Gum disease: causes, signs, and how it is treated

Gum disease is the most common chronic inflammatory condition in the world, affecting the majority of adults to some degree. It is also the leading cause of tooth loss in adults over 35. Yet the condition is largely silent in its early stages — most patients experience no pain and notice no obvious signs until the disease has already caused measurable damage to the supporting bone.

Understanding gum disease — what causes it, how it progresses, and how it is treated — is one of the most important things any dental patient can learn. The earlier it is detected, the more predictably it can be managed.

• Gum disease is caused by the accumulation of bacterial biofilm at and below the gum line
• Gingivitis — inflammation of the gum tissue — is the earliest and most reversible stage
• Periodontitis — destruction of the bone and ligament supporting the teeth — is not fully reversible

How gum disease progresses

The process begins with plaque — a sticky, colourless film of bacteria that forms continuously on tooth surfaces. When plaque is not removed effectively by brushing and interdental cleaning, it hardens into calculus, which cannot be removed by brushing alone. The bacteria within the biofilm trigger an inflammatory response in the gum tissue, causing the redness, swelling, and bleeding on probing that characterise gingivitis.

At this stage, the damage is confined to the soft tissue and is fully reversible with professional cleaning and improved home care. However, if left untreated, the inflammation extends deeper. The body's immune response to the bacterial challenge causes the destruction of the periodontal ligament and the supporting alveolar bone — a process that is progressive, cumulative, and cannot be undone.

• Bone loss associated with periodontitis is permanent — destroyed bone does not fully regenerate
• Pocket depths greater than 3mm indicate attachment loss and require clinical intervention
• Risk factors including smoking, diabetes, and stress significantly accelerate disease progression

Recognising the warning signs

Bleeding gums are the most commonly dismissed warning sign of gum disease. Many patients believe that bleeding during brushing is normal or caused by brushing too hard. In reality, healthy gum tissue does not bleed in response to routine brushing. Bleeding is a clinical sign of active inflammation and should always be investigated.

Other warning signs include persistent bad breath, gum recession, teeth that appear longer than they used to, sensitivity at the gum line, and — in advanced cases — tooth mobility. Any of these symptoms warrants a full periodontal assessment.

• Bleeding on brushing or flossing is the earliest and most common clinical sign of gum disease
• Halitosis that persists despite good oral hygiene is frequently associated with active periodontal infection
• Gum recession exposes root surfaces that are more vulnerable to sensitivity and decay

How gum disease is treated

Treatment depends entirely on the severity and extent of the disease at the time of diagnosis. Gingivitis is resolved with professional supragingival cleaning combined with improved patient home care. Mild to moderate periodontitis is typically managed with a programme of root surface debridement — deep cleaning under local anaesthesia to remove calculus and disrupt the biofilm below the gum line. Severe periodontitis may additionally require surgical intervention to access and debride pockets that cannot be reached non-surgically.

• Root surface debridement under local anaesthesia is the primary treatment for established periodontitis
• Periodontal maintenance appointments every 3 months are essential to prevent disease recurrence after active treatment
• Surgical options including flap surgery and guided tissue regeneration are available for advanced cases

"Most of the patients who come to us with significant gum disease had no idea anything was wrong. The disease is quiet until it is not. Regular screening is the only reliable way to catch it early."