease Treatment Costs

Here are the average costs for common gum disease treatments:

Scaling and root planing

The average cost of scaling and root planing is $180 to $300 per quadrant of the mouth.¹⁶ Many dental insurance plans cover at least half of this procedure.¹⁶ If you're concerned about exceeding the annual maximum allowed charge on your plan, you may be able to split up the procedure (e.g., two quadrants at the end of one year and two quadrants at the start of the next) to maximize your insurance benefits.¹⁶

Antibiotics

The average cost of antibiotics ranges from about $12 to $380 without insurance.¹⁷ Your price will depend on the antibiotic prescribed, whether you get the generic or brand-name medication, and any insurance coverage you may have.¹⁷

Laser treatment

The average cost of laser treatment is $1,000 to $4,000, depending on the severity of your gum disease and the technology used by your provider.¹² If laser treatment is deemed medically necessary, your dental insurance may help cover the cost.¹²

Tray delivery system

The average cost of a tray delivery system is around $400 per year for the trays and prescription medication.¹³ More and more insurance companies provide coverage for this type of therapy.¹³

Gum graft surgery

The average cost of gum graft surgery is $600 to $1,200 at the base of one tooth or in a small area.¹⁸ Costs can be higher if you need to use material from a tissue bank rather than from your own mouth.¹⁸ Your dental insurance is likely to cover a portion of the costs for gum graft surgery.¹⁸

Dental crown lengthening

The average cost of dental crown lengthening is $1,000 to $3,000, depending on how the crown is made and how many crowns you'll need.¹⁹ Your dental insurance may cover part of the cost if the procedure is part of restorative dental treatment, rather than for purely cosmetic purposes.¹⁹

Gingival flap surgery

The average cost of gingival flap surgery ranges from $4,000 to $6,000, but it can run higher if you have extensive damage.¹⁸ Most dental insurance plans cover gingival flap surgery, though copayments and annual maximums may limit those benefits.¹⁸

Dental bone grafting

A simple dental bone graft that uses synthetic bone typically costs $300 to $800 for each implant area.²⁰ If the graft will use your own bone, the estimated cost is $2,500 to $3,500.²⁰ That's because you'll need to be hospitalized to extract the bone, adding an orthopedic surgeon and anesthesiologist to your care team.¹⁶ Your dental insurance may supplement or cover the cost of medically necessary bone grafts.²⁰

CareCredit Financing for Gum Disease Treatment

Regular dental checkups are important to help prevent, identify and treat dental problems before they become more advanced. The CareCredit credit card can help you pay for dental exams, cosmetic dental procedures, and other costs that insurance doesn't cover — to help you keep your pearly whites bright and healthy.* Apply today and use our Acceptance Locator to find a dentist or periodontal practice near you that accepts CareCredit. Make the most of your wellness journey by downloading the CareCredit Mobile App. You can find a provider on the go, manage your CareCredit account, and easily access the Well U hub for more great articles, podcasts, and videos.

Author Bio

Robyn Tellefsen is a freelance writer and editor with nearly 20 years of experience covering health and wellness, finance, and more. Her work has appeared on sites such as LoopNet, Beachside Rehab, First Horizon Bank, SoFi, A Place for Mom, American Express, Chase and more.