Warning signs

Any one of these is a reason to have your gums checked. Several together make it more likely that something is already happening below the gumline.

  • Bleeding when you brush or floss. Bleeding is usually a sign of inflamed tissue, and it is often the earliest sign anyone notices. It can also come from brushing too hard, from some medications, or from changes in pregnancy, which is why it should be examined rather than dismissed.
  • Bad breath or a bad taste that keeps returning. The bacteria below the gumline give off compounds that brushing your tongue will not reach.
  • Gums that look puffy, shiny or dark red. Healthy gum is firm and sits in a thin edge against the tooth. Swollen, glossy tissue points to inflammation.
  • Receding gums and teeth that look longer. Recession exposes root surface that was never meant to be exposed, and it happens slowly enough that people often notice it first in photographs.
  • Sensitivity at the gumline. Exposed root has no enamel over it, so it can react to cold, to sweet foods and to air.
  • Teeth that have moved. New gaps, front teeth flaring forward, a bite that feels different. Teeth can move when the bone supporting them has been lost.
  • A tooth that feels loose. This tends to be a late sign rather than an early one, and it warrants an appointment.
  • A partial denture that has stopped fitting. Clasps grip teeth in fixed positions, so if a partial rocks or has to be forced, the teeth have probably moved.

Why it is often painless until late

Dental pain is usually associated with decay, where the problem reaches the nerve and the pressure has nowhere to go. Periodontal disease behaves differently, which is part of why it goes unnoticed for so long.

Periodontal breakdown is slow inflammation in tissue that has room to swell, and a pocket tends to drain rather than build pressure. Each change is small enough that the body adapts to it, so there is often no single moment of pain.

That is why the condition can be well established before anything demands attention, and why a tooth that feels loose has often already lost a good deal of its support. One exception is a periodontal abscess, which can flare up with swelling and throbbing. Call the office rather than waiting if that happens.

Stages of gum disease

These describe stages rather than a means of self-diagnosis. Only measured charting can place you on the scale.

Healthy
Firm gum with a thin edge against the tooth, shallow readings, no bleeding when probed, and steady bone levels.
Gingivitis
Inflammation confined to the gum. Bleeding and puffiness, with no loss of attachment or bone. Generally reversible once the deposits are removed and daily cleaning reaches the gumline.
Early periodontitis
Attachment has begun to break down and pockets are deepening past what a brush and floss can clean. The first bone changes show on x-rays. Often there are no symptoms beyond bleeding.
Moderate periodontitis
Deeper pockets, visible recession, root sensitivity, sometimes involvement where the roots of a back tooth divide, and occasionally slight movement.
Advanced periodontitis
Substantial bone loss, teeth that are mobile or have drifted, repeated abscesses, and teeth that may not be possible to keep. Referral to a periodontist is usual at this point.

What research says about gums and the rest of your body

Research has repeatedly found associations between periodontitis and cardiovascular disease, poorly controlled diabetes, adverse pregnancy outcomes such as preterm birth, and certain respiratory infections. Those findings have appeared across enough populations to merit attention.

These are associations, and on their own they do not establish cause and effect. People with gum disease often share other risk factors, smoking being an obvious one, and a link across a population does not show that treating one condition prevents the other. A fair summary is that the connection is real and the mechanism behind it is still being investigated.

Diabetes is the exception in how well the mechanism is understood, and there the relationship does appear to run both ways. High blood sugar can make gum infection more severe, and severe gum infection can make blood sugar harder to control. Tell us if you have diabetes, and keep your physician informed.

The clearest reason to treat periodontitis is to keep your teeth, and that reason stands regardless of where the wider research eventually settles.

Common questions about periodontal disease

My gums only bleed sometimes. Does that matter?

It merits an examination. Intermittent bleeding often means a few specific sites are inflamed rather than the whole mouth, and those sites tend to be the hardest to clean, typically between the back teeth.

I brush twice a day. How did I get gum disease?

Brushing leaves the spaces between teeth largely untouched, and that is where gum disease often starts. Risk also depends on diet, saliva flow, medications, smoking, diabetes and genetics, so careful brushing on its own does not always prevent gum disease. Brushing and flossing covers the rest.

Will my gums grow back after treatment?

Gum that has receded does not generally grow back on its own, and neither does lost bone, although grafting can cover exposed root and regenerative procedures can rebuild bone in selected defects. More often, swollen tissue shrinks back to its true level once the inflammation settles, which can make teeth look longer.

Can gum disease cause bad breath?

Often, and it is a common reason for appointments. Breath that returns within an hour of brushing points to bacteria below the gumline rather than anything on the tongue. Treatment usually resolves it.