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Periodontitis: Symptoms, Causes and Treatment

Periodontitis is a serious gum infection that damages the tissues holding your teeth in place. This guide explains the signs, the causes and the stepwise treatment.

Key points

  • Periodontitis is a serious gum infection that damages the tissues and bone holding teeth in place, and it starts as untreated gingivitis.
  • Signs include bleeding, red and swollen gums, bad breath or taste, shrinking gums and loose teeth, although it may cause no pain early on.1
  • Treatment follows steps: habits and risk factors, cleaning below the gum, further treatment where pockets remain and supportive care.3
  • Smoking and diabetes affect gum disease, and smokers respond less well to treatment.14
  • Periodontitis is a long-term condition, so regular supportive visits are part of the treatment.

Periodontitis starts as untreated gingivitis. Plaque and inflammation spread below the gum, and the bone and fibres that support the teeth begin to break down. It is a major cause of tooth loss in adults, but it can be controlled, and the earlier it is found, the better.

Gingivitis versus periodontitis

Gingivitis is inflammation of the gums caused by plaque, and clinical gum health can be restored after treatment.2 Periodontitis is when support for the teeth has been lost. It can be controlled, but a person with a history of it stays at increased risk of it returning and has to be closely monitored.2

Signs and symptoms

  • Gums that bleed when you brush, floss or eat hard foods, or that are red, swollen and sore.1
  • Bad breath or a bad taste that does not go away.1
  • Gums that are shrinking, or teeth that feel loose.1
  • Pockets found at an examination, which the dentist measures with a probe.3

Periodontitis often causes no pain in its early stages. Many people only notice when teeth become loose or the gums recede. Without treatment, complications can include bad breath, a bad taste, shrinking gums, loose or lost teeth and a dental abscess.1

Causes and risk factors

The main cause is plaque that is not removed. Several factors raise the risk.

  • Smoking, which increases the risk of gum disease.1 In 17 studies, smokers had 0.33 mm less pocket depth reduction and 0.20 mm less attachment gain than non-smokers after non-surgical treatment.4
  • Diabetes. The NHS advises regular check-ups for people with type 2 diabetes.1 In 9 trials, deep cleaning in people with type 2 diabetes lowered HbA1c and C-reactive protein, so the gums and the blood sugar are treated together.5
  • Pregnancy, because of hormonal changes.1
  • Family history and genetics, which affect how the body responds to plaque.
  • Some medicines, and a dry mouth.
  • Stress and poor general health, in some people.

How it is diagnosed

The dentist examines the gums, measures pocket depth, checks for bleeding and loose teeth, and takes X-rays to see the bone. They explain the diagnosis, the causes, the risk factors, the treatment choices and the expected risks and benefits, including the option of no treatment.3

How it is treated: the stepwise approach

The European guideline sets out treatment in steps.3

Step 1: habits and risk factors. You learn how to remove plaque at home, and the dentist helps with stopping smoking and with diabetes control. Professional plaque removal above the gum is done at this step.3

Step 2: cleaning below the gum. Plaque and hard deposits are removed from the roots with hand or powered instruments, either by quarter of the mouth or all at once within 24 hours, and the roots are smoothed.3 The guideline strongly recommends it to reduce pocket depth, gum inflammation and the number of diseased sites.3 See our page on deep cleaning.

Step 3: more treatment where pockets remain. After the gums have healed, the dentist measures the pockets again. Where pockets of 4 mm or more with bleeding, or deep pockets of 6 mm or more, remain, the third step may include repeated cleaning or gum surgery, and the NHS says the dentist may refer you for further tests and treatment.13

Step 4: supportive care. Once the aims are reached, you join a programme of regular visits so that the result lasts, with the same home cleaning advice at every visit.3

What is not routine

The guideline does not recommend routine antibiotics with cleaning below the gum, because of concerns for your health and public health, though they may be considered for specific patients.3 Lasers and similar add-ons are not advised as routine extras. Ask your dentist about any extra that is proposed.

Home care

  • Brush with fluoride toothpaste at least twice a day, and spit without rinsing afterwards.1
  • Clean between your teeth every day.1
  • Do not use mouthwash straight after brushing, and do not smoke.1
  • Keep to the supportive visits you are given.3

Stopping smoking

Smokers respond less well to treatment than non-smokers,46 and help to stop smoking is part of treatment in the guideline.3

Living with periodontitis

Periodontitis is a long-term condition. After treatment, the teeth may look different: gums can shrink as swelling goes down, and gaps may appear between teeth. The aim is a stable, healthy mouth. Regular check-ups every few months are usual, and daily cleaning is the foundation.

When it is urgent

See a dentist urgently if gums are very sore and swollen, teeth are loose or falling out, there are ulcers or red patches, or there is a lump in the mouth or on the lip.1 A dental abscess needs prompt treatment. See our guide on loose teeth.

Learn more

Our guides to gingivitis and pyorrhea and gum diseases complement this one, and our page on gum disease treatment explains how we manage it.

What the supportive care visits are like

After the active treatment, you join a programme of regular visits to keep the gums stable.3 A typical visit includes:

  1. a check of your gums, with measurement of the pockets around the teeth;
  2. a look at bleeding and plaque, to see how your cleaning is working;
  3. professional cleaning above and below the gum where needed;
  4. a review of risk factors such as smoking, diabetes and medicines;
  5. advice on your cleaning, with any change to the tools you use;
  6. an agreed date for the next visit, which may be every few months.

