Gum disease, also known as periodontal disease, is an inflammatory condition that affects the tissues surrounding and supporting the teeth. If left untreated, gum disease can lead to receding gums, bone loss, loose teeth, and ultimately tooth loss. The early stages of gum disease, known as gingivitis, are reversible with professional treatment and good oral hygiene. However, the more advanced stages which involve bone loss are irreversible. Fortunately, several treatments are available to help restore gum tissue that has been damaged by periodontal disease.

What causes gum disease?

Gum disease is caused by plaque, a sticky film of bacteria that constantly forms on the teeth. If plaque is not removed by brushing and flossing daily, it will harden into calculus (tartar). Plaque and calculus irritate the gums and provoke an inflammatory response. As the disease progresses, the tissues and bone that support the teeth are broken down, leading to tooth loss if untreated. Several risk factors can increase susceptibility to gum disease:

• Poor oral hygiene habits
• Smoking or tobacco use
• Diabetes
• Medications that cause dry mouth
• Hormonal changes during pregnancy
• Crooked teeth
• Genetic predisposition

Stages of gum disease

Gum disease progresses through several stages:

Gingivitis

The earliest and mildest form of gum disease is gingivitis. In this stage, plaque accumulates along and under the gumline, causing the gums to become inflamed and swollen. Symptoms include:

• Red, swollen, tender gums
• Gums that bleed easily when brushing or flossing
• Bad breath

At this point, the disease is reversible with professional cleaning and improved oral hygiene.

Periodontitis

If gingivitis is left untreated, it can advance to periodontitis. In this stage, plaque spreads below the gumline and toxins stimulate a chronic inflammatory response. As inflammation persists, the attachment fibers and supporting bone that hold the teeth in place are broken down. Signs and symptoms include:

• Gums that are pulled away from the teeth, forming pockets
• Receding gums
• Loose or shifting teeth
• Pus around the teeth and gums
• Persistent bad breath
• A change in the way teeth fit together when biting

At this point, professional deep cleaning is required to remove plaque and calculus from below the gumline. Antibiotics or antimicrobial rinses may be used to reduce infection. The disease is still reversible if treated promptly.

Advanced periodontitis

Without treatment, periodontitis will continue worsening until the tissues and bone supporting the teeth are destroyed. Signs and symptoms include:

• Significant gum recession with exposure of tooth roots
• Loose, moving, or separating teeth
• Changes in bite alignment
• Pus discharge
• Tooth loss

At the advanced stage, gum and bone loss is irreversible. However, steps can be taken to halt progression of the disease and prevent tooth loss.

Stage	Signs & Symptoms	Treatment	Reversibility
Gingivitis	Swollen, red gums; Bleeding when brushing; Bad breath	Professional cleaning; Improved oral hygiene	Reversible
Periodontitis	Gum recession; Pockets around teeth; Loose teeth	Deep cleaning; Antibiotics; Antimicrobial rinse	Reversible if treated promptly
Advanced Periodontitis	Significant gum and bone loss; Loose, moving, or lost teeth	Surgical treatments; Tooth extraction	Irreversible gum and bone loss

Can receding gums grow back?

Gum recession occurs when the margin of the gum tissue surrounding the teeth pulls back, exposing more of the tooth surface and root. Receding gums are a common symptom of periodontal disease. If gum recession is caught early, it may be possible to regrow some of the lost gum tissue. However, severe gum recession is usually permanent.

Mild to moderate gum recession

When gum recession first begins, and only a small amount of tissue has been lost, your dentist may recommend procedures to help regrow gum tissue. Options may include:

• Deep cleaning – Removing built-up plaque and tartar from under the gums encourages gums to reattach and grow back closer to their original position.
• Antimicrobial therapy – Prescription antimicrobial mouthwashes or antibiotics may be used to control infection and allow the gums to heal.
• Gum grafting surgery – A thin piece of tissue is removed from the roof of the mouth or another site and stitched into place around the exposed root surfaces.

With mild recession, the gains in regrown tissue are usually small. But even a slight gain can help reduce sensitivity from exposed roots.

