Gum disease (periodontal disease) is inflammation and infection of the gums and the bone that support the teeth. It is common, often painless in the early stages, and a leading cause of tooth loss in adults. This article explains the stages, signs and causes, how it is diagnosed and treated, and how to keep it under control.

Gingivitis and periodontitis

Gingivitis is inflammation of the gums caused by plaque, the sticky film of bacteria that builds up on teeth. The gums may be red, swollen and bleed when brushing. No bone has been lost, and gingivitis can be reversed with good cleaning at home and professional care.

Periodontitis develops when inflammation spreads below the gum line and damages the ligament and bone holding the teeth. Pockets form between the gums and teeth, gums may recede, and teeth can become loose. The bone lost cannot fully grow back, but treatment can stop or slow the disease.

Signs to look for

Gums that bleed when brushing or flossing.
Red, swollen or tender gums.
Persistent bad breath or a bad taste.
Receding gums, or teeth that look longer.
Loose or shifting teeth, or changes in how your teeth meet when biting.
Pus between the teeth and gums.

Smokers may have less bleeding, which can hide the disease.

Causes and risk factors

Plaque and tartar (hardened plaque) left on the teeth.
Smoking, one of the strongest risk factors.
Diabetes, especially when poorly controlled.
Hormonal changes, such as during pregnancy.
Family history.
Some medications that reduce saliva or cause gum overgrowth.
Stress and a poor diet, which may affect the body’s response to infection.

Gum health and general health

Research has found links between periodontitis and several conditions. The link with diabetes works both ways: diabetes increases the risk of gum disease, and treating gum disease can modestly improve blood sugar control. Gum disease has also been associated with heart disease, and in pregnancy with preterm birth, but these associations do not prove that gum disease causes them.

How gum disease is diagnosed

The dentist or hygienist checks the gums and measures the depth of the space between each tooth and the gum with a small probe. Healthy pockets are shallow; deeper pockets suggest periodontitis. X-rays show the level of bone around the teeth. Medical history, smoking and diabetes are also considered.

Non-surgical treatment

Professional cleaning and deep cleaning

Gingivitis is usually treated with a professional scale and clean plus better cleaning at home. For periodontitis, a deep clean, often called scaling and root planing or root debridement, removes plaque and tartar from below the gum line and smooths the root surfaces so the gums can heal. It is usually done under local anaesthetic, sometimes over more than one visit.

Antimicrobials and antibiotics

Chlorhexidine mouth rinse may be prescribed for a short time. In some cases antibiotics, taken by mouth or placed into deep pockets, are used alongside cleaning. They do not replace removing plaque and tartar.

Home care

Brush twice a day with fluoride toothpaste and a soft or electric toothbrush, angling the bristles towards the gum line.
Clean between your teeth daily with floss or interdental brushes.
Stop smoking; ask your doctor or Quitline (13 78 48) for support.

Surgical treatment

If deep pockets remain after non-surgical treatment, surgery may be advised, often by a periodontist, a registered specialist in gum disease.

Flap surgery: the gums are lifted back so the roots and bone can be cleaned, then stitched into place to reduce pocket depth.
Bone grafts and guided tissue regeneration: graft material or special membranes are used to help rebuild some lost bone and attachment in suitable sites.
Gum grafts: tissue is added to cover exposed roots where gums have receded.

Maintenance and preventing return

Periodontitis is a long-term condition that can return. After treatment, regular maintenance visits, often every three to six months, are used to remove new tartar, check pocket depths and catch problems early. Keeping up daily cleaning at home and not smoking make the biggest difference.

Diet and other lifestyle factors

A balanced diet with fruit and vegetables supports healing, and limiting sugar reduces plaque. Managing diabetes and stress also helps. Natural remedies such as oil pulling, herbal rinses and probiotics have little good evidence and should not replace brushing, cleaning between teeth and professional treatment.

Common questions

Can gum disease be cured?

Gingivitis can be reversed. Periodontitis can be controlled so it stops getting worse, but it needs ongoing care.

Is bleeding when I brush normal?

No. Bleeding is usually a sign of gum inflammation and is worth having checked. Keep brushing gently rather than avoiding the area.