What Is Gum Disease?

Unhealthy gums lead to bone loss and wobbly teeth

By Dr John Barclay | DRJB Smile Clinic, Ruabon, North Wales

If you gently touched your eyes and they bled, you’d be concerned.

If your nose bled every time you wiped it, you’d see your doctor.

If your arm bled for weeks or months every time you touched it, you wouldn’t ignore it.

But bleeding gums?

Most people do.

They assume it’s normal. They assume it’s brushing too hard.

I’m afraid it isn’t normal.

Bleeding gums are often the first warning sign of gum disease — a condition that affects the foundations holding your teeth in place.

Gum disease doesn’t appear overnight

It’s not an on/off switch. It’s a progression — usually slow, usually silent.

The one line that matters most:

• Gingivitis = inflammation and bleeding, but no bone loss

• Periodontitis = bone loss has started — and that damage does not reverse

Why periodontitis is different

Once bone has been lost, you don’t “catch” gum disease again.

You now have a history of periodontitis, and now have to manage any future bone loss.

What changes over time is whether it’s:

• Active (damage happening now), or

• Stable (damage paused)

Active vs stable gum disease (the bit no one explains)

You might be told:

“You’ve got gum disease, but it’s stable.”

That isn’t a contradiction.

• Stable (inactive) Deep pockets may still be there—little or no bleeding. No damage is happening right now.

• Active Inflammation is switched back on. Bleeding from deeper pockets — often delayed. This is when further bone loss can occur.

You can move between these two states over time.

Each flare-up carries risk.

What do the numbers mean? (BPE – in plain English)

When we call out numbers during a gum check, we’re using a BPE(Basic Periodontal Examination).

It’s not a diagnosis. It’s a risk and effort gauge.

BPE 0 – Perfect

• Healthy gums

• No bleeding

• Everything zipped up nicely

Nothing to fix.

BPE 1 – Bleeding, but superficial

• Bleeding when gently checked

• No deep problems

• No bone loss

This usually means:

You’ve missed a bit for a few days. (Gingivitis).

BPE 2 – Debris ± bleeding

• Plaque and/or hardened plaque (calculus)

• Bleeding may or may not be present

This usually means:

You’ve missed a bit for a few weeks. (Still gingivitis).

The germs have had time to mineralise —like limescale in your kettle or on your taps.

They’ve built themselves a cozy home, and your body is getting annoyed.

BPE 3 – Unzipped ligaments ± delayed bleeding

• Early pocketing

• Ligaments starting to “unzip”

• Bleeding may be deep or delayed

• Bone loss potential starts here

This is where:

Your body is now properly fed up. (Now it's periodontal disease!)

Risk has stepped up.

BPE 4 – Significant deep pockets (worst score)

• Deep pockets extending >50% of the root

• Ligaments unzipped

• Delayed deep bleeding

• Greatest bone-loss potential

• Often a lot of damage already done

It's now a war between you and the bacteria. (Periodontal disease+++)

This is the most serious category — not because it’s hopeless, but because it needs the most effort to stabilise.

One thing people misunderstand

It doesn’t matter if:

• It’s everywhere

• Or just one tooth

If a BPE 3 or 4 exists anywhere, it matters.

The difference isn’t whether stability is possible —it’s how much work is needed to achieve and maintain it.

The takeaway (this is the bit to remember)

• Bleeding gums are not normal

• Gingivitis is reversible

• Periodontitis means bone loss

• Bone loss can be stable or active

• Active disease = risk

• Stable disease = the goal

• BPE scores tell us how hard we need to work

Understanding this stops small problems becoming big ones.

If this has worried you...

Don’t panic — gum disease is common, and stability is possible at every level. The key is knowing where you are now and what “stable” looks like for you.

If you’d like us to check your gums (or explain a previous report), we’re happy to help.

Ready to book?

Whether its your first hygienist appointment or your 50th — we’ll guide you safely and predictably.

📞 01978 823490📧 wrexham2-tco@mydentist.co.uk

We’re here to help you achieve brighter, healthier, science-driven results.

📸 Start Your Smile Journey with our TCO team — Faz, Hannah, or Angie.

📍 DR JB Smile Clinic – Ruabon, North Wales

(Next: why gum disease behaves differently in different people)

References & Further Reading

1. Tonetti MS, Greenwell H, Kornman KS.Staging and grading of periodontitis: Framework and proposal.Journal of Periodontology, 2018.→ Supports staging, grading, progression, and stability concepts.

2. Chapple ILC, Mealey BL, et al.Periodontal health and gingival diseases and conditions.Journal of Clinical Periodontology, 2018.→ Defines gingivitis vs periodontitis and reversibility.

3