Periodontitis: When Gum Disease Reaches the Bone
For anyone told they have periodontitis: how it differs from gingivitis, what it destroys, staging, symptoms and when to get help, diagnosis, treatment, each tooth's outlook, long-term control and referral. The core takeaway: lost bone is largely irreversible, so treatment aims to stop or slow periodontitis, not reverse it.
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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 include BDS, BSc (Hons) and MSc (Leeds).
What is periodontitis?
Periodontitis is gum disease that has spread beyond the gum and destroys the attachment and bone holding a tooth in place.
Delivering Better Oral Health, the UK government's dental prevention toolkit, describes it as plaque-linked inflammation driven by the body's immune reaction, the host response. In this chronic form of periodontal disease, the gum comes away from the tooth to form a periodontal pocket (Leeds Teaching Hospitals NHS Trust).
How does periodontitis differ from gingivitis?
Gingivitis stays within the gum and can be reversed, while periodontitis has destroyed part of the tooth's attachment.
Delivering Better Oral Health states that gingivitis does not reach the root covering, the periodontal ligament or the bone, and can be reversed by reducing plaque. Not everyone with it develops periodontitis. Our page on gingivitis covers the early stage.
What does periodontitis destroy, and can it be stopped?
Periodontitis destroys the attachment and bone around the root; that bone loss is largely irreversible, but treatment aims to stop or slow it.
- Attachment loss: the tissues joining the tooth to gum and bone lose their hold, showing as a pocket, recession, or both.
- Alveolar bone loss: the bone of the tooth socket is lost, which X-rays show.
- Furcation involvement: in teeth with more than one root, bone is lost between the roots.
- Tooth mobility: untreated, teeth can loosen and fall out or need removing.
NHS guidance says gum disease, including receding gums, should be checked by a dentist, and loose or falling-out teeth with gum disease need an urgent dentist appointment.
Leeds Teaching Hospitals states that bone loss cannot be reversed, and that in some cases treatment can only slow the disease. Delivering Better Oral Health adds that the stage cannot reduce.
How is periodontitis staged and graded?
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 classification, adapted for the UK by the British Society of Periodontology and set out in Delivering Better Oral Health. Stage uses the worst-affected tooth:
| Stage | Bone loss along the root |
|---|---|
| Stage I (early) | Under 15%, or under 2 mm |
| Stage II (moderate) | Coronal third |
| Stage III (severe) | Middle third |
| Stage IV (very severe) | Apical third, near the tip |
Grade divides the percentage of bone lost by age in years: under 0.5 is grade A (slow), 0.5 to 1.0 grade B and over 1.0 grade C (rapid).
What are the symptoms of periodontitis?
Periodontitis can cause bleeding, swollen or receding gums, bad breath and loose teeth, but Leeds Teaching Hospitals notes it can go unnoticed for years.
The leaflet adds that gums bleed less readily in smokers. NHS guidance gives an action for each sign of gum disease:
- Gums that bleed when you brush or eat hard foods, or bad breath: see a dentist.
- Gums shrinking or receding: the NHS lists this among the effects of gum disease, which it says should be checked by a dentist.
- Painful, swollen gums: see a dentist. Very sore and swollen gums alongside gum disease: ask for an urgent dentist appointment.
- Teeth becoming loose or falling out, 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.
If you do not have a dentist or cannot get an emergency appointment, call 111.
What if periodontitis causes pain or swelling?
Gum disease can cause toothache. NHS guidance says to see a dentist if toothache lasts more than 2 days, does not go away with painkillers, or comes with a high temperature, pain when you bite, red gums, a bad taste or a swollen cheek or jaw. If you do not have a dentist or cannot get an emergency appointment, call 111 or visit 111 online.
Go to A&E or call 999 if the area around your eye or your neck is swollen, or swelling in your mouth or neck makes it difficult to breathe, swallow or speak, and do not drive yourself. Our urgent dental care pages explain how to reach the practice.
To ask about gum disease treatment, book online or call 0114 288 2121.
How is periodontitis diagnosed?
In UK guidance, periodontitis is diagnosed by probing for bleeding and pockets, charting them, and using X-rays to assess bone loss around the teeth.
The screening check is the basic periodontal examination (BPE), scored 0 (healthy) to 4 (a pocket of 6 mm or more). Delivering Better Oral Health notes it is a screen, not a diagnosis: deeper pockets lead to a six-point chart, X-rays, a stage and a grade. Our guide to how gum disease is diagnosed explains pocket depths.
How is periodontitis treated?
In UK guidance, periodontitis is treated by improving daily cleaning and controlling risk factors, then deep cleaning below the gum line.
