A Guide to Gum Health and Dental Hygiene

Healthy gums are pink and firm, hold the teeth securely, and do not bleed when you brush or touch them. That is how UK public health guidance on gum disease (nidirect) describes them, and it gives a simple baseline to check your own gums against in a mirror.

Colour, firmness and bleeding are the three things to look at. Gums that are red, puffy or sore, or that bleed when you brush, are showing inflammation. Blood on the toothbrush or in the sink is not a normal part of brushing. The NHS advises seeing a dentist if your gums bleed when you brush your teeth or eat hard foods, or if your gums are painful and swollen.

Gums can also look different as they recover. The British Society of Periodontology's patient leaflet explains that when someone starts a better cleaning routine, the gums may shrink back as the swelling goes down and may turn a lighter shade of pink as they heal.

The plaque biofilm is the soft film of bacteria that forms on the teeth, and its build-up is what causes gum disease. Delivering Better Oral Health describes dental plaque as a highly organised film of bacteria held in an organic matrix on the tooth surface.

A biofilm is organised and attached, not a loose layer of food. That is why it has to be removed mechanically, by brushing and by cleaning between the teeth. The Leeds Teaching Hospitals leaflet points out that mouthwashes do not physically remove plaque and so cannot replace brushing or interdental cleaning. The British Society of Periodontology's patient advice is that the biofilm needs removing twice a day at home to help keep the gums stable.

Gum inflammation is the body's reaction to that biofilm. Delivering Better Oral Health describes gingivitis as the result of interactions between dental plaque and the body's immune response. Plaque that sits at the gum margin, and just below it, irritates the gum, and the gum becomes red and swollen. Remove the plaque and the inflammation can settle; leave it and the reaction continues.

What is calculus, and why can't you brush it away?

Calculus, also called tartar, is plaque that has hardened on the teeth, and it cannot be removed by brushing. The Leeds leaflet explains that plaque which is not removed properly becomes hardened into calculus, which then has to be removed by the dental team.

Calculus matters because it holds plaque against the gum. Delivering Better Oral Health lists calculus as a plaque retention factor in its table of BPE codes, alongside an overhanging restoration such as a filling with a ledge. A professional clean removes calculus above the gum line, and calculus on the root surface below the gum line is what deep cleaning is designed to remove. Our page on plaque and calculus explains the difference between the two in more detail.

Periodontitis is controlled rather than cured because it is a chronic disease that returns and worsens if plaque control lapses, even after successful treatment. Treatment makes the gums stable; it does not make them immune.

UK guidance is consistent on this. Delivering Better Oral Health states that periodontitis will recur and worsen without good plaque control, and that the stage of periodontitis cannot reduce, because the bone loss is largely irreversible, although it may increase. The Leeds Teaching Hospitals leaflet describes periodontitis as a long-term condition, and says that even when all pockets resolve after treatment, gum disease can relapse, so regular attendance allows relapse to be picked up quickly. Our page on whether gum disease can be reversed explains which changes can settle and which cannot.

That puts periodontitis in the same category as other long-term conditions that are managed over years rather than fixed by a single treatment. Success is measured by stability: less bleeding, shallower pockets and no further loss of support. A good result is not a mouth that never needs care again, but gums that stay stable year after year. SDCEP describes the last step of care, supportive periodontal care, as preventing deterioration and maintaining stability, and accepts that some residual pockets may persist even then. Delivering Better Oral Health adds that supportive care involves a long-term commitment from the patient.

The rhythm of care changes once gum disease has been treated. SDCEP expects recall intervals in supportive care to range from 3 to 12 months, depending on the person, and between visits the daily routine at home does most of the work.

This model also explains why a single clean is not the end of the matter. A professional clean removes what has built up, but the biofilm keeps forming, which is why the British Society of Periodontology advises removing it twice a day at home. Long-term control comes from the combination: thorough cleaning at home, attention to risk factors such as smoking, and regular professional checks that measure the gums.

At Deepcar Dental Care, the usual recall interval with healthy gums is 6 months, and after treated gum disease it is 3 to 6 months.

Gum treatment can stop or slow periodontitis, but it is not generally able to reverse bone loss, and it depends on daily cleaning to work. Those two limits are worth knowing before treatment starts.

The Leeds Teaching Hospitals leaflet explains that successful treatment reduces bleeding and the depth of pockets, but that in some cases the aim is only to slow the disease down. Smoking makes treatment less likely to work, and some pockets may not respond to the first round of deep cleaning and need further treatment.

Gums can change after deep cleaning. As the gums become healthier and the swelling goes down, they may shrink, so you might notice new spaces between the teeth or teeth that look longer. Teeth may become sensitive to hot, cold or sweet things as the gums shrink. The Leeds leaflet says this often gets better after a few weeks, and that a toothpaste for sensitive teeth may be needed. Our hygiene aftercare section covers healing and comfort after treatment.