Gum Disease: Causes, Stages, Treatment and Long-Term Control
For anyone who wants to understand gum disease (periodontal disease): its cause, why it often causes no pain, its stages and grades, diagnosis, treatment at Deepcar Dental Care, risk factors and general health links. The core takeaway: gingivitis can be reversed, while periodontitis is controlled long term through treatment, daily cleaning and regular checks.
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Clinically reviewed by Dr Ibraheem Ijaz, dentist · GDC 301711
Medical disclaimer: This page is for general information only. It does not replace an examination or treatment by a dentist.
Dr Ibraheem Ijaz, GDC 301711, a General Dental Practitioner and the principal dentist at Deepcar Dental Care, reviewed this page. His qualifications are BDS, BSc (Hons) and MSc (Leeds).
What is gum disease?
Gum disease, or periodontal disease, is inflammation of the gums and the tissues that hold the teeth, caused by a build-up of plaque. Delivering Better Oral Health, the UK government's prevention toolkit for dental teams, describes this plaque biofilm as a highly organised film of bacteria on the teeth.
Gum disease can start when the balance between the plaque and the body's immune system, known as the host response, is disrupted. The toolkit notes that it is initiated by plaque in susceptible people.
Gingivitis is inflammation that stays within the gum, and the toolkit states it is reversible by reducing plaque at and below the gum margin. Periodontitis destroys the attachment between gum and tooth: a periodontal pocket forms and the supporting bone is gradually lost. Gingivitis is a risk factor for periodontitis, though not everyone with it progresses.
Plaque left in place hardens into calculus, or tartar, which the Leeds Teaching Hospitals NHS Trust gum disease leaflet notes cannot be removed by brushing. Our guide to gum health explains how healthy gums stay healthy.
Why is gum disease often silent?
Gum disease is often silent because it may cause no pain, even while periodontitis is damaging the bone. The Leeds leaflet says you can be unaware of active disease for many years.
Bleeding when you brush can be an early sign, and the leaflet notes that gums bleed less readily in smokers. Loose teeth come later, once bone support is damaged. The NHS advises seeing a dentist if your gums bleed when you brush or eat hard foods, and asking for an urgent dentist appointment if you have gum disease and teeth become loose or fall out.
Delivering Better Oral Health states that early detection and treatment of periodontitis increases the likelihood of keeping the teeth.
Which signs of gum disease need a dentist?
The main signs are bleeding, sore or swollen gums, bad breath and, later, loose teeth. NHS guidance gives an action for each, and advises calling 111 if you have no dentist or cannot get an emergency appointment:
- Gums that bleed when you brush, floss or eat hard foods: see a dentist.
- Painful, swollen gums: see a dentist. Gum disease with very sore and swollen gums: ask for an urgent dentist appointment.
- Swelling around your eye or neck, or swelling in your mouth or neck that makes it hard to breathe, swallow or speak: go to A&E or call 999, and do not drive yourself.
- Bad breath: see a dentist.
- Gum disease with teeth becoming loose or falling out: ask for an urgent dentist appointment.
- Ulcers or red patches in your mouth, or a lump in your mouth or on your lip, alongside gum disease: ask for an urgent dentist appointment.
- A child with sore, bleeding gums: see a dentist.
What if you think you have a dental abscess?
Gum disease can lead to a dental abscess, a build-up of pus from an infection, which the NHS says needs urgent treatment by a dentist. Signs include intense pain in the gums or a tooth, a swollen face or jaw and a high temperature. If you think you have a dental abscess, ask for an urgent dentist appointment or get help from NHS 111.
Our urgent dental care pages explain how to reach the practice. Call 999 or go to A&E if you are finding it hard to breathe, speak or swallow, have a swollen or painful eye or suddenly have problems with your eyesight, have a lot of swelling in your mouth, or are finding it hard to open your mouth. Do not drive yourself to A&E.
What are the stages of gum disease?
UK guidance stages periodontitis from I to IV by bone loss and grades it from A to C by speed of progression.
This is the 2017 World Workshop classification as adapted for the UK by the British Society of Periodontology. It records a stage, the damage so far, and a grade, how fast it happened.
| Stage | Bone loss at the worst-affected tooth | Description |
|---|---|---|
| Stage I | Under 15% of the root, or under 2 mm | Early or mild |
| Stage II | Coronal third of the root | Moderate |
| Stage III | Middle third of the root | Severe |
| Stage IV | Apical third of the root, near its tip | Very severe |
The grade compares the percentage of bone lost with your age: under 0.5 is grade A (slow), 0.5 to 1.0 is grade B (moderate) and over 1.0 is grade C (rapid). Extent is localised (up to 30% of teeth), generalised (more than 30%) or a molar and incisor pattern, so a diagnosis might read localised periodontitis, stage II, grade B.
Delivering Better Oral Health states that the stage cannot reduce, because the bone loss is largely irreversible, although it may increase.
How is gum disease diagnosed?
Gum disease is diagnosed by probing the gums for bleeding and pockets, then charting them in detail where screening finds deeper pockets.
The screening check is the basic periodontal examination (BPE). Delivering Better Oral Health sets out the codes: 0 healthy, 1 bleeding on probing, 2 a plaque trap such as calculus or an overhanging filling, 3 a pocket of 4 to 5.5 mm and 4 a pocket of 6 mm or more. An asterisk marks furcation involvement.
The BPE is a screen, not a diagnosis. In UK guidance, codes 3 and 4 lead to a six-point pocket chart. The Leeds leaflet notes X-rays may be taken to look for bone loss, and UK guidance works out stage and grade from it.
