Gum Disease: What It Is, What It Does, and What to Do Next

Gum disease (also called periodontal disease) is an infection of the structures that support your teeth — the gums, the periodontal ligament, and the bone beneath. It is caused primarily by a build-up of bacterial plaque along and below the gumline that, if not removed, triggers an inflammatory response in the surrounding tissue.

There are two main stages:

Gingivitis is the early stage, affecting only the gum tissue. The gums may appear redder than usual, swell slightly, or bleed when you brush or floss. Gingivitis is reversible with improved cleaning and professional hygiene treatment.

Periodontitis is the more advanced stage, where the inflammation has spread beneath the gumline and begun to damage the bone supporting your teeth. At this stage, the gum may pull away from the tooth (forming pockets), and some bone loss may already have occurred. Periodontitis is not reversible — but it can be halted and managed effectively with the right treatment.

Unlike toothache, gum disease is frequently painless in its early and middle stages. Many people attribute bleeding gums to brushing too hard, and some forms of gum disease cause very little obvious redness or swelling despite active infection beneath the surface.

The signs most worth paying attention to include:

• Gums that bleed when you brush or floss, even occasionally
• Gums that look redder or more swollen than usual
• Persistent bad breath that doesn't resolve with brushing
• Teeth that feel looser than they used to
• Gums that appear to be pulling away from the teeth, making them look longer
• Discomfort when biting or chewing

None of these symptoms on their own confirm a diagnosis — only a clinical assessment can do that. But if you recognise several of them, it is worth having your gum health reviewed professionally.

The consequences of untreated periodontal disease extend beyond the mouth. Research has identified associations between gum disease and a number of systemic health conditions, including cardiovascular disease, diabetes, and respiratory conditions. The nature of these relationships is still being studied, but the evidence is sufficient that gum health is now considered part of broader health management, not a purely cosmetic concern.

Within the mouth, the progression of untreated gum disease typically involves:

• Deepening gum pockets as the tissue detaches from the tooth
• Gradual loss of the bone that anchors each tooth
• Increasing tooth mobility and — in advanced cases — eventual tooth loss

The critical point is that bone loss, once it has occurred, cannot be regenerated naturally. This is why early identification and treatment is so much more effective than waiting.

The approach to treating gum disease depends on the stage at which it is caught and how it has responded to initial treatment. In most cases, the first line of treatment is non-surgical.

Professional cleaning (scale and polish) removes plaque and tartar above and at the gumline. For gingivitis, this — combined with improved home cleaning — is often sufficient to resolve the inflammation.

Root surface debridement (deep cleaning) is the standard treatment for periodontitis. Working with local anaesthetic in most cases, a hygienist or therapist cleans below the gumline, removing bacterial deposits from the root surfaces and smoothing them to make reattachment easier and future plaque build-up less likely. Several appointments are typically needed, and the results are assessed over subsequent months.

Surgical treatment is sometimes recommended when non-surgical treatment has not fully controlled the condition, or when pocket depths are such that effective cleaning cannot be achieved without access surgery. This is a specialist procedure.

Maintenance is a permanent part of managing periodontal disease. Once stabilised, patients typically attend more frequently than the standard annual or biannual review, so that any recurrence is caught early.

Home care cannot replace professional treatment, but it has a significant effect on outcomes. The most important elements are:

• Brushing twice daily with a fluoride toothpaste, using a method your dental team recommends for your situation
• Cleaning between your teeth daily using interdental brushes, floss, or water flossers — the choice of which is less important than consistency
• Not smoking, or seeking support to stop — smoking significantly impairs healing and masks the visual signs of gum disease
• Managing blood sugar if you have diabetes, as the relationship between diabetes and gum disease runs in both directions

This guide is for general information purposes only and does not constitute clinical advice. The presence or absence of the symptoms described is not a reliable indicator of your gum health without professional assessment. Individual circumstances vary significantly — please consult a qualified dental professional for advice specific to your situation.