"My gums bleed a little when I floss, but that's normal, right?" We hear some version of that almost every week. It's common, but it isn't normal, and what it means depends on which stage of gum disease you're in. Gingivitis is inflammation of the gums only, and it goes away with the right care. Periodontitis means the infection has started to eat into the bone and fibers that hold your teeth in. That damage can be stopped, but not fully reversed.
What gingivitis looks and feels like
Gingivitis starts when plaque sits along the gumline long enough for the gums to react. Common signs:
- Gums that bleed when you brush or floss
- Red or puffy gums instead of firm and pale pink
- Tenderness along the gumline
- Bad breath that keeps coming back
Gingivitis usually doesn't hurt, which is why many people ignore it. Luckily, it responds well to a professional cleaning and better daily brushing and flossing. Most people see the bleeding settle within a couple of weeks.
What changes with periodontitis
If gingivitis continues for months or years, the inflammation can move below the gums. The gum pulls away from the tooth and forms a "pocket" where bacteria collect and tartar builds up out of reach of a toothbrush. Over time the bone around the tooth is lost. Signs include:
- Gums that look like they are shrinking or teeth that look longer
- New spaces opening between teeth
- Teeth that feel loose or shift
- Pus between teeth and gums
- A change in how your teeth fit together when you bite
Many of these signs show up late. Early periodontitis can look a lot like gingivitis in the mirror.
How a dentist tells them apart
The difference is measured, not guessed. During an exam, a thin probe is placed gently between each tooth and the gum to measure pocket depth at several points around each tooth. Healthy pockets are shallow, usually 1 to 3 millimeters. Deeper readings, bleeding at the bottom of the pocket and bone loss on X-rays point to periodontitis.
These measurements are recorded at each visit, so your dentist can see whether things are getting better or worse over time.
Treatment for each stage
Gingivitis
A regular cleaning and exam removes plaque and tartar above the gumline, followed by a solid home routine: brushing twice a day for two minutes and cleaning between teeth once a day.
Periodontitis
Treatment usually starts with scaling and root planing, often called a deep cleaning. Tartar is removed from the root surfaces inside the pockets, and the roots are smoothed so the gums can reattach. Read more in our guide to scaling and root planing.
After that, periodontal maintenance cleanings are typically scheduled more often than every six months, because the deeper pockets refill with bacteria faster. Advanced cases may need gum surgery or bone grafting, which is where a periodontist comes in. At our office, gum disease treatment is provided by Dr. Bijan Afar, a board-certified periodontist.
Who is more at risk
- Smokers and vapers
- People with diabetes, especially if blood sugar isn't well controlled
- People with a family history of gum disease
- Pregnancy and other hormonal changes
- Some medications that cause dry mouth or gum overgrowth
Research also links gum disease with heart disease and diabetes. We explain those connections in gum health, diabetes and heart health.
When to book a visit
If your gums bleed most times you brush, or you've noticed recession, a loose tooth or a taste that won't go away, don't wait for it to hurt. Gingivitis takes a cleaning and a few weeks of good habits to fix; periodontitis takes a lot more. Book a gum check and we'll measure where you stand.