At Deepcar Dental Care, a BPE is recorded at every examination, and full six-point periodontal charting is also available.
To ask about gum disease treatment, book online or call 0114 288 2121.
How is gum disease treated?
Gum disease is treated by removing the plaque and calculus that drive the inflammation, alongside better daily cleaning and control of risk factors.
The NHS lists cleaning advice and a professional clean for early gum disease and, for serious disease, deep cleaning under the gums, antibiotics, removal of some teeth or gum surgery.
Deep cleaning below the gum line
In general, deep cleaning removes hardened plaque, or calculus, from above and below the gum line, as the Leeds leaflet explains. At Deepcar Dental Care, deep cleaning, or non-surgical periodontal therapy, is given as a course of 2 to 4 visits, with a re-check 4 to 6 weeks after, and root surface debridement is carried out under local anaesthetic.
Gum surgery and advanced gum treatment at the practice
Treatment for advanced gum disease (severe periodontitis) and regenerative gum treatment are done in house. Gum surgery and gum grafting are carried out in house by our dentists. To read about each treatment, you can browse the hygiene and gum treatments section.
Can gum disease be cured or reversed?
Gingivitis can be reversed, but the bone lost to periodontitis largely cannot, so periodontitis is controlled rather than reversed.
Delivering Better Oral Health states that periodontitis is a chronic disease that will recur and worsen without good plaque control. The Leeds leaflet says the aim of treatment is to stop it getting worse in some cases and only to slow it in others, and that gum disease can relapse even when pockets have resolved.
What increases the risk of gum disease?
Plaque is the cause, but smoking, diabetes, some medicines, family history and pregnancy can make gum disease more likely or harder to treat.
Delivering Better Oral Health says tobacco has a profound effect on periodontitis risk and impairs the response to treatment, and the Leeds leaflet adds that in smokers gum disease is more likely to worsen faster and to return. Smoking cessation advice is available at the practice.
The toolkit advises assuming an increased risk for anyone with diabetes, and says raised blood sugar also impairs the response to treatment. Some medicines can cause a dry mouth or overgrown gums. The Leeds leaflet notes that gum disease can run in families, and that pregnancy hormones can aggravate existing gum disease.
Is gum disease linked to general health?
Gum disease and diabetes affect each other, while any link with heart disease is less clear.
The diabetes association runs both ways: the Leeds leaflet notes that poorly controlled diabetes can speed up gum disease, and active gum disease can make diabetes harder to control. A 2022 Cochrane review of 30 trials found moderate-certainty evidence that cleaning below the gum line improves blood sugar control in people with periodontitis and diabetes, for up to 12 months. It does not replace diabetes care.
For heart disease, Delivering Better Oral Health notes shared genetic and environmental influences, and says the role of periodontitis in cardiovascular disease is still debated, with no firm conclusions.
How can you prevent gum disease and keep it under control?
Daily plaque removal at home is the most important way to prevent gum disease and keep treated disease stable. The NHS advises these habits:
- Brush with fluoride toothpaste at least twice a day, then spit rather than rinse.
- Clean between your teeth every day with floss or interdental brushes.
- Do not use mouthwash straight after brushing, and do not smoke.
- Have regular dental check-ups, especially if you are pregnant or have type 2 diabetes.
At Deepcar Dental Care, the usual recall interval is 6 months with healthy gums and 3 to 6 months after treated gum disease.
How much does gum disease treatment cost?
Gum disease treatment costs depend on what your gums need. On the current fee list, a routine patient examination is from £63.
Deep cleaning, treatment for advanced gum disease, gum surgery, grafting and regenerative treatment have no line on the fee list, so ask the practice about the cost. Prices are on the current fee list.
Frequently asked questions
Can you book a hygiene appointment without seeing a dentist first?
Yes, you can book directly with our dental therapist at Deepcar Dental Care without seeing a dentist first. You do not need to register as a patient, and hygiene appointments can be booked online through the booking portal. Appointments usually last 30 to 60 minutes.
Does gum disease affect other dental treatment?
Yes, gum health matters before several treatments. At Deepcar Dental Care, gum disease is treated before composite bonding, and teeth whitening is not suitable while gum disease is active. Our page on whether you can have dental implants with gum disease explains how gum health affects implant suitability.
Why do gums bleed more when you start cleaning them properly?
Inflamed gums often bleed when they are first cleaned well. Leeds Teaching Hospitals explains that this comes from the inflammation, not from damage, and reduces over time if you keep going. Bleeding still needs checking: the NHS advises seeing a dentist if your gums bleed when you brush.
Does deep cleaning for gum disease hurt?
Deep cleaning is usually done under local anaesthetic, so the gums are numb during treatment. At Deepcar Dental Care, numbing gel is applied before every injection. Leeds Teaching Hospitals notes that teeth may feel sensitive to hot, cold or sweet things afterwards, which often improves after a few weeks, sometimes with a sensitive toothpaste.
Will your gums look different after gum disease treatment?
Your gums may shrink as they become healthier. Leeds Teaching Hospitals explains that as the swelling goes down, you might notice new spaces between the teeth or teeth that look longer. Treatment is not generally able to reverse bone loss, so the aim is to stop gum disease getting worse or, in some cases, only to slow it.
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You can book online through the practice booking portal or call 0114 288 2121.
Deepcar Dental Care is at 334 Manchester Road, Deepcar, Sheffield, S36 2RH, with free parking directly outside, and the practice is on the ground floor and wheelchair accessible. Our page on hygiene appointments explains professional hygiene care at the practice, and patients describe their visits in our patient reviews.
334 Manchester Road
Deepcar, Sheffield S36 2RH
0114 288 2121
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