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Gum Disease: Causes, Risks, Prevention And When To See Your Dentist
People say the eyes are the window to your soul, but your mouth may be the window to your health. It's estimated that up to 50% of Americans currently have mild gum disease, or gingivitis, while up to 80% have dealt with the more severe form, periodontitis, at some point. And it's not just your teeth that are at risk. According to family dentist Kristy Gretzula, DMD, gum disease has been linked to a higher risk of diabetes and heart problems, like atherosclerosis, heart attack and stroke.
To help you better understand gum disease, our team spoke with two dentists and one periodontist who gave us the lowdown on what causes it and what you can do to prevent it.
What is gum disease?Gum disease is an infection and inflammation of the tissues surrounding and supporting teeth. There are two primary forms: gingivitis and periodontitis.
Gingivitis is the mildest form and is quite common. It causes localized irritation, swelling and redness of your gums. If gingivitis isn't treated, it can progress to periodontitis, a more severe form of gum disease.
There are different stages of periodontitis, from mild to advanced, but they all go beyond the gums, affecting the deeper tissues and bones that support the teeth.
What are the symptoms of gum disease?Symptoms of gum disease aren't always obvious. "Periodontal disease is often silent, meaning symptoms — particularly pain — may not appear until an advanced stage of the disease," says Y. Natalie Jeong, DMD, periodontist and professor and chair at Tufts University Department of Periodontology.
However, she recommends being on the lookout for the following signs and symptoms:
Red, swollen or tender gums or other pain in your teeth or mouth
Bleeding while brushing and flossing or when eating certain foods
Receding teeth — gums that are receding or pulling away from the teeth, causing the teeth to look longer than before
Loose or separated teeth
Pus between your gums and teeth
Mouth sores
Persistent bad breath
A change in the way your teeth fit together when you bite
A change in the fit of partial dentures
You may not have all of these symptoms since they largely depend on the stage of gum disease. There are four, from gingivitis to advanced periodontitis.
According to restorative dentist Naomi Levy Goldman, DMD, the lack of pocketing around the teeth separates gingivitis from periodontal disease. "We use a small probe to measure the space that exists between the tooth and the gum tissue that surrounds it. If this space is between 1 mm and 3 mm, the pocket is classified as healthy. If the measurement is higher than 3 mm, this is the beginning of periodontal disease," she says. When you hear your hygienists calling out numbers during your cleaning, they're measuring this.
Here's a breakdown of the four stages and their most common symptoms.
Gingivitis: As mentioned, gingivitis is the earliest stage. You may notice red, swollen gums that likely bleed easily during brushing or flossing. Bad breath and tender gums are also common in this stage.
Early periodontitis: In this stage, inflammation moves deeper into the gum tissues, causing pockets between the gums and teeth. The gums may begin to recede, making the teeth appear longer. Gums may bleed more, and there may be some bone loss.
Moderate periodontitis: As the gum disease progresses, pockets get deeper. Gums recede even more, and you may notice loose or shifting teeth. Bad breath, bleeding gums and moderate bone loss are also hallmarks of this stage.
Advanced periodontitis: This is the most severe stage. In advanced periodontitis, you'll have deep gum pockets, significant bone loss, loose or shifting teeth and possibly pus between the teeth and gums. Teeth are more likely to fall out at this stage, or you might have to get them removed.
Gum disease is typically caused by an accumulation of bacterial plaque — a sticky, colorless film — on the teeth and gums due to poor oral hygiene. If plaque isn't adequately removed through regular brushing and flossing, it can harden into tartar, which can only be removed by a dentist or dental hygienist. If that tartar isn't cleaned off regularly, it can cause gum infection and inflammation.
However, there's also a genetic component. "If a close family member has gum disease, there's a higher chance that you might also develop it, even with good oral hygiene practices," says Gretzula.
There are also other contributing factors:
What are the risks associated with gum disease?These can include bone and tissue deterioration, loosening of teeth, dental infections and eventually tooth loss.
According to Jeong, several studies have also shown a link between periodontal disease and other health issues, including:
Gum disease has also been linked to other health conditions, such as rheumatoid arthritis, Alzheimer's disease, depression, certain cancers and kidney disease, although more research is needed to understand how they may be connected.
Gum disease treatmentTreatment options depend on the condition's severity. Usually it begins with professional scaling and root planing, also known as deep cleaning.
During a deep cleaning, your dentist or periodontist removes plaque and tartar from beneath the gum line and roots of the teeth. "Root planing [also] allows your periodontist to smooth the tooth root to prevent future plaque or toxins from adhering," says Jeong. Depending on your case, antibiotics may also be prescribed to help control bacterial infection in the gums.
Many people respond well to deep cleaning and don't require any further treatment. However, severe cases may need surgery. There are two surgical options in these cases.
