Healthy gums do not bleed upon brushing. Following tooth brushing, pink-red coloured saliva in the sink indicates inflammation of the gums.

Gingival diseases are widely variable ranging from simple gingivitis (inflammation of gums) to severe infections (periodontitis), in which structural tissue loss occurs in the jaw bones and teeth loosen and fall out. These diseases cause the gums to swell, redden, bleed, and recede; therefore, causing teeth to appear longer and be displaced with empty spaces in between. Foul mouth odour and teeth loss occur.

It is well-established that the major factor is the formation of microbial dental plaques. However, several other systemic, environmental or genetic factors constitute risk factors for developing the disease.

The micro-organisms involved in the development of periodontal disease and the harmful substances synthesized by them are mainly associated with diabetes. Scientific studies have demonstrated that the development of periodontal disease is more likely in patients with uncontrolled diabetes compared to patients whose diabetes are controlled even though the mouth hygiene has been found to be equivalent in both groups.

The micro-organisms involved in the development of periodontal disease and the harmful substances released by them pose a threat to the foetal-placental unit. The risk factors of premature birth and abortion include a young age of the mother, use of medications, alcohol use and smoking, stress, genetic factors, genito-urinary system infections, and periodontal disease.

It has been established that cigarette smoking is a risk factor for increased bone tissue loss in periodontal diseases and that it diminishes tissue response to periodontal treatments. Poor clinical outcomes have been reported in individuals smoking more than 10 cigarettes a day. This finding has been associated with the negative effects of smoking on new vessel formation, on the functions of defending cells of the body, on the collagen synthesis, and it has been found to be related to unfavourable changes in the inflammatory response.

Healthy gums are usually pale pink in colour, opaque, dimpled, having a hard consistency. They do not bleed and they end sharply without any swellings where they touch the tooth surface.

As they are the same colour as the teeth, it is very difficult to detect them by the naked eye. The structure of the plaque is soft and it can easily be removed from the dental surfaces by tooth brushing and flossing. If these plaques are not removed, they will calcify and harden forming dental calculus. The rough structure of the dental calculus facilitates the accumulation of the plaque. Therefore, inflammatory processes are facilitated too and gingival recessions occur.

This disease usually follows a chronic course and it may be unnoticed for some period of time because pain may not occur despite the developing inflammatory processes. Presence of bleeding and enlarged gums, dental calculus, loose teeth with empty spaces in between, a feeling of a bad taste in the mouth, and a foul odour of mouth indicate an urgent need to visit a dentist.

Recent studies have demonstrated that bacterial plaques cause not only gingival diseases but also plaque formation in the vessels of the heart, resulting in the development of coronary artery disease.

Inhalation of micro-organisms associated with the development of periodontal disease and their accumulation in the airways leads to pulmonary infections (infections in the lungs).

Several medications used in the treatment of systemic diseases may cause the growth of gums to become larger. These medications include drugs prescribed for the treatment of epilepsy or hypertension.

The primary requirement in periodontal disease is to eliminate the causing factors. In order to achieve this, dental calculi are removed, oral hygiene is improved, and pockets formed between the tooth and gingiva gum are removed using several methods (gingival curettage, flap surgery).