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Health condition · Clinically reviewed

Periodontitis, the gum disease that quietly costs you teeth.

Often painless until it isn't. Caught early, periodontitis is highly manageable with the right cleaning, habits and follow-up.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK dental clinician before publication.

  • 02

    Sourced from guidance

    Checked against BSP and NICE guidance and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance including staging and grading, non-surgical therapy and maintenance review.

Key facts

Periodontitis at a glance.

The essentials, in plain English - what it is, how it starts, and how it's treated in the UK today.

  • What it is

    A chronic inflammatory disease of the supporting structures of the teeth - gums, periodontal ligament and alveolar bone.

  • How it starts

    Almost always progresses from untreated gingivitis, a reversible gum inflammation caused by bacterial plaque.

  • Why it often goes unnoticed

    It can be largely painless until advanced, which is a major reason it is underdiagnosed.

  • Main risk factors

    Smoking, poorly controlled diabetes, poor oral hygiene and genetic susceptibility all raise the risk.

  • First-line treatment

    Professional scaling and root surface debridement, plus better oral hygiene technique at home.

  • Untreated outcome

    Progressive bone loss, loosening teeth and, eventually, tooth loss if the disease is not controlled.

Why this guide matters

A silent disease that responds well to early action.

Periodontitis is common, largely preventable and - caught in time - very treatable. The three points below shape everything else on this page.

  • It rarely hurts until it is advanced

    Painlessness is exactly why routine dental checks and periodontal probing matter, even when your gums feel fine.

  • Cleaning is the foundation

    Scaling and root surface debridement, backed by good daily interdental cleaning, controls most cases without surgery.

  • Smoking and diabetes change the odds

    Addressing these two risk factors head-on measurably improves how well treatment works and how long it lasts.

How the diagnosis is made

From routine check-up to a staged plan.

The steps a UK dentist or hygienist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Dental history and risk review

    Smoking status, diabetes control and family history are checked alongside your brushing and flossing routine.

  2. 02

    Assessing

    Full periodontal examination

    A visual check for bleeding, recession, plaque and calculus across every tooth.

  3. 03

    Assessing

    Periodontal probing

    Pocket depths are measured around each tooth with a probe - the key measurement for how advanced the disease is.

  4. 04

    Confirming

    Dental X-rays

    Radiographs assess the amount of alveolar bone loss and confirm the pattern of disease.

  5. 05

    Confirming

    Staging and grading

    Findings are classified using current staging (severity and extent) and grading (rate of progression) systems.

  6. 06

    Preparing

    Risk-factor optimisation plan

    Smoking cessation support and diabetes control are built into the treatment plan from the outset.

  7. 07

    Preparing

    Referral where needed

    Advanced, complex or poorly responding disease is referred to a specialist periodontist.

Typical timeline: a full periodontal assessment usually takes one to two appointments.

Symptoms

What periodontitis actually looks like.

The classic mix of bleeding, recession and bad breath - and the features that mean it's time to escalate.

  • Bleeding gums

    Particularly noticeable when brushing - often the earliest sign, and easy to dismiss.

  • Gum recession

    Gums pull away from the tooth, exposing more of the root surface over time.

  • Bad breath (halitosis)

    Persistent bad breath or a bad taste, driven by bacteria in deepening periodontal pockets.

  • Loose teeth

    A sign of advanced disease, as supporting bone and ligament are progressively lost.

  • Gum abscesses

    Painful, swollen pockets of infection that can develop around affected teeth.

  • Tender or swollen gums

    Gums may look red, puffy or shiny rather than the usual firm pink appearance.

  • Often painless early on

    Many people feel nothing until the disease is well established, contributing to underdiagnosis.

  • Red flag - tooth mobility or drifting

    Teeth that feel loose or have visibly shifted position need prompt periodontal assessment.

Treatment

How periodontitis is treated in the UK.

Scaling and debridement first, risk-factor control alongside - and surgery or extraction reserved for disease that doesn't settle.

  • Scaling and root surface debridement

    Professional removal of plaque and calculus above and below the gumline - the first-line treatment for everyone.

  • Oral hygiene education

    Tailored brushing and interdental cleaning technique, since home care underpins every other treatment.

  • Smoking cessation support

    Stopping smoking significantly improves healing and treatment outcomes - support is offered alongside dental care.

  • Managing systemic conditions

    Better diabetes control measurably improves periodontal healing and reduces relapse risk.