Flap surgery/pocket reduction surgery: In advanced gum disease, flap surgery may be needed to reduce pocket depth and make cleaning the teeth and gums easier. During this surgery, the gum is lifted away from the tooth, the roots are cleaned, and the gum is sewn back into place.
Bone or tissue grafts: If there's significant bone or tissue loss around the teeth, grafting procedures may be necessary to regenerate lost bone or soft tissue. If your teeth are exceptionally sensitive, Jeong says you might also need gum grafting — your dentist or periodontist will take gum tissue, usually from the roof of your mouth, and place it where there is little to no gum tissue (like over a receding gum line).
If your dentist does recommend surgery, don't worry. "We have a lot of techniques that we utilize now that didn't exist in the past, and people may be a bit intimidated by the procedure, but it's not something to be scared about," says Jeong.
Gum disease preventionStill, it's always best to prevent gum disease if you can. Fortunately, most cases are avoidable with good oral hygiene. Our experts recommend:
Brushing twice daily for at least 2 minutes
Using an electric toothbrush, if possible
Flossing once per day
Using a water flosser once per day
Scheduling professional dental cleanings every six months, or more frequently if you have gum disease
Eating less sugar
Gretzula also says a nutrient-rich diet is crucial, focusing on vitamin C and calcium, which can support gum health.
When to see your dentistIf you think you have gum disease, you should see your dentist as soon as possible to prevent further bone loss and tissue damage around the teeth. Even if you don't think you have gum disease, it's essential to maintain a regular schedule with your dentist to keep your gums and teeth healthy.
For most people, a hygiene visit every six months, followed by twice-daily brushing and once-daily flossing and water flossing is ideal, according to Goldman. "For patients who tend to build up with tartar more quickly, or patients with a diagnosis of periodontal disease, regular three- to four-month maintenance is recommended," she says.
FAQs Is there anything you can do to fix gum disease at home?It depends on how advanced the gum disease is. "Daily flossing or use of a Waterpik can be used to fix gingivitis at home, provided there is no tartar buildup creating the inflammation," says Goldman. However, if tartar is present, it needs to be professionally removed first.
Can salt water help with gum disease?Yes, salt water can help with gum disease in the early stages of gingivitis, according to Gretzula. "Salt water has anti-inflammatory properties that can help reduce swelling and soothe inflamed gums. Salt water can [also] promote healing by creating a slightly hypertonic environment, which helps reduce bacterial count and supports tissue repair," she says. That said, if gum disease has progressed to one of the later stages, salt water may not be as effective.
Is it possible to reverse gum disease?You can reverse gum disease if you catch it early but not once it's advanced to a certain point. "In the later stages of gum disease, the supporting structures of the teeth, including bone and connective tissues, have been extensively damaged or destroyed. Once bone loss occurs, it is challenging to regenerate," says Gretzula, adding that current treatment options don't fully restore the connective tissue that anchors the teeth.
Meet our expertsNaomi Levy Goldman, DMD, owner and cosmetic and restorative dentist, Levy Goldman Dentistry, Peabody, Mass.
Kristy Gretzula, DMD, Dentist, Hawley Lane Dental, Stratford, Conn.
Y. Natalie Jeong, DMD, professor and chair at Tufts University Department of Periodontology, Boston
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EXCLUSIVEDoctor Claims Toxic Chemicals In Old NC State University Building Caused His Leukemia
North Carolina State University played a huge role in Darren Masier's life — first as a student earning his degree and PhD, then as a lecturer.
But now he fears the college could be the death of him.
Professor Masier, 57, began suffering unusual symptoms in mid-2022 — a weeks-long eye infection, gum infections that lasted for months and gout.
Then last summer, despite being a triathlete and avid runner, he was diagnosed with a rare and deadly blood cancer that normally strikes people in their 70s or 80s.
As the father-of-one began treatment, he started to hear from former colleagues who were also struck down by mysterious illnesses including unusual tumors.
Professor Masier is pictured above within Poe Hall giving a presentation on his dissertation. He had not previously had concerns over the building
Professor Masier is pictured above leaving hospital after 133 days in the units for treatment
'I started hearing from people that I knew about this Poe Hall thing, and a lot of them were being diagnosed with different cancers,' Professor Masier told DailyMail.Com.
'There were about six or seven of us who were pretty close during our time at NC State. One of us had leukemia, another of us had cancer, and another had an immune disorder.
'And that's just us six. When they heard I had leukemia, they all tipped me off about this.'
The number of cases in his group led Professor Masier — who teaches human resource management — believe there was an issue with the building where they taught.
Professor Masier had attended classes and lectured at Poe Hall — on the college's North Campus in Raleigh — for five years, from 2009 to 2013.
