Gum disease (periodontal disease) is the leading cause of tooth loss in adults — ahead of cavities. It is also linked to increased risk of heart disease, diabetes complications, adverse pregnancy outcomes, and stroke. Yet because gum disease is often painless in its early stages, most people with it do not know they have it.
How Gum Disease Starts
The chain begins with plaque — the sticky film of bacteria that forms on teeth within hours of brushing. When plaque is not removed, bacteria release toxins that irritate the gum tissue, triggering an inflammatory response. This is gingivitis: the earliest and only reversible stage of gum disease.
If gingivitis is not treated, the inflammation advances below the gum line. The gum pulls away from the tooth, forming "pockets" where bacteria accumulate and thrive without oxygen (which is lethal to the bacteria that cause surface plaque but not to the deeper periodontal pathogens). These bacteria begin destroying the bone and ligaments that hold teeth in place. This is periodontitis — and it is not reversible, only controllable.
Warning Signs
- Gums that bleed when you brush or floss (even a little)
- Red, swollen, or tender gums
- Gums that have pulled away from the teeth, making teeth look longer
- Persistent bad breath not explained by food or dry mouth
- Pus between the gum and tooth
- Loose teeth or teeth shifting position
- A change in how your teeth fit together when you bite
Note: bleeding gums when brushing is not normal. It is the most common early sign of gingivitis and should prompt a dental visit.
Treatment by Stage
Gingivitis: A professional cleaning to remove tartar, combined with improved brushing and flossing at home, reverses gingivitis in most cases within two to four weeks.
Mild to moderate periodontitis: Scaling and root planing (deep cleaning) under local anesthesia removes bacteria and tartar from below the gum line and smooths root surfaces. This is typically done in two appointments covering one half of the mouth each. Follow-up maintenance cleanings every three months are then essential.
Severe periodontitis: When deep cleaning is not enough, periodontal surgery may be required. Options include flap surgery to access and clean deep pockets, bone grafting to rebuild destroyed bone, and guided tissue regeneration.
The Role of Risk Factors
Smoking is the strongest modifiable risk factor for gum disease — it suppresses the immune response and reduces blood flow to gum tissue, making treatment less effective. Diabetes significantly increases risk (and gum disease worsens blood sugar control, creating a bidirectional relationship). Genetic predisposition, stress, certain medications (particularly those causing dry mouth or gum overgrowth), and hormonal changes also play roles.
Maintenance: The Lifelong Commitment
Gum disease cannot be cured — it can only be controlled. Once diagnosed with periodontitis, most patients need professional cleanings every three months indefinitely. Research consistently shows that bacteria associated with gum disease recolonise treated pockets within approximately 90 days. Three-month intervals keep bacterial levels below the threshold that causes active tissue destruction.