Can Gum Disease Be Reversed? Gingivitis vs Periodontitis

Maybe your gums bleed a little when you brush, or your last cleaning turned up a few 4s worth keeping an eye on. Either way, you want to know whether you can reverse gum disease, or whether the best you can do is keep it from getting worse.

The answer depends on which kind you have, because gingivitis, which affects only the gums, can be reversed. Periodontitis has already cost some of the bone that holds your teeth, and that bone does not grow back on its own. With periodontitis, the aim is to stop the damage and hold what is left.

What is the difference between gingivitis and periodontitis?

Both start with plaque, the sticky film of bacteria that forms on teeth every day. Plaque and tartar contain bacteria that trigger inflammation, and inflammation is what makes gums red, swollen and quick to bleed. Plaque left in place hardens into tartar, and only a professional cleaning removes tartar.

In gingivitis, the inflammation stays in the gum tissue. The fibers that attach the gum to the tooth are still intact, and so is the bone underneath. Take the bacteria away and the swelling settles, because nothing structural was lost. That is why the CDC calls gingivitis reversible.

In periodontitis the inflammation goes deeper, breaking down the attachment between gum and tooth and then the bone around the root. The gum pulls away from the tooth, and the small groove where gum meets tooth deepens into a pocket. The CDC is direct about this stage: periodontitis cannot be reversed, but it can be slowed down and managed with professional treatment.

It is also common: in CDC survey data from 2009 to 2014, about 4 in 10 U.S. adults aged 30 and older had some level of periodontitis.

How do you know which stage you are in?

You cannot tell from the mirror, because both stages can bleed. The answer is measured in millimetres, with a thin probe that slides into the groove around each tooth and reads how deep it goes. In a healthy mouth that groove is usually between 1 and 3 millimetres. Dr. Tarek reads the numbers this way: 3mm is healthy, 4mm is early disease, and 5mm or deeper is concerning.

The 4mm line is worth a second look, because many patients have heard that a 4 is acceptable. Dr. Tarek's view is that this idea comes from how insurance plans decide what to pay for, not from what is healthy. Read his way, a 4 is the earliest sign of disease and worth acting on.

An x-ray adds the other half of the picture. It shows whether there is any bone loss, and bone loss is the line between the two stages.

What happens if periodontitis is left alone?

A deeper pocket gives bacteria more room to collect under the gum. The inflammation they keep going breaks down more attachment and bone, which deepens the pocket again. Down there, plaque hardens into tartar that only a professional cleaning removes.

As the bone keeps going, the tooth loses its support. NIDCR describes where that ends: as the bone is destroyed, teeth can loosen and shift, and in the worst cases they have to come out.

Habits are not the whole story. Smoking is the most significant risk factor, and diabetes, some medications, hormones and genetics all play a part. That is why good habits help, and for some people they are still not enough on their own.

Can brushing harder reverse gum disease?

No, and trying can cause a second problem. When gums bleed, many people respond by scrubbing harder or switching to a hard brush. Dr. Tarek sees this as a common mistake that leads to toothbrush abrasion, where the brush wears enamel away. Enamel does not grow back, which is also why an early cavity can be stopped but a hole cannot refill itself.

The ADA recommends a soft-bristled brush and gentle pressure to lower the risk of injuring the gums. What reverses gingivitis is removing the plaque every day: the CDC advises brushing twice a day and flossing every day, along with regular professional cleanings.

Nor is a stronger rinse the shortcut: the trouble with mouthwash explains why killing more bacteria does not make a mouth healthier.

What does stopping periodontitis involve?

The first step is getting the bacteria and tartar off the root, down to the bottom of each pocket. That deep cleaning is called scaling and root planing. Scaling removes plaque and tartar from the pockets, and root planing smooths the root to keep plaque from sticking to it again. The cleaning does not bring back bone the disease already took, but it removes the bacteria that were taking it.

The American Academy of Periodontology notes that most patients need ongoing maintenance therapy afterwards to keep the gums healthy. Measuring the same pockets again at those visits shows whether the numbers are holding. Our page on gum disease treatment walks through the charting, the deep cleaning and the maintenance schedule.

Some lost bone can be rebuilt, but not by cleaning or home care. The same group describes regenerative procedures, a gum surgery using membranes, bone grafts or tissue-stimulating proteins, that can reverse some of the damage.

So is it reversible or not?

Gingivitis can be reversed. Periodontitis cannot, but it can be stopped, and stopping it early keeps more of the bone you still have. That is why the measuring matters more than the bleeding, since a pocket caught at 4mm leaves more bone to protect than one found later.

Checkups, cleanings and x-rays are part of our general dentistry care. If you pay out of pocket, the Membership Club includes a Periodontal tier for guests managing gum disease.

If your gums bleed, or you were told about a few 4s and never followed up, book an appointment or call (703) 444-5108.