Testing in November 2023 revealed the air and surfaces in the building contained chemicals known as polychlkorinated biphenyls (PCBs) which cause cancer and were outlawed in the US in 1979 — after previously been widely used in construction materials, paints and electronic equipment.
Tests found levels of this substance at up to 38 times the safe limit in the building, as recommended by the Environmental Protection Agency (EPA).
More than 211 people have now come forward saying they have fallen sick after attending classes at Poe Hall, the 1971-built seven-storey brutalist building.
Poe Hall, a class building at North Carolina State University, was found to be contaminated with PCBs — which were outlawed in the US in 1979
The building was constructed in 1971, when PCBs were more commonly used in construction materials
Rebekah Dunston, a 35-year-old former communications student who was diagnosed with stage three colon cancer after attending classes at the hall.
Sarah Glad was also a former student and who died less than two years after she was diagnosed with an aggressive breast cancer.
Professor Masier was diagnosed with acute myeloid leukaemia (AML), a type of aggressive cancer that affects white blood cells.
The majority of cases are diagnosed in those aged 65 years or over, with most occurring in the late 70s and early 80s.
Professor Masier pictured above with his wife
He is now in remission after being treated with a bone marrow transplant, but eight months later is yet to regain his full strength and can only jog a little.
He also had to have the top part of his left lung removed after he developed a fungal infection while in hospital.
Professor Masier said: 'I have been a very avid runner and triathlete my whole life, but I can't really run anymore. I just walk and jog a little.
'I am recovering well, but still have about ten pounds to gain back. I am also still bald, but that hair should grow back soon.'
Doctors say his cancer has now disappeared, although he remains concerned that it could return. Statistics show that 70 percent of AML patients die within five years of their diagnosis.
He has since instructed attorneys to fight to gain access to Poe Hall to allow independent testing of the air to be carried out.
He does not plan to seek damages at this time, but rather wants to find the cause of the illnesses in order to help others who were in the building but have since been diagnosed with an illness.
This week, independent testing finally began in the building after a settlement was reached with the university — following a four-month battle.
Darren Masier, 57, pictured above with his wife, was diagnosed with a type of blood cancer a decade after he was teaching in Poe Hall at North Carolina State University
NC state received complaints over the building's ventilation system as early as 2007, but did not close it until November 2023
Other victims include Rebekah Dunston (left, in hospital) who discovered she had stage three colon cancer just weeks after Sarah Glad found out she had terminal breast cancer. The pair were in their early thirties and in the prime of their lives — Sarah was 14 weeks pregnant (with her baby boy) and Mrs Dunston had just got married
They plan to take more than 1,000 swabs in order to build a picture of the extent of PCB contamination in the building.
Records show concerns were first raised over the air quality in Poe Hall — the former home of the psychology and education classes — in 2007, when staff said they needed to put 'cheesecloth-like' fabrics over vents in order to use the building.
More recently, people also reported a black liquid dripping out of air ventilation units and onto their desks.
The university only closed the building in November 2023, after independent testing revealed it was laced with PCBs.
These are man-made chemicals previously used in caulking substances — putty used to seal gaps and joints in buildings — among others.
They may leach out and evaporate into the air, however, where they can be breathed in by humans and enter the blood stream — where they play havoc with the immune system and raise the risk of conditions like cancer.
The EPA has labeled them a 'potential carcinogen' and lab studies in animals have linked them to blood cancers like non-Hodgkin's lymphoma and cancers of the liver, breast and brain.
Dr Norman Sharpless, the former director of the National Cancer Institute and professor of cancer policy and innovation at the University of North Carolina, previously told DailyMail.Com: 'The data is reasonably strong that PCBs can be linked to certain kinds of cancer.'
NC State alumna Christie Lewis (pictured left), who attended the university from 2007 to 2012, said that she started having night sweats while she was taking classes in Poe Hall. 'I could not figure out what was happening,' she told Fox News Digital
Dr Suneel Kamath, an oncologist at the Cleveland Clinic, added: 'While we can't say for certain that PCBs at Poe Hall were the cause of the cancers observed in patients, it is highly unusual that so many young and otherwise healthy people would get cancers at such a high rate.
'It definitely suggests that some environmental exposure is the culprit. It's unlikely this number of people would have hereditary/genetic reasons to develop cancer, especially without a strong family history.'
Professor Masier was in Poe Hall from about 8am to 3pm every day, and then often in the evenings for other classes.
In 2013, he left to become a professor at Meredith College also in Raleigh, North Carolina.
While being treated for his cancer, he had four rounds of chemotherapy and a bone marrow transplant — when he nearly lost his life after his body showed signs of rejecting the new tissue.
