How Gingivitis and Periodontitis Differ: A Guide to the Stages of Gum Disease
Gingivitis is early gum disease in which inflammation stays in the soft tissue of the gums, and periodontitis is the stage in which inflammation has spread to the bone and periodontal ligament. Gingivitis can return to normal gums with tartar removal and proper brushing, but bone dissolved by periodontitis is mostly hard to restore. On the surface both look alike, with swelling and bleeding, so they are told apart by a pocket examination and X-rays.
Key facts
| Gingivitis | An early state with inflammation limited to the soft tissue of the gums (source: Korea Disease Control and Prevention Agency (KDCA, 질병관리청) National Health Information Portal) |
|---|---|
| Periodontitis | A state in which inflammation has resorbed and destroyed the alveolar bone (source: KDCA National Health Information Portal) |
| Periodontal disease prevalence, age 19 and over | 23.4% (2018 Korea National Health and Nutrition Examination Survey, oral examination) (source: KDCA National Health Information Portal) |
| Periodontal disease prevalence in the 20s | Men 5.2%, women 2.9% (2018) (source: KDCA National Health Information Portal) |
| Periodontal disease prevalence in the 50s | Men 49.7%, women 32.8% (2018) (source: KDCA National Health Information Portal) |
What is gingivitis?
Gingivitis is a state in which the gum margin turns red and swollen because of toxins made by bacteria in plaque. Common symptoms are bleeding when brushing and bad breath, and there is almost no pain, so it is easy to ignore.
Because the inflammation has not yet reached the bone, removing tartar and correcting brushing and flossing habits can bring the color and shape of the gums back to normal. Gingivitis is the stage of gum disease with the lightest treatment burden.
Gingivitis is not caused by plaque alone. The KDCA explains that hormonal changes with puberty, menstruation, and pregnancy, blood disorders such as leukemia, and the use of some blood pressure drugs, anticonvulsants, immunosuppressants, and oral contraceptives can also cause or worsen gum inflammation independently of plaque. In such cases, information about the underlying disease or medication is reflected in the gingivitis treatment plan.
What changes once it becomes periodontitis?
In periodontitis, the attachment between gum and tooth breaks down and a gap called a periodontal pocket deepens. Tartar and bacteria build up inside it, the bone dissolves, and the gums move toward the root so that the teeth begin to look longer.
As it advances, pus from the gums, loose teeth, and a feeling of weakness when chewing appear. The KDCA explains that recovery to the original state is hard at the periodontitis stage, so the treatment goal is to protect the bone that remains.
Periodontitis advanced enough to loosen the teeth often ends in extraction. That is why catching the disease at the border between gingivitis and periodontitis, when there is bleeding but bone loss has not yet begun or has just begun, matters most for keeping teeth for a long time.
How are the two stages told apart?
Gingivitis and periodontitis are hard to tell apart by looking in a mirror. The dentist measures the depth around each tooth with a periodontal probe and checks the bone height on intraoral X-rays. The KDCA explains that X-rays alone cannot diagnose it and a clinical examination must accompany them.
- Gum color, size, shape, firmness, and whether they bleed
- Depth around the tooth measured with a periodontal probe
- Tooth mobility tested by pressing with a finger or instrument
- Bone height shown on intraoral X-rays
How do treatment methods differ?
Gingivitis often ends with scaling and brushing instruction. Periodontitis proceeds step by step: root planing to scrape tartar from under the gums, and flap surgery, in which the gum is cut open, if deep pockets remain.
If gingivitis can be treated by tartar removal alone, people aged 19 and over in Korea can have one scaling a year covered by national health insurance. When periodontitis treatment follows, the exact covered items and number of sessions are best confirmed item by item with the dentist when you receive the treatment plan.
After periodontitis treatment, you are re-examined every 3 to 6 months to check that the pockets are not deepening again. Even people whose problem ended at gingivitis are advised by the KDCA to have scaling and a gum check once a year.
Does the risk change with age?
In the 2018 Korea National Health and Nutrition Examination Survey oral examination, the prevalence of periodontal disease rose with age and increased sharply from age 50. It was 5.2% for men in their 20s but 49.7% for men in their 50s.
The KDCA says periodontal disease mostly begins in the mid-30s and recommends regular checkups and proper brushing habits from the 20s and 30s. The earlier it is found at the gingivitis stage, the simpler the treatment.
Common myths and facts
Myth: If the gums bleed only a little, it is not gum disease yet.
Bleeding when brushing is a typical symptom of gingivitis. Even without pain, if bleeding keeps recurring it is wise to have a pocket examination at a dental office.
Myth: Periodontitis is cured with a single scaling.
Periodontitis must be treated down to the tartar and contaminated root surface below the gums, so additional treatment such as root planing is often needed.
Myth: Dissolved gum bone grows back with treatment.
The KDCA explains that tissue regeneration is possible only in extremely limited cases, and for most people the aim of treatment is to stop or slow the progress of periodontitis.
Frequently asked questions
Does untreated gingivitis become periodontitis?
If plaque and tartar keep remaining, inflammation can spread below the gums and progress to periodontitis. Removing tartar at the gingivitis stage is the point at which treatment is lightest.
Can periodontitis be cured completely?
Dissolved bone is hard to restore, but treatment and regular maintenance can calm the inflammation of periodontitis and slow its progress. Checkups every 3 to 6 months are recommended after treatment.
Are swollen gums during pregnancy also gingivitis?
The KDCA explains that hormonal changes such as pregnancy can affect gum inflammation independently of plaque. If your gums swell and bleed during pregnancy, tell the dentist how many weeks pregnant you are and have the gums checked.
Can I tell at home whether I have gum disease?
Gum bleeding, swelling, bad breath, and food stuck between teeth are signs you can notice yourself. However, the pocket depth and bone condition that separate gingivitis from periodontitis can be confirmed only by a dental examination. If your gums have receded so the teeth look longer, or you feel looseness, you may already have periodontitis, so do not put off an examination.
Does health insurance cover gingivitis treatment?
For people aged 19 and over whose treatment ends with tartar removal alone, national health insurance covers one scaling a year. A second scaling in the same year is treated as not covered. You can check in advance whether you have a session left this year through the dental treatment information inquiry for tartar removal on the National Health Insurance Service (NHIS, 국민건강보험공단) website or app.
Related topics
- Gum Disease Treatment
- Gum Disease Treatment
- Scaling Health Insurance
- Periodontal Curettage and Root Planing
- Gum Maintenance Interval