Gum disease comes in two stages. Gingivitis is inflammation of the gum only, and it is completely reversible. Periodontitis is what happens when that inflammation extends into the bone holding the teeth — and bone that has been lost does not grow back.
The line between those two is the most important distinction in this subject, because everything about the outlook and the treatment depends on which side of it you are on.
Stage one: gingivitis
Plaque accumulates at the gum margin. The body mounts an inflammatory response to the bacteria in it: the gum becomes red, swollen and fragile, and bleeds when brushed or flossed.
Nothing has been destroyed at this point. The attachment between gum and tooth is intact, the bone is untouched, and removing the plaque consistently resolves it — typically within one to two weeks. See gingivitis: the reversible stage.
Gingivitis is extremely common. Most adults have it somewhere at some point, and most never know, because the only sign is bleeding they may dismiss.
Stage two: periodontitis
In some people, and not all, the inflammation extends deeper. The fibres attaching the gum to the tooth break down, and the bone supporting the tooth begins to resorb.
As the attachment is lost, the space between gum and tooth deepens into a pocket. Pockets are harder to clean than a normal gum margin — beyond about three millimetres you cannot reach the bottom with a toothbrush — so plaque accumulates undisturbed, hardens into tartar, and drives further destruction. The process becomes self-sustaining.
Eventually enough bone is lost that teeth loosen, drift, or are lost. This is the leading cause of tooth loss in adults — ahead of decay. See periodontitis: when bone is involved.
Why it goes unnoticed
Periodontitis is almost always painless. There is no toothache, no sensitivity, nothing to prompt an appointment. It progresses over years, usually in episodes rather than steadily, and the first thing most people notice is a tooth becoming loose — by which time a great deal of bone has gone.
The signs that do appear are easy to rationalise: bleeding put down to hard brushing, bad breath put down to diet, gums receding put down to age.
The numbers your dentist calls out
During a periodontal assessment, a fine probe is placed gently between gum and tooth at several points around each tooth, and the depth is recorded.
- 1 to 3 mm with no bleeding: healthy.
- 1 to 3 mm with bleeding: gingivitis — inflammation without attachment loss.
- 4 to 5 mm: a pocket has formed. You cannot clean this yourself.
- 6 mm and deeper: significant attachment and bone loss.
Bleeding on probing is recorded as well as depth, because it indicates whether the disease is currently active. Radiographs show the bone level itself and allow comparison over years — see why dental X-rays are taken.
It is entirely reasonable to ask for your numbers and what they mean. They are the most objective information you will get about your own gums.
What causes it
Plaque is necessary but not sufficient. Two people with identical plaque levels can have very different outcomes, because the destructive part of periodontitis is the body’s own inflammatory response.
What shifts that response: smoking, which is the single largest modifiable risk factor; poorly controlled diabetes, which has a two-way relationship with gum disease; genetic susceptibility; stress; certain medications; and hormonal changes. See who is at higher risk of gum disease.
What treatment achieves
For gingivitis: full resolution. Better cleaning, plus professional removal of tartar, and the gum returns to health.
For periodontitis: the aim is to stop it progressing, not to restore what was lost. Deep cleaning below the gum line — scaling and root planing — removes the deposits driving the inflammation, pockets shrink as the tissue tightens, and the disease becomes stable. Surgical treatment is used for deeper pockets where non-surgical treatment has not been enough, and in selected cases some regeneration is possible. See scaling and root planing explained.
Stability then has to be maintained, permanently, with regular professional cleaning at intervals shorter than standard — see periodontal maintenance visits.
Why it matters if you are having other treatment
Gum disease must be stabilised before implants, orthodontics, veneers or crowns. Implants placed into a mouth with active periodontal disease are at high risk of peri-implantitis. Teeth moved through inflamed tissue lose bone faster. Cosmetic work placed against inflamed gums looks wrong within a year as the margin changes.
This is not a delaying tactic — it is what makes the rest of the treatment last.
Frequently asked questions
Can gum disease be cured?
Gingivitis, yes. Periodontitis is controlled rather than cured — stable, monitored, and maintained.
Will the bone grow back?
Generally no. Certain defects can be regenerated surgically in selected cases; the realistic aim is to stop further loss.
Is it contagious?
The bacteria can transfer between people, but developing the disease depends on your own response and risk factors.
My gums do not bleed, so I am fine?
Not necessarily, particularly if you smoke — nicotine suppresses bleeding. Ask for a periodontal assessment.
Does it cause bad breath?
Frequently — see bad breath: causes worth investigating.
Ask for a periodontal assessment
It takes a few minutes and gives you a measured baseline rather than an impression. See our gum and periodontal care page.
To arrange a consultation at our clinic on Abbas El-Akkad in Nasr City, call +20 101 969 7597 or message us on WhatsApp.
