GPAtlas🧭 When to suspect
Gum (periodontal) disease is a plaque-driven inflammatory spectrum. It begins as gingivitis – inflammation confined to the gum margin that is fully reversible with good oral hygiene – and, in susceptible people, progresses to periodontitis, where inflammation destroys the supporting bone and attachment, producing irreversible recession, pocketing, tooth mobility and ultimately tooth loss. Some degree of gum disease affects around half of UK adults, making it one of the commonest conditions a GP encounters incidentally.
Suspect gum disease when a patient reports gums that bleed on brushing, flossing or eating, often with red, swollen or sore gums, persistent bad breath (halitosis), an unpleasant taste, gum recession or loosening teeth. The strongest risk factors are poor plaque control, smoking (the dominant modifiable driver) and diabetes; others include immunosuppression, pregnancy, and certain drugs that cause gum overgrowth.
The GP's role is deliberately narrow: recognise the pattern and refer to the dental team (only a dentist can probe, scale and definitively diagnose or treat), manage the modifiable risk factors, and – most importantly – never miss the red flags: oral cancer, a spreading dental infection, or acute necrotising ulcerative gingivitis (ANUG).
| Condition | Key features | Reversible? / GP action |
|---|---|---|
| Gingivitis | Red, swollen gums that bleed easily; little or no pain; no attachment or bone loss | Reversible – dental review, plaque control |
| Periodontitis | Recession, deep pockets, drifting/loose teeth, bone loss | Not reversible – staged dental treatment; control risk factors |
| Necrotising gingivitis (ANUG) | Rapid onset; painful, “punched-out” ulcerated papillae; grey slough; marked halitosis; ± fever | Urgent – dental referral; interim metronidazole if systemic involvement |
Source: SDCEP · NICE NG12
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