Gum disease: early signs and treatment

Gum disease is an infection of the tissues that hold your teeth in place, caused mainly by plaque left along the gum line. Its early signs are gums that bleed when you brush, look red or swollen, or smell bad. Caught early, it is usually reversible with a professional cleaning and better daily care.

What is gum disease?

Gum disease, also called periodontal disease, is an inflammation of the gums and of the deeper structures that support the teeth: the ligament that attaches each root and the jawbone around it. It is very common in adults and often develops quietly, without pain.

It starts with plaque, a soft, sticky film of bacteria that forms on teeth every day. If plaque is not removed by brushing and cleaning between the teeth, it irritates the gums. Over time it hardens into tartar (also called calculus), which cannot be removed with a toothbrush and gives bacteria an even better place to grow.

Gingivitis: the early, reversible stage

Gingivitis means inflammation of the gums only. The gums may bleed, look red and feel tender, but the bone and the fibres holding the teeth are still intact. At this stage the damage is reversible: with a professional cleaning and good daily care, the gums usually return to health within a few weeks.

Periodontitis: when the support of the tooth is affected

If gingivitis is left untreated, in some people the inflammation spreads deeper. The gum starts to detach from the tooth, forming small gaps called periodontal pockets, where bacteria collect out of reach of the toothbrush. Slowly, the bone around the roots can be lost. This stage is called periodontitis. The lost bone does not usually grow back on its own, but the disease can, in most cases, be stopped and kept under control.

Early signs of gum disease you should not ignore

Because gum disease is rarely painful at first, it helps to know what to look for. Common early signs include:

• gums that bleed when you brush, floss or eat something hard such as an apple;
• gums that look red, puffy or swollen instead of pale pink and firm;
• tender or sore gums;
• persistent bad breath or a bad taste in the mouth;
• tartar you can see as yellow or brown deposits near the gum line.

Bleeding is often the very first warning. Many people then brush less, which makes things worse. Our article on bleeding gums when brushing explains what that bleeding usually means and what to do about it.

Signs that the disease may have moved to a later stage include gums that seem to pull back from the teeth so that the teeth look longer, sensitivity to cold, pus between the teeth and gums, teeth that feel loose or have started to move, gaps appearing between teeth, or a change in the way your teeth fit together when you bite. Ongoing bad breath can also be linked to gum problems; you can read more in our guide to the real causes of bad breath.

What causes gum disease and who is more at risk?

The main cause is plaque that is not removed well enough, day after day. But the way your body reacts to that plaque varies from person to person, and some factors make gum disease more likely or more severe:

• smoking or other tobacco use, including narghile (shisha), which also tends to hide bleeding and delay diagnosis;
• diabetes, especially when blood sugar is not well controlled;
• hormonal changes, for example during pregnancy, when the gums often become more sensitive;
• some medicines that cause a dry mouth or overgrowth of the gums;
• a family history of gum disease;
• crowded teeth, old fillings or crowns with rough edges that trap plaque;
• stress, a poor diet and conditions that weaken the immune system.

How gum disease is diagnosed and treated, step by step

The good news is that gum disease is treatable at every stage. The aim is always the same: remove the bacteria and tartar, let the gums heal, and help you keep them clean afterwards. As the NHS explains, early gum problems are usually managed with a professional clean and better daily cleaning, while more serious cases may need deeper cleaning under the gums.

Step 1: examination (about 20 to 40 minutes)

The dentist looks at your gums and teeth, checks for bleeding and tartar, and gently measures the depth of the space between each tooth and the gum with a thin, blunt instrument called a periodontal probe. Healthy gums usually have shallow spaces of a few millimetres; deeper pockets suggest periodontitis. X-rays may be taken to check the level of the bone around the roots.

Step 2: scaling and polishing (usually 30 to 60 minutes)

For gingivitis and mild cases, the main treatment is scaling, which means removing plaque and tartar from the teeth above and just below the gum line, followed by polishing to leave the surfaces smooth. Most people find it comfortable. Our article on how often you need a professional cleaning explains what to expect and how regularly it is usually recommended.

Step 3: deep cleaning under the gums, if needed

When pockets have formed, the dentist cleans the root surfaces below the gum line to remove hardened deposits and bacteria. This is often called deep cleaning or root surface debridement. It is usually done under local anaesthesia and is often spread over two to four visits, treating one area of the mouth at a time.

