Is this gum disease, or am I overreacting?

You noticed blood when you spat, then you looked closely at your gum line, and now you have read enough to be convinced your teeth are about to fall out.

Some of what you can see at home does answer the question. The part that decides how serious it is cannot be seen in a mirror at all, and knowing which is which saves a fortnight of worry.

Bleeding when you brush is the first sign and the most reliable one

Gums that bleed when brushed are inflamed, and inflamed gums are the first stage of gum disease. Healthy gums do not bleed when a brush passes over them, at any pressure a brush is meant to be used at.

That stage is gingivitis, and it is fully reversible with ordinary brushing and flossing. The tissue settles within about two weeks once the plaque along the gum line stops accumulating.

So blood in the sink is a real finding rather than an overreaction. It is also the most treatable thing on this page.

They bleed because they are inflamed; you have a level of gum disease called gingivitis. The good news is that with diligent care, this can be reversed. You just need to brush and floss your teeth regularly.

— r/askdentists

Gingivitis and periodontitis are one disease at two stages

Gingivitis is inflammation of the gum only, and nothing underneath has been lost yet. Periodontitis is the stage after it, where the inflammation has reached the bone holding the tooth and taken some of it.

The difference is not how bad it looks or how much it bleeds. Heavy bleeding with no bone loss is gingivitis; quiet gums with significant bone loss is periodontitis, and smokers often have exactly that second pattern.

Bone does not come back. That is the whole reason the distinction matters and the reason people are told to take bleeding seriously while it is still only bleeding.

Literally every dentist on this thread is saying the same thing yet you ask the same questions again and again. It's all periodontitis=periodontal disease=gum disease. Recession, bone loss, gum swelling, loose teeth, bleeding and aching gums are all it's symptoms. I hope you understand it this time.

— r/askdentists

What you genuinely cannot tell at home

Pocket depth and bone level are the two measurements that separate the stages, and neither is visible in a mirror. Pockets are measured with a thin probe, tooth by tooth, and bone level is read off an X-ray.

A full set of those numbers takes about ten minutes and produces a chart. Everything about how urgent the situation is comes out of that chart, which is why no amount of photographing your own gums settles it.

Swelling also hides the answer. Inflamed gums puff up and fill the spaces between teeth, so recession frequently looks worse after a cleaning than before one.

• pocket depth, measured with a probe
• bone level, read from an X-ray
• how much attachment has been lost, not how much it bleeds

When you have gum disease, your gums may be receded, but due to the present inflammation they swell up and give a false appearance of full embrasures. Now that you’ve gotten a cleaning done, inflammation is settling down and you can see the true extent of the recession.

— r/askdentists

The signs that mean it has gone past gingivitis

Dark triangular gaps opening between teeth, teeth that look longer than they used to, or a tooth that has begun to feel mobile all point past the first stage. So does a bad taste that keeps returning from one particular spot.

Hard dark deposit sitting on the tooth at the gum line is calculus, and its presence means the plaque has been there long enough to mineralise. A brush does nothing to it at that point.

Pus, or an area that aches rather than just feeling tender, moves the appointment to this week rather than next month.

Why the appointment is called treatment and not a cleaning

Scaling and root planing is the standard treatment once pockets have formed, and it is a clinical procedure rather than a polish. Deposits are removed from the root surface below the gum line, usually with the area numbed, often across two visits.

Hygienists are often insistent on the wording, and they have a point. Calling it a cleaning leads people to skip it as cosmetic, which is how moderate periodontitis becomes severe periodontitis.

Quotes for it can carry a lot of added line items. Ask what each one is for, and ask whether the core procedure can be done without the extras.

NAD, former hygienist. Can the dental professionals please start using “treatment” instead of “cleaning” - especially in THIS scenario (mod-severe periodontitis)?!!? OP - take their advice, but please understand you will be having your gum disease TREATED. It is not just “cleaning teeth”. You have a moderate-severe condition that requires non-surgical treatment.

— r/askdentists

What to do this week

Brush the places that bleed, gently, twice a day with a soft brush angled into the gum line, and floss once. Keep going for two weeks even while they bleed, because the bleeding is what resolves.

Book an appointment and ask specifically for pocket measurements. That request is understood immediately and it is the only way to find out which stage you are at.

Mention any medication and whether you smoke. Both change the picture considerably and neither gets connected without being said out loud.

Common questions

Do bleeding gums always mean gum disease?

Bleeding when brushing means inflammation, and inflammation at the gum line is the first stage of gum disease. Healthy gums do not bleed from brushing. The good news is that this stage is reversible with consistent brushing and flossing.

How do I know if I have gingivitis or periodontitis?

Only by measurement. Gingivitis means the gum is inflamed with nothing lost underneath; periodontitis means bone has been affected. Pocket depths are read with a probe and bone level from an X-ray, and neither is visible at home.

Can gum disease be stopped?

Gingivitis resolves completely with good daily cleaning. Periodontitis can be stabilised and kept stable for decades with treatment and maintenance, though lost bone does not return. Earlier is far easier in both cases.

What are the dark triangles between my teeth?

Usually spaces left as gum tissue recedes and the inflammation that was filling them settles down. They often become visible after a cleaning rather than being caused by it, because swollen gums had been hiding the true gum level.

Is scaling and root planing the same as a normal cleaning?

No. A routine cleaning works above the gum line; scaling and root planing removes deposits from the root surface below it, usually with local anaesthetic and often over two appointments. It is treatment for a diagnosed condition.

Start brushing the bleeding areas properly tonight and keep at it for a fortnight. If the bleeding stops, it was gingivitis and you have already treated it.

Either way, book the appointment and ask for pocket measurements. That one number per tooth is the difference between worrying and knowing, and the whole thing takes ten minutes.