These visits matter because the disease can return, and a person with a history of periodontitis stays at increased risk of it returning. Missing them is one of the commonest reasons gums get worse again.

Living with shrinking gums and sensitivity after treatment

After treatment, swelling goes down and the gums may shrink, which can make teeth look longer and open spaces between them. Exposed root surfaces can feel sensitive to cold, air or brushing.

  • Use a soft brush and a gentle technique, and do not scrub.
  • Try a desensitising toothpaste, and ask your dentist about other options.
  • Use interdental brushes in sizes that fit the new spaces, as shown by the hygienist.
  • Keep up daily cleaning, since root surfaces decay more easily than enamel.
  • Mention any discomfort that lingers.

These changes are a result of the disease and the healing, and they are managed with good cleaning and regular care.

Questions to ask your dentist

  • What stage is my gum disease, and how much support have I lost?
  • Which teeth are most affected, and are any loose?
  • What are the steps of my treatment, and how long will each take?
  • What can I do at home to help, and what tools should I use?
  • How will you check that treatment has worked?
  • How often will I need supportive visits?
  • Do my smoking, diabetes or medicines affect my treatment?1

Why gum health matters beyond the mouth

Dentists treat periodontitis because of what it does to the teeth, but gum health is also linked with general health. The NHS advises regular dental check-ups for people with type 2 diabetes, since gum disease and blood sugar affect each other.1 If you have diabetes, keeping your gums healthy is part of looking after yourself, and keeping your blood sugar under control helps your gums respond to treatment. Tell your dentist and your doctor about both conditions, and keep both sets of appointments.

Frequently asked questions

Can periodontitis go away completely?

It can be controlled, but a person with a history of it stays at increased risk of it returning and has to be closely monitored.2

Will I lose my teeth?

Not necessarily. Treatment aims to stop the loss of support, and many teeth can be kept with good care.

Is deep cleaning painful?

Local anaesthetic is usually used, and the gums may be sore for a few days afterwards.

Does gum disease affect general health?

Gum disease and diabetes interact, so the gums and blood sugar are treated together.5

Can periodontitis be reversed?

It can be controlled, but the lost support does not grow back on its own. Treatment stops the disease progressing and the tissues can stabilise, but a person with a history of periodontitis stays at increased risk, so regular supportive care continues.

Will my loose teeth tighten again?

Sometimes they firm up as inflammation settles, but teeth that have lost a lot of support may stay loose. Your dentist can tell you what to expect for each tooth.

Can I get implants if I have had periodontitis?

Sometimes, after the gum disease has been treated and is stable. A history of periodontitis raises the chance of inflammation around an implant, so your dentist will assess your gums and plan careful follow-up.

About the author

Portrait of Dr Anupam Sinha

Dr Anupam Sinha, BDS, MDS – Orthodontics. BDS (2002), KLE Vishwanath Katti Institute of Dental Sciences, Belgaum. MDS in Orthodontics (2006), SDM College of Dental Sciences, Dharwad. His thesis work won a national research award in 2005, and he holds a certification in aesthetic dentistry. He sees patients at Orion Dental Clinic in Greater Kailash 1, South Delhi. Read the full profile of Dr Anupam Sinha.

Sources

  1. NHS website. Gum disease (patient information). Page review date 20 April 2026. https://www.nhs.uk/conditions/gum-disease/
  2. Chapple ILC, Mealey BL, Van Dyke TE, Bartold PM, Dommisch H, Eickholz P, et al. Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Journal of Periodontology, 2018;89(Suppl 1):S74-S84. https://pubmed.ncbi.nlm.nih.gov/29926944/
  3. Sanz M, Herrera D, Kebschull M, Chapple I, Jepsen S, Beglundh T, Sculean A, Tonetti MS, on behalf of the EFP Workshop Participants and Methodological Consultants. Treatment of stage I-III periodontitis: the EFP S3 level clinical practice guideline. Journal of Clinical Periodontology, 2020;47(Suppl 22):4-60. https://pubmed.ncbi.nlm.nih.gov/32383274/
  4. Chang J, Meng HW, Lalla E, Lee CT. The impact of smoking on non-surgical periodontal therapy: a systematic review and meta-analysis. Journal of Clinical Periodontology, 2021;48(1):60-75. https://pubmed.ncbi.nlm.nih.gov/33022758/
  5. Baeza M, Morales A, Cisterna C, Cavalla F, Jara G, Isamitt Y, Pino P, Gamonal J. Effect of periodontal treatment in patients with periodontitis and diabetes: systematic review and meta-analysis. Journal of Applied Oral Science, 2020;28:e20190248. https://pubmed.ncbi.nlm.nih.gov/31939522/
  6. Chambrone L, Preshaw PM, Rosa EF, Heasman PA, Romito GA, Pannuti CM, Tu YK. Effects of smoking cessation on the outcomes of non-surgical periodontal therapy: a systematic review and individual patient data meta-analysis. Journal of Clinical Periodontology, 2013;40(6):607-615. https://pubmed.ncbi.nlm.nih.gov/23590649/

Medically reviewed by Dr Anupam Sinha, BDS, MDS – Orthodontics, on . General information for patients from Orion Dental Clinic, last updated 23 October 2026. It is not advice for one person, so ask a dentist what suits you. To report an error, contact us.