Step 4: review after healing

The gums need time to settle. A review appointment is usually planned after several weeks, often around two to three months, to measure the pockets again and see how the gums have responded. In some cases, short-term antibiotics or medicated mouthwash may be added, but they are not a substitute for cleaning.

Step 5: advanced cases

If deep pockets remain despite good cleaning, further treatment such as gum surgery may be needed. This is usually done by a periodontist, a dentist who specialises in gums, and your dentist will explain the options clearly if this applies to you.

See our preventive dentistry and gum care page for an overview.

Does gum treatment hurt? Anaesthesia and recovery

Scaling and polishing is generally not painful. You may feel vibration, scraping and some sensitivity, especially if there is a lot of tartar or the gums are very inflamed. If an area is particularly sensitive, the dentist can numb it.

Deep cleaning under the gums is usually done with local anaesthesia, an injection that numbs only the area being treated, so you should feel pressure rather than pain. Afterwards, it is normal to have:

• tender gums for one to three days;
• some sensitivity to cold for a few days or weeks, as the cleaned roots are exposed;
• light bleeding when brushing at first.

Everyday painkillers usually help. Keep brushing gently but thoroughly, even if the gums bleed a little at first; the bleeding normally decreases as the gums heal. As inflammation settles, the gums may tighten and shrink slightly, so some teeth can look a little longer. This is a sign of healing, not of new damage.

Aftercare: keeping your gums healthy for the long term

Treatment removes the bacteria and tartar, but plaque comes back every day. How long the results last depends mainly on what happens at home and on regular follow-up.

1. Brush twice a day for two minutes with a fluoride toothpaste, angling a soft brush towards the gum line.
2. Clean between your teeth once a day with interdental brushes or floss; your dentist can show you the right size and technique.
3. Stop smoking and narghile if you can; this makes a real difference to how the gums heal.
4. Keep diabetes and other health conditions under control with your doctor.
5. Attend regular maintenance visits. People who have had periodontitis are often advised to have check-ups and cleaning every three to six months, depending on their risk.

Gingivitis usually clears completely if these habits are kept. Periodontitis is a long-term condition: once treated, it can stay stable for many years, but it can return if plaque control slips or follow-up is missed.

Risks of leaving gum disease untreated, and the alternatives

Untreated periodontitis can slowly destroy the bone that holds the teeth. Over the years, teeth may become loose, drift, or eventually need to be removed. It is one of the main causes of tooth loss in adults. Replacing lost teeth is possible but usually more complex, and implants and bridges also need healthy gums to last.

There is no real alternative to removing plaque and tartar: mouthwashes, herbal remedies or antibiotics alone cannot clean pockets under the gums. They may help alongside professional treatment, not instead of it. Some treatments, such as gum surgery, may be delayed or adapted if you have certain medical conditions or are pregnant, so always tell the dentist about your health and the medicines you take.

What affects the cost of gum treatment

The cost of treating gum disease varies from one person to another, so it can only be estimated after an examination. The main factors are:

• the stage of the disease, from gingivitis to advanced periodontitis;
• how many teeth and areas of the mouth need deep cleaning;
• the number of visits needed, including review appointments;
• whether X-rays, medication or specialist care are needed;
• how often maintenance visits are recommended afterwards.

The earlier gum disease is treated, the simpler treatment usually is. After your consultation, the dentist will explain the plan and its cost before anything is started.

Gum care at Ajam Dental Clinic in Tripoli

At Ajam Dental Clinic, preventive care includes check-ups, scaling and polishing, and advice adapted to the condition of your gums. Dr. Abdel Rahman Ajam and Dr. Soumaya Ajam work together at the clinic; for children and teenagers with bleeding or swollen gums, care is handled by Dr. Soumaya Ajam, whose specialty is paediatric dentistry. If your gums need more advanced specialist care, the dentist will explain your options honestly.

Patients come to our clinic on Fouad Chehab Boulevard, Al-Makateb Building, 1st Floor, from across Tripoli, including Abu Samra, Al-Qobbeh, El Mina, Al-Haddadine and the old souks, as well as from Akkar and the rest of North Lebanon. If your gums bleed, feel sore or have changed, contact us to book a consultation by phone or WhatsApp.

This article provides general information for patients. It does not replace an examination by a dentist, who can advise you on your own situation.