The five stages of gum health

The five stages at a glance

Every stage after the second involves losing the bone that holds your teeth in place. That is the single most useful thing to understand about gum disease: the tooth itself is usually fine. What fails is its foundation.

What each stage means

Stage 1 — Healthy

The gum sits tightly against the tooth and the bone underneath is at full height. There is no bleeding when you brush or floss. A shallow natural space of about one to three millimetres between gum and tooth is normal and healthy.

What it needs: Routine cleanings and daily brushing and flossing. Nothing more is needed.

Stage 2 — Gingivitis

Plaque left along the gum line inflames the gum. It looks redder, feels puffy, and bleeds when brushed. Crucially, no bone has been lost — which is why this stage is the one that matters most. Gingivitis is fully reversible.

What it needs: A professional cleaning and a corrected home routine. Gums typically settle within weeks.

Stage 3 — Early periodontitis

Inflammation has passed below the gum line and the body begins to lose the bone holding the tooth. The space between gum and tooth deepens into a pocket that a toothbrush cannot reach. Bone lost at this stage does not grow back.

What it needs: Deep cleaning below the gum line — scaling and root planing — then closer monitoring.

Stage 4 — Moderate periodontitis

Pockets are deeper, more bone is gone, and the gum has receded far enough that teeth start to look longer. Some people notice teeth drifting or a bite that feels different. Sensitivity to cold is common as exposed root has no enamel on it.

What it needs: Deep cleaning, sometimes laser gum treatment, and a maintenance interval shorter than six months.

Stage 5 — Advanced periodontitis

Enough of the supporting bone is gone that teeth become loose, painful to chew on, and may be lost or need removing. This is the leading cause of adult tooth loss — ahead of decay.

What it needs: Periodontal treatment to stabilise what remains, and a plan for replacing anything lost — implants or a bridge. See our services.

The line that matters: gingivitis versus periodontitis

Almost everything about gum disease turns on one distinction.

Gingivitis is inflammation of the gum alone. Remove the plaque causing it and the gum returns to health. Nothing has been permanently lost.

Periodontitis means the inflammation has reached the bone, and bone that has gone does not come back. Treatment can halt the disease and hold it stable for decades — but it cannot rebuild what was lost.

This is why bleeding gums are worth acting on immediately rather than waiting. Bleeding is the last stage at which the damage is still fully reversible. See also: why gums bleed when you floss.

How to tell which stage you are at

Honestly — you often cannot, and that is the difficulty with gum disease. It is largely painless until it is advanced, so it progresses without announcing itself. Warning signs worth taking seriously:

• Gums that bleed when you brush or floss
• Gums that look red or puffy rather than firm and pale pink
• Persistent bad breath or a bad taste
• Teeth that look longer than they used to
• New sensitivity to cold along the gum line
• Any tooth that feels loose, or a bite that has changed

The stage is confirmed by measurement, not by looking. A dentist walks a small calibrated probe around each tooth and records the pocket depth in millimetres, and an x-ray shows the bone level directly. It takes a few minutes and it is not painful.