Severe gum recession

When gum recession is severe, with extensive loss of tissue and exposure of multiple tooth roots, regrowth of lost gum tissue is usually not possible. However, procedures can be performed to protect exposed tooth roots and prevent further gum recession:

• Deep cleaning – Thorough plaque and calculus removal from tooth surfaces and any pockets helps limit additional attachment loss.
• Gum grafting – Grafted tissue is placed over exposed roots to act as a protective barrier.
• Guided tissue regeneration – Barrier membranes are placed under gum grafts to encourage regeneration of bone and connective tissues.
• Bone or soft tissue grafts – Natural or synthetic bone materials are placed around teeth to halt bone loss and stimulate bone regrowth.

The goal of these procedures is to stabilize areas of gum recession and prevent them from worsening. Regrowth of significant amounts of lost gum tissue is unlikely, but further attachment loss can be prevented.

Can lost bone be regenerated?

Periodontal disease damages the bone structures that support the teeth. As the disease progresses and inflammation persists, bone loss occurs around teeth. This can eventually lead to tooth loss. Until recently, lost bone was thought to be irreplaceable. However, regenerative therapies have made it possible to not only stop bone loss, but even regrow lost bone in some cases.

Bone grafting

Bone grafting surgery can be used to stimulate bone regrowth and regeneration where bone has been lost to gum disease. The graft material serves as a scaffold onto which new bone cells can attach and grow. Common bone graft materials include:

• Autografts – Small pieces of bone taken from elsewhere in the patient’s body, often the chin or jaw.
• Allografts – Bone tissue taken from a bone bank, sourced from human donors.
• Xenografts – Bone tissue taken from other species, such as cows.
• Alloplasts – Synthetic bone substitutes.

Over 3-9 months following graft placement, the bone material is naturally replaced by new bone growth originating from the patient’s own body. Though bone grafting cannot completely regenerate lost structures, it may help rebuild and stabilize bone, reducing tooth looseness.

Guided tissue regeneration

This advanced technique uses barrier membranes to direct the growth of bone and connective tissues around teeth. Membranes are placed under the gums, over areas where bone has been lost. This guides the body to regrow lost bone and periodontal structures in the desired location.

Various materials are used for the membranes, such as collagen proteins or synthetic mesh-like fabrics. Over 4-6 months, the membrane gradually degrades as bone and connective tissues regenerate beneath it.

Enamel matrix derivatives

Treatment with enamel matrix derivatives (EMD) supports periodontal regeneration. EMDs contain enamel matrix proteins that play an important role in formation of root cementum, periodontal ligament, and alveolar bone.

When applied to prepared teeth, EMD stimulates periodontal cells to regenerate new cementum, periodontal ligament fibers, and bone. This biomimetic approach takes advantage of the body’s natural growth mechanisms.

Platelet-rich plasma

Platelet-rich plasma (PRP) contains concentrated growth factors and cytokines from the patient’s own blood that promote healing and regeneration. PRP is prepared from blood drawn shortly before procedures. When applied to the surgical site, it releases proteins that stimulate regeneration and repair of bone, connective tissues, and blood vessels.

Can lost gum tissue be regenerated?

Restoring gum tissue lost to periodontal disease is challenging but possible in select cases using regenerative therapies. These cutting-edge treatments aim to regrow periodontal ligaments, gums, and bone by stimulating the body’s natural healing mechanisms.

Gum grafting

Gum grafting involves transplanting a small piece of donor gum tissue to an area where gum recession has occurred. Over time, blood vessels grow into the transplanted tissue, allowing it to mature and blend in with the existing gums. Though gum grafting does not achieve true regeneration, it can restore enough root coverage to reduce sensitivity and improve aesthetics.

Guided tissue regeneration

This technique uses small collagen membranes to encourage regeneration of gum, bone and connective tissues destroyed by periodontitis. The membranes help direct the growth of periodontal ligament fibers and gingival connective tissues to stimulate regeneration of a new periodontal attachment apparatus.

Enamel matrix derivative proteins

Treatment with EMDs provides biologic mediators that trigger the body’s natural capacity to regenerate periodontal tissues. EMD proteins are involved in the formation of root cementum and periodontal ligament. Applying EMD to cleaned and prepared tooth roots stimulates regeneration of cementum, periodontal ligament fibers, and alveolar bone.

