Gum Disease

Bleeding gums when brushing or flossing is not normal — it is the primary sign of gingivitis (inflammation of the gum tissue). Healthy gums do not bleed. The cause: bacterial plaque accumulating along the gum line triggers an inflammatory immune response — the gums become swollen, red, and fragile, bleeding easily. The good news: gingivitis is completely reversible. Professional cleaning by a dentist or hygienist removes the hardened plaque (tartar/calculus) that you can't remove at home, and consistent improved brushing and flossing at home allows the gum tissue to heal within 2-4 weeks. A common mistake: people stop brushing near bleeding gums, which allows more plaque to accumulate and worsens the condition. Gentle but thorough brushing at the gum line is exactly what is needed. Persistent bleeding despite good home care warrants a dental visit to rule out periodontitis or other causes.

Gingivitis is inflammation confined to the gum tissue — the bone and supporting fibre around the tooth are intact. It is reversible with professional cleaning and better home care. Periodontitis is the progression of gingivitis into the deeper support structures — bacteria advance below the gum line and the immune response destroys the bone and periodontal ligament supporting the tooth. Bone loss is irreversible — once destroyed, bone does not regenerate without specialist surgical intervention. Pockets form between the tooth and gum; these deepen as disease advances and become increasingly impossible to clean at home. Teeth become loose in advanced periodontitis and may eventually fall out or require extraction. Early signs of periodontitis beyond bleeding gums: increased sensitivity (exposed roots from gum recession), teeth that feel loose or shifting, food packing between teeth where it didn't before, and persistent bad breath. A dentist measures pocket depth to distinguish gingivitis from periodontitis.

Professional cleaning (scale and polish, or 'scaling') removes tartar (calcified plaque) and staining from tooth surfaces — both above and below the gum line. Tartar cannot be removed with a toothbrush at home; it requires ultrasonic scalers and hand instruments. The procedure is not painful for most patients with healthy gums — patients with inflamed, bleeding gums may find it sensitive initially, though the gums rapidly improve after cleaning. For periodontitis, 'deep cleaning' (root planing or scaling and root planing — SRP) is performed: cleaning below the gum line into the periodontal pockets under local anaesthesia. This is the cornerstone of periodontal treatment. Frequency: every 6 months for most adults with healthy gums; every 3-4 months for patients with treated periodontitis (maintenance phase — preventing recolonisation of pockets is critical to preventing disease recurrence).

Smoking is the most significant modifiable risk factor for periodontitis — smokers have 2-7 times higher risk of developing gum disease, more severe disease, and poorer response to treatment. The mechanisms: nicotine reduces blood flow to the gums (masking bleeding — smokers' gums often bleed less despite worse disease, giving a false reassurance), impairs the immune response that normally fights periodontal bacteria, and reduces healing capacity. Smokers lose more bone per year, have deeper pockets, and have significantly worse outcomes from periodontal surgery and implant placement. The deceptive part: because smoking reduces gum bleeding, smokers often don't notice early disease. Stopping smoking is the single most impactful thing a smoker with gum disease can do — response to treatment and healing improve measurably within weeks of quitting.

Gingivitis (the early, bone-sparing stage) is completely reversible — the gums return to full health with professional cleaning and consistent home care. Periodontitis (the bone-destroying stage) is not reversible in the sense of regenerating lost bone — but it is highly manageable: progression halts with treatment, and properly maintained patients can keep their teeth for life. The key: following through with the active treatment phase (deep cleaning, possibly surgery for advanced cases), then maintaining the 3-4 monthly maintenance appointments that prevent bacteria from re-colonising the pockets. Patients who complete treatment but skip maintenance appointments predictably relapse. Bone regeneration is possible in selected cases using guided tissue regeneration membranes and bone grafts during periodontal surgery — restoring some of the lost support. But prevention and early treatment remain far better than trying to restore what's been destroyed.