The Scottish Dental Clinical Effectiveness Programme (SDCEP) starts with cleaning coaching, help with risk factors such as smoking and diabetes, and removing plaque and tartar above the gum line. Deep cleaning follows as treatment for gum disease below the gum line at pockets of 4 mm or more that hold deposits or bleed, sometimes with local anaesthetic.
SDCEP advises against routine antibiotics alongside deep cleaning. Leeds Teaching Hospitals notes that treatment only succeeds if you clean your teeth effectively.
Will periodontitis make you lose your teeth?
Not necessarily, but no one can promise a particular tooth will be saved, and the outlook is judged tooth by tooth.
The European Federation of Periodontology (EFP) guideline calls periodontitis preventable and treatable in most cases, but notes that in severe stage III disease treatment goals may not be reached for every tooth. Factors linked with how each tooth responds:
| Factor at each tooth | What guidance and research say |
|---|---|
| Bone support left | Less bone means less support; teeth that have lost a lot of bone may be removed (Leeds) |
| Pocket depth after treatment | Of the treatment results commonly reported, pocket reduction is the strongest predictor of tooth loss; pockets of 4 mm or more that still bleed are likely unstable (EFP) |
| Furcation involvement | More complex care, yet many teeth respond; advanced involvement raises the risk of loss, but alone is no reason for removal (SDCEP) |
| Mobility | Very loose teeth may be removed, which can make neighbouring teeth easier to clean (Leeds) |
NHS guidance says loose teeth with gum disease need an urgent dentist appointment. Plaque control, smoking, diabetes and regular care affect every tooth. Our page on loose teeth from gum disease covers mobility, and repairing and rebuilding damaged teeth covers saving natural teeth that also need repair.
How is periodontitis kept under control long term?
Periodontitis is kept under control by daily plaque removal and regular reviews, because it will recur and worsen without good plaque control.
Delivering Better Oral Health calls this supportive periodontal care: a long-term commitment from you, with regular checks of plaque, pockets and bleeding, and cleaning where needed. SDCEP reports observational evidence that people who keep it up lose fewer teeth, and the EFP guideline notes that even stable, treated patients remain at increased risk of it returning.
What does UK guidance say about advanced periodontitis and referral?
In UK guidance, uncomplicated periodontitis should be treated in general dental practice, and referral may be considered for severe or complex cases.
SDCEP, drawing on British Society of Periodontology guidelines, advises referral for grade C or stage IV disease with pockets of 6 mm or more, after risk-factor control and non-surgical treatment. For pockets that do not respond, options include further treatment, surgery or referral, and unmet goals raise the risk of tooth loss.
Gum disease care at Deepcar Dental Care
At Deepcar Dental Care, BPE screening is part of every examination, and full six-point periodontal charting is available.
Recall with healthy gums is 6 months, and recall after treated gum disease is 3–6 months. Smoking cessation advice is also available.
Treatment of advanced gum disease (severe periodontitis) and regenerative gum treatment are done in house, as are gum surgery and gum grafting. Gum recession treatment is available at the practice.
Deep cleaning, or non-surgical periodontal therapy, is a course of 2 to 4 visits, with a re-check 4 to 6 weeks after. Root surface debridement is carried out under local anaesthetic, with topical numbing gel before every injection.
Frequently asked questions
Does periodontitis run in families?
It can. Leeds Teaching Hospitals explains that gum disease can run in families, especially forms that progress rapidly, so your risk may be higher if relatives had gum disease, particularly at a young age. Delivering Better Oral Health notes it shares some genetic and environmental influences with conditions such as diabetes.
Does smoking make periodontitis worse?
Yes. Delivering Better Oral Health says tobacco has a profound effect on periodontitis risk and impairs the response to treatment, and that stopping can prevent further deterioration. Leeds Teaching Hospitals adds that in smokers it is more likely to return after treatment. Our page on smoking and gum disease explains more.
Is periodontitis linked to diabetes?
Yes, both ways. Leeds Teaching Hospitals explains that poorly controlled diabetes can speed up gum disease and make treatment harder, while active gum disease can make diabetes harder to control. Delivering Better Oral Health notes that periodontal treatment may improve diabetes control.
Does treatment for periodontitis hurt?
Deep cleaning is usually done with local anaesthetic, which numbs the gums to make treatment as comfortable as possible. Leeds Teaching Hospitals notes that teeth may feel sensitive to hot, cold or sweet things afterwards, which often gets better after a few weeks, though a sensitive toothpaste may be needed.
What happens if a tooth cannot be kept?
A tooth that cannot be kept may be removed. Leeds Teaching Hospitals lists replacements including a denture, a bridge or dental implants, recommending implants only once gum disease is well controlled. Our page on whether you can have dental implants with gum disease explains more.
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To ask about gum disease treatment, 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. Patients describe their visits in our patient reviews.
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Deepcar, Sheffield S36 2RH
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