Growth factors

Growth factors enhance the body’s innate healing abilities. Platelet-rich plasma and platelet-rich fibrin provide concentrated growth factors from the patient’s blood to encourage periodontal regeneration. There are also recombinant human growth factors that can be applied topically or within grafting materials to stimulate tissue and bone regeneration.

Stem cell therapy

Stem cells possess the ability to develop into many different cell types, including ligament, bone, and gingival cells. Although still experimental, stem cell therapy shows promise for regenerating periodontal tissues destroyed by disease. Stem cells can be obtained from the patient’s own oral tissues or mesenchymal stem cells from bone marrow.

Treatments to restore gum and bone

Depending on the severity of gum and bone loss, different treatment approaches may be recommended. Mild to moderate recession may be treated with nonsurgical options first before considering surgery.

Nonsurgical treatments

• Deep cleanings
• Antimicrobial mouth rinses
• Oral antibiotics
• Topical gels/ointments

These treatments help control bacterial infection and inflammation, allowing gums to reattach and grow back closer to their original position. Mild bone loss can sometimes be reversed as inflammation is reduced.

Surgical treatments

• Gum grafting
• Guided tissue regeneration
• Bone grafts
• Soft tissue grafts
• Growth factors

Surgical procedures aim to cover exposed roots, regenerate lost tissues, and rebuild bone to support teeth. They are often necessary when recession or bone loss is extensive.

Treatment Type	Procedures	Purpose
Nonsurgical	Deep cleanings, antibiotics, antimicrobial rinses	Reduce bacterial infection; Allow gums to reattach and grow back
Surgical	Gum grafts, bone grafts, guided tissue regeneration	Cover exposed roots; Rebuild lost gum tissues and bone

Proper home care

While professional treatments are needed to reverse gum recession and bone loss, excellent at-home oral hygiene is essential for managing periodontal disease. Effective daily care can halt disease progression and support healing after treatment.

Tooth brushing

Brush at least twice daily using proper technique:

• Use a soft-bristled brush with a small head.
• Brush at a 45-degree angle towards the gums.
• Gently brush each surface using short back-and-forth strokes.
• Brush for a full 2 minutes each time.

Take extra care brushing in areas of gum recession. Avoid excessive pressure or aggressive scrubbing of receding gums.

Interdental cleaning

Floss once daily and use interdental cleaners to remove debris from between teeth and below the gumline. This helps prevent plaque accumulation in areas your toothbrush can’t reach.

Antimicrobial rinses

Rinse daily with antimicrobial mouthwash to reduce oral bacteria between brushing. Choose a product without alcohol such as cetylpyridinium chloride for the most benefit.

Tobacco cessation

Avoid all tobacco products to help your gums heal. Smoking and smokeless tobacco greatly increase gum disease risk and interfere with healing after treatment.

Regular dental visits

See your dentist and hygienist at recommended intervals for professional cleanings and monitoring of your periodontal health. Ongoing care is key to preventing recurrence of gum disease.

Maintaining a healthy mouth for life

Gum disease can be halted and reversed if caught early. But without treatment, it will steadily worsen over time. Severe gum and bone loss is irreparable. Though regeneration of destroyed tissues is possible in some cases, it is complex and not always effective. The best approach is prevention.

It’s important to have any signs of gum problems evaluated promptly. With early detection and treatment, it is possible to regain lost gum and bone. Left too long, extensive damage can occur. But by keeping up with your oral care routine and regular dental visits, you can protect your gums for the long term.

Consistent daily brushing and flossing, healthy diet and lifestyle habits, regular dental cleanings and exams, and prompt treatment if problems arise are key to maintaining the health of your gums and the supporting bone. Avoiding tobacco and managing health conditions like diabetes are also essential steps. With diligent care of your teeth and gums, you can minimize your risk of significant gum recession and bone loss.

Conclusion

Periodontal disease can destroy gum tissues and the underlying bone that support teeth. Mild to moderate gum recession and bone loss may be reversed through treatments like deep cleanings, antimicrobial therapy, and gentle surgical techniques. More advanced stages of tissue and bone loss are difficult to restore completely. Prevention is key.