'It was a rough Christmas and New Year's,' he said, 'but I made it out of the intensive care unit and back'.
He is pictured again above with his wife following discharge from the hospital
Professor Masier added: 'If they find out what caused my leukemia, that could provide assistance to doctors and assist with the treatment of myself or anyone else who falls ill after spending time at Poe Hall.
'If they are hiding something, and everything is pointing towards that they are hiding something, this might infuriate me, who knows. I just want answers.'
'The way NC State has fought us really makes me wonder, there are so many people that have come forward that spent a significant amount of time in Poe Hall, it makes me wonder about that building.'
NC State has set up a webpage for those who are concerned about the air quality in Poe Hall, and says it is now looking into replacing the ventilation system.
A spokesman said: 'We are pleased that we have reached an agreement with all law firms — including those involved in the pending litigation — that have reached out to us on behalf of potential claimants to allow them access to Poe Hall to conduct testing and visual inspections of the building.
'While the building remains closed and access limited, this approach ensures that the interested law firms are able to gather the information they are seeking in an orderly process prior to any remediation of the building.'
Chancellor Randy Woodson adds online: 'The university remains committed to doing the right things to ensure this is a safe place to work, learn and live.'
Why Brushing, Flossing And Dental Visits Matter So Much
Dental hygiene and health is an essential part of maintaining overall health. (Getty Images)
Sign up for our LI Press email newsletter to get news, updates, and local insights delivered straight to your inbox!Many people don't give much thought to their oral health until they have a toothache. But taking good care of your teeth on a regular basis can help you avoid a host of health problems – both inside your mouth and beyond.
Good oral care helps ward off gum disease, also known as periodontal disease, which is a very common problem. According to the Cleveland Clinic, nearly half of adults age 30 and older – 47% – have some form of gum disease. Left untreated, gum disease can lead to tooth loss. It has also been associated with certain broader health problems, including diabetes, heart disease and dementia.
The good news is that gum disease is largely preventable and treatable.
Gum disease
Sugar and starches in the food you eat mix with bacteria in your mouth to form plaque, a sticky film, on the teeth. Brushing and flossing remove plaque, but it quickly reforms. If plaque remains on your teeth for an extended time, it can harden into tartar, or calculus, which requires a professional dental cleaning to remove. Plaque and tartar contain bacteria, and when they build up around your teeth and gums, you can develop inflammation and infection in your gums and the bone surrounding your teeth.
"Early gum disease, which is called gingivitis, is treatable and reversible," says Keri Logan, D.M.D., director of the Stephen B. Gold Dental Clinic at St. Charles Hospital in Port Jefferson. "If left untreated, gingivitis can advance to periodontitis, which is treatable but not reversible. We can treat it and possibly maintain it, but the damage cannot be reversed."
Periodontitis can lead to tooth loss. "This is because it affects not only the gums, but also the bone," Logan says. "The bone recedes, and with this loss of height of the bone, your tooth becomes more mobile, and then you get more tartar, which will lead to more inflammation and eventually tooth loss."
Preventing gum disease
According to Logan, "Everyone should be brushing their teeth at least twice a day for two minutes at a time, and flossing every day to remove debris that gets stuck inside the teeth."
Although flossing is an integral component of oral hygiene, most Americans have stubbornly resisted adding it to their daily routine. According to a large study recently published in JADA (The Journal of the American Dental Association), only about one in three adults in the United States floss daily, and the prevalence of flossing increased only slightly from 2009 to 2020.
"There are new flossing products, such as water flossers and air flossers, which get between the teeth and make flossing more effortless," says Logan. "If something is easier to do, people are more likely to do it, and air flossing or water flossing is better than not flossing at all."
It is also important to visit your dentist twice a year for cleanings, exams, X-rays and routine dental work. "This allows any problems inside your mouth to be identified early, when they can be treated and sometimes reversed," she says.
If your gums are bleeding, red or sore, this may be a sign of gingivitis or periodontitis.
"If you have these symptoms, do not wait to go to the dentist," Logan says.
Connections to other illnesses
In addition to tooth loss, advanced gum disease has been associated with an increased risk for certain other diseases, including diabetes, heart disease and dementia.
"There is evidence that diabetes and periodontitis have a bidirectional link, in that if someone has diabetes, they are more likely to have periodontitis, and vice versa," says Logan. "There are also links between periodontitis and cardiovascular disease and stroke. If our patients have periodontitis, we will refer them to their primary care doctor for a workup if they haven't been to their doctor in a while."
The connection between periodontitis and systemic disease is not fully understood. According to the National Center for Biotechnology Information, "a growing body of evidence is accumulating supporting the direct and indirect impact of periodontal pathogens on systemic health." More studies are needed to develop a deeper understanding of the relationship between periodontitis and other chronic diseases.
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