How Can You Recognise Periodontitis?

Periodontitis is a chronic inflammatory disease of the tissues that support the teeth.

The problem is that the disease can progress without causing severe pain early on. The German Society of Periodontology therefore points out that many people initially do not realise that their periodontal tissues are affected.

Early changes in particular can easily be dismissed as “sensitive gums” or temporary irritation.

A considerable amount of time may therefore pass between the onset of inflammation and the point at which clear symptoms become noticeable.

Bleeding gums are an important warning sign — but not a diagnosis.

If the gums bleed regularly during toothbrushing, interdental cleaning or even chewing, this can indicate inflammation.

The inflammation may initially be limited to the gums. This is known as gingivitis.

Periodontitis is present only when structures of the tooth-supporting apparatus are also damaged.

The practical rule is therefore:

Bleeding gums should be taken seriously, but should not be self-diagnosed as periodontitis.

With gingivitis, inflammation is limited to the gums.

Typical signs can include:

• redness,
• swelling,
• and bleeding on contact or cleaning.

With periodontitis, the disease extends deeper. Tissues that hold the tooth in the jaw are broken down.

These include:

• fibres of the periodontal ligament,
• root cementum,
• and jawbone.

This distinction cannot be assessed reliably by simply looking in a mirror.

That is precisely why a professional periodontal examination is important.

Yes.

Red, swollen or tender gums can indicate an inflammatory reaction.

However, these signs are not specific to periodontitis.

They can also occur with gingivitis without any loss of periodontal support.

For patients, the key is therefore not to name the disease themselves, but to recognise that:

Recurring or persistent signs of inflammation should be examined.

Persistent bad breath or an unpleasant taste in the mouth can occur with periodontal disease.

However, they have many possible causes.

Bad breath can also be associated with:

• tongue coating,
• dry oral mucosa,
• caries,
• inflammation in other areas,
• diet,
• or other medical factors.

“Bad breath = periodontitis” is therefore not a useful self-diagnosis.

If bad breath persists despite normal oral hygiene, dental assessment can be appropriate.

No.

When the gums recede, teeth can appear longer and tooth necks may become more visible or sensitive.

Such recession can occur with periodontitis, but it can also have other causes.

The European Federation of Periodontology explicitly notes that receding gums can, for example, result from mechanical factors such as brushing too aggressively.

The visible gum line alone should therefore not be used to decide whether periodontitis is present.

What matters is whether there is actual loss of periodontal support.

With advanced periodontal damage, teeth can change position.

Possible changes include:

• new gaps,
• increasing spaces between teeth,
• changes in tooth alignment,
• or the feeling that individual teeth are “moving”.

Such changes can occur when the supporting structures of a tooth become weakened.

However, they can also have other causes, for example changes in the bite or missing neighbouring teeth.

New and unexplained tooth movement should therefore be examined.

Teeth becoming loose can be a sign of advanced periodontitis.

If a substantial part of the periodontal support has been lost, the tooth becomes less well supported.

There are, however, other causes of tooth mobility.

Examples include:

• injuries,
• severe functional overloading,
• inflammation from other causes,
• or certain endodontic or bone-related problems.

A loose tooth is therefore not a symptom that should be diagnostically interpreted at home.

It should be examined by a dentist.

Yes. In inflammatory periodontal conditions, pus can discharge from a periodontal pocket.

This is not a sign that should simply be watched and ignored.

Pus, marked swelling, acute pain or rapid change can indicate active local inflammation and should be assessed promptly by a dentist.

Periodontitis is not automatically the cause. Other dental infections can produce similar symptoms.

Yes.

That is one of the reasons the disease can be difficult to recognise.

Periodontitis is often painless for long periods. Pain can occur, but does not have to be present.

Someone who relies solely on the principle:

“It does not hurt, so everything must be healthy”

can miss periodontal changes.

Regular dental reviews and periodontal screening are therefore more important than the patient's own perception of pain.

Yes.

Bleeding gums can be less noticeable in smokers.

Nicotine affects blood vessels in the gums. As a result, less bleeding may be visible even when inflammation is present.

This is particularly important for self-assessment:

No visible bleeding does not automatically mean the gums are healthy in smokers.

