Gingivitis vs periodontitis: the two stages of gum disease compared

Gum disease begins when a sticky layer of bacteria called plaque builds up on the teeth and along the gumline. If it is not removed, the gums become irritated, red, swollen and sore. At this point it is called gingivitis. The Oral Health Foundation says that, caught at this stage, it can be reversed.

If gingivitis is not treated, it can develop into periodontitis, also called periodontal disease. Here the inflammation damages the bone and tissues that hold the teeth in place. The Oral Health Foundation says the gums can pull away from the teeth and the teeth may become loose or be lost. The damage cannot be undone, but the disease can be controlled with the right care. That difference, reversible against controllable, is the most important distinction between the two.

The table brings together the NHS gum disease page and the Oral Health Foundation. Only a dental examination can say which stage you have.

The NHS explains that gum disease is caused by plaque, and that it builds up and irritates the gums when it is not cleaned away by brushing and by cleaning between the teeth. Over time, plaque that is left in place hardens into tartar, which the Oral Health Foundation says a dentist or hygienist removes.

Not everyone with gingivitis develops periodontitis, and the pace varies from person to person. The reason to take gingivitis seriously is that it is the stage at which the damage can still be fully reversed. Several things raise the stakes: the NHS says to see a dentist and hygienist for regular check-ups, especially if you are pregnant or have type 2 diabetes, and not to smoke, which it includes in its prevention tips and in the early-stage advice given by dentists.

The NHS lists the symptoms of gum disease as gums bleeding when you brush your teeth, floss or eat hard foods such as apples, and gums that are swollen, red and sore. Gum disease can lead to bad breath and a bad taste in the mouth, gums shrinking, teeth becoming loose or falling out, and a dental abscess.

Ask for an urgent dentist appointment, the NHS says, if you have gum disease and other symptoms such as very sore and swollen gums, teeth becoming loose or falling out, ulcers or red patches in your mouth, or a lump in your mouth or on your lip. If you cannot reach a dentist, call 111 for advice. Ulcers, red patches and lumps are not features of gum disease alone, which is why they are flagged separately.

For gingivitis, the NHS says that in the early stages your dentist will give advice about keeping your teeth clean, for example using interdental brushes, advise you to stop smoking if you smoke, and advise you to have your teeth cleaned by a hygienist. The Oral Health Foundation says your dentist or hygienist will thoroughly clean your teeth to remove plaque and tartar, show you the best way to clean at home and recommend the right tools. You may need several appointments, especially if gum disease is more advanced.

For serious gum disease the NHS says you may need deep cleaning under your gums, antibiotics, to have some teeth removed, or gum surgery. Your dentist may refer you to a specialist for further tests and treatment. Day to day, the Oral Health Foundation advises brushing for 2 minutes last thing at night and once more during the day with fluoride toothpaste, and cleaning between the teeth once a day with interdental brushes or floss, plus regular dental visits as advised.

The NHS adds that you should not use mouthwash straight after brushing, and that you should brush with fluoride toothpaste at least twice a day and spit after brushing without rinsing.

The NHS says you should have regular dental check-ups even if you have no problems, and should see a dentist if you have not had a check-up for 2 years (or 1 year if under 18). NHS dental treatment is free for some people, including children under 18 (or under 19 and in full-time education), people who are pregnant or have had a baby in the past 12 months, and people on some benefits. Otherwise you will usually pay NHS charges. Free dental care applies during pregnancy and for a year after birth, so it is worth asking a midwife or GP about the maternity exemption certificate.