Types of gum disease and their symptoms

What causes gum disease?

It starts with plaque, the sticky film of bacteria that forms on teeth every day. When plaque sits along the gumline, your gums become inflamed. Plaque that isn’t cleaned off hardens into tartar, which a toothbrush can’t remove, and that gives bacteria an even better place to grow.

Some things make gum disease more likely or harder to control:

• Smoking or using other tobacco
• Diabetes, especially when blood sugar is not well controlled
• Hormone changes, such as during pregnancy
• Medicines that cause dry mouth
• Crowded or overlapping teeth that are hard to clean
• A family history of gum disease
• Long gaps between professional cleanings

What is gingivitis?

Gingivitis is the mildest and most common form. Bacteria irritate the gum tissue, but the bone and the fibers that anchor your teeth are still healthy. That is why it can be fully reversed.

Typical signs of gingivitis include:

• Gums that bleed when you brush or floss
• Red or darker-than-usual gums instead of firm pink ones
• Puffy or tender gums, especially between teeth
• Bad breath that keeps coming back

Gingivitis is often painless, which is why many people ignore it. Daily brushing, cleaning between your teeth and a professional dental cleaning usually bring the gums back to health. Left alone, it can move on to periodontitis. Our post on the early signs of gum disease goes into more detail.

What is periodontitis?

Periodontitis means the infection has gone below the gumline. The gums pull away from the teeth and form deeper spaces called pockets. Bacteria collect in those pockets, and the body’s own inflammation starts to break down the bone and connective tissue that hold teeth in place.

Signs that point to periodontitis include:

• Gums that have receded, making teeth look longer
• New gaps between teeth or a change in how your teeth fit together
• Teeth that feel loose or shift
• Pus between the teeth and gums, or a constant bad taste
• Ongoing bad breath that brushing doesn’t fix

Bone lost to periodontitis does not grow back on its own, but the disease can be stopped and kept under control with treatment and regular follow-up care.

How do dentists describe how serious periodontitis is?

Dentists now describe periodontitis by stage and grade. The stage, from I to IV, reflects how much damage has already happened, from early attachment loss to severe bone loss that threatens teeth. The grade, from A to C, estimates how quickly the disease is likely to progress, taking factors like smoking and diabetes into account. Together they help your dentist plan treatment and decide how often you need to be seen.

What is necrotizing gum disease?

This is a rare but serious type that can appear quickly. The gums become very painful, bleed easily and develop grayish ulcers, especially at the tips of the gum between teeth. It may come with a strong foul odor and fever. It is more common in people with a weakened immune system, severe stress, poor nutrition or heavy smoking. It needs prompt care, not a wait-and-see approach.

How is gingivitis different from periodontitis?

	Gingivitis	Periodontitis
Gums	Red, puffy, bleed easily	Receding, pulling away from teeth
Bone loss	None	Yes, from mild to severe
Gum pockets	Shallow	Deeper than normal
Teeth	Firm	May loosen, shift or be lost
Can it be reversed?	Yes	No, but it can be controlled
Usual treatment	Cleaning plus better home care	Scaling and root planing, then periodontal maintenance

Can you have gum disease without symptoms?

Yes. Gum disease often causes no pain until it is advanced. Smokers in particular may notice less bleeding, because tobacco reduces blood flow to the gums and hides one of the most common warning signs. That is why routine checkups matter even when your mouth feels fine.

How is gum disease diagnosed?

At an exam, we gently measure the depth of the space between each tooth and the gum with a small probe. Healthy spaces are shallow; deeper readings, bleeding and recession point to periodontitis. X-rays show whether bone has been lost around the roots. Together these tell us which type you have and how far it has gone.

How is each type of gum disease treated?

Gingivitis usually clears with a professional cleaning and a better routine at home. Our guide to how often to floss covers the technique that matters most.

Periodontitis needs deeper care. Scaling and root planing removes tartar and bacteria from below the gumline and smooths the root surfaces so the gums can tighten back up. After that, most people need periodontal maintenance visits, often every 3 to 4 months, to keep the disease from flaring again. We treat gum disease here in our Richmond office and will explain your options in plain terms. If cost is a concern, see what determines the cost of scaling and root planing.

Frequently asked questions

Sources

• American Academy of Periodontology
• CDC Oral Health
• National Institute of Dental and Craniofacial Research