Smoking is also an important risk factor for the development and progression of periodontal disease.

Sensitivity can occur, but it is non-specific.

Sensitive tooth necks can, for example, result from gum recession. Inflamed gums can also make contact uncomfortable.

Sensitivity alone cannot reliably distinguish gingivitis from periodontitis.

The combination of findings and a professional examination are what matter.

Not by one visible symptom.

During a dental examination, the periodontal tissues are assessed systematically.

Periodontal screening

A special periodontal probe can be used to identify signs suggesting that further investigation may be required.

The Periodontal Screening Index (PSI), or a basic periodontal examination, is used to identify suspicious areas and decide whether more detailed diagnostics are necessary.

Measuring periodontal pockets

During a more detailed examination, probing depths are recorded at different points around the teeth.

Bleeding on probing is also assessed.

Attachment and bone support

Diagnosis does not depend only on how deep a pocket measures.

What matters is whether supporting tissues have actually been lost. Clinical findings and, where necessary, radiographs are assessed together.

Classification

Once periodontitis is diagnosed, it is classified according to extent, severity and risk of progression.

This helps tailor treatment to the actual disease.

Not reliably.

A periodontal pocket is not simply a visible gap whose depth can be assessed at home.

Inserting objects or measuring aids into the gum margin yourself is neither a reliable diagnostic method nor advisable.

Pocket depth is checked using a periodontal probe designed for the purpose and must be interpreted together with other findings.

If the gums bleed repeatedly or over a prolonged period, the cause should be clarified.

This is particularly important when other changes are also present, such as:

• swelling or marked redness,
• persistent bad breath,
• receding gums,
• newly formed gaps,
• tooth movement,
• or increasing tooth mobility.

Even without these additional symptoms, frequent gum bleeding should not be regarded as permanently “normal”.

Inflammation can still be present.

Interdental spaces are areas where biofilm can accumulate.

If these areas have not been cleaned for a long time, the gums there may initially be tender and inflamed.

This does not mean that interdental cleaning should simply be stopped.

If bleeding remains regular or is pronounced, dental assessment is advisable.

Professional teeth cleaning can form part of an individual prevention plan, but it does not replace systematic periodontal treatment when periodontitis is present.

More about professional teeth cleaning

Not automatically.

Professional teeth cleaning removes accessible deposits and supports prevention.

If periodontitis is already present, however, targeted periodontal diagnostics and — depending on the findings — structured treatment are required.

The first question should therefore not be:

“Can I solve this with a teeth cleaning?”

But rather:

“Is periodontitis actually present, and if so, how advanced is it?”

Prompt dental examination is particularly advisable in cases of:

• recurring or spontaneous bleeding gums,
• marked swelling,
• pus discharge,
• new tooth movement,
• increasing tooth mobility,
• or a combination of several changes.

With acute severe swelling, significant pain or rapid deterioration, it is better not to wait for a routine preventive appointment.

These symptoms can also have other dental causes and need diagnostic assessment.

The table is intended solely as orientation and not for self-diagnosis.

Periodontitis can remain unnoticed and cause little pain for a long time.

Possible warning signs include:

• recurring bleeding gums,
• red or swollen gums,
• persistent bad breath,
• gum recession,
• new spaces or movement of teeth,
• teeth becoming loose,
• and, in some cases, pus discharge.

But:

None of these signs alone proves periodontitis.

Distinguishing it from gingivitis is particularly important. Only a professional periodontal examination can determine whether structures supporting the teeth have already been damaged.

For detailed information about diagnostics and treatment:

Periodontitis treatment

The medical information in this article is based in particular on current patient information from the German Society of Periodontology (DG PARO) and the European Federation of Periodontology (EFP).

DG PARO points out that periodontitis is often painless and can therefore go unnoticed for a long time. The EFP describes bleeding, redness, swelling, bad breath, recession and changes in tooth position as possible warning signs, while also emphasising that gum recession, for example, is not specific to periodontitis.

A diagnosis is therefore based on periodontal examination, not on a symptom list.

Editorial review date: 9 August 2026. This article does not replace an individual dental examination or diagnosis.