  • Antimicrobial mouthwash

    Used as a short-term adjunct alongside mechanical cleaning, not as a stand-alone treatment.

  • Surgical periodontal treatment

    For pockets that remain deep or active after non-surgical therapy, to gain better access for cleaning.

  • Periodontal maintenance and review

    Regular hygienist reviews after initial treatment to catch and treat any recurrence early.

  • Extraction and implant planning

    Severely compromised teeth may need extraction, with dental implants considered once the disease is stable.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your dentist or hygienist knows your mouth and history and can tell you which parts apply to you. If in doubt, get seen.

  • British Society of Periodontology and Implant Dentistry (BSP). Guidelines for periodontal screening and treatment.

  • NICE. Guidance relevant to periodontal disease and diabetes management.

  • European Federation of Periodontology (EFP). Classification of periodontal and peri-implant diseases.

  • Public Health England. Delivering better oral health toolkit.

Red flags

When gum disease needs urgent attention.

Most periodontitis is managed well in general dental practice. These are the situations that aren't - and where a specialist opinion is needed.

  • Rapid, severe bone loss at a young age

    Aggressive periodontitis in younger patients needs prompt specialist referral and a careful risk-factor review.

  • Tooth mobility or drifting

    Teeth that feel loose or have moved suggest advanced attachment loss needing urgent assessment.

  • Recurrent gum abscesses

    Repeated periodontal abscesses point to poorly controlled disease that needs active management.

  • Uncontrolled diabetes with gum disease

    The relationship runs both ways - poor glycaemic control worsens periodontitis, and periodontitis worsens glycaemic control.

  • Heavy smoking with poor healing

    Smokers respond less well to standard treatment - continued smoking is a major reason for treatment failure.

  • Pregnancy with gum inflammation

    Hormonal changes can worsen gum disease in pregnancy - assessment and gentle treatment are safe and advised.

  • Necrotising periodontal disease

    Punched-out ulcerated gums with pain and a distinctive odour need same-day dental assessment.

  • Unexplained tooth loss

    Losing a tooth with no obvious cause should prompt a full periodontal work-up rather than just a replacement plan.

  • Persistent pockets after treatment

    Deep pockets that do not improve after debridement may need surgical treatment or specialist review.

Living with it

A manageable condition, with a clear routine.

Four things that make the biggest difference day to day - daily interdental cleaning, patience with healing, addressing smoking and keeping every review.

A quiet reminder

Consistency beats intensity, every time.

Small, steady habits - kept up for months and years - do more than a burst of effort before a check-up.

  1. 01 Routine

    Clean between the teeth daily

    Interdental brushes or floss reach where a toothbrush cannot - this is where periodontitis usually starts.

  2. 02 Patience

    Healing takes weeks, not days

    Gums typically settle over several weeks after debridement - judge progress at your next review, not immediately.

  3. 03 Habit

    Address smoking early

    Cutting down or stopping smoking is one of the single biggest things you can do to improve your outcome.

  4. 04 Escalate

    Keep every maintenance visit

    Periodontitis can recur - regular hygienist reviews catch relapse while it is still easy to treat.

Frequently asked

Everything we get asked about periodontitis.

Quick answers on gingivitis, treatment, smoking and long-term outlook.

  • What is periodontitis?

    A chronic inflammatory disease affecting the gums, periodontal ligament and alveolar bone that support the teeth. It develops when untreated gingivitis progresses, as bacterial plaque triggers an immune response that damages these tissues.

  • Is periodontitis the same as gingivitis?

    No. Gingivitis is reversible gum inflammation without bone loss. Periodontitis is the next stage, where the supporting bone and ligament are permanently damaged if left untreated.

  • Why might I not notice periodontitis until it is advanced?

    Periodontitis can be largely painless in its early and middle stages, which is a major reason it is underdiagnosed. Bleeding gums or bad breath are often the only early clues.

  • What is the first-line treatment?

    Professional scaling and root surface debridement to remove plaque and calculus, combined with improved oral hygiene technique at home. Most people respond well to this alone.

  • Does smoking really make a difference?

    Yes, significantly. Smoking impairs healing and blood supply to the gums, making treatment less effective. Stopping smoking measurably improves outcomes at every stage of care.

  • Can periodontitis be cured?

    It can be controlled and stabilised, but the tissue damage already caused is not fully reversible. With consistent home care and regular maintenance review, further progression can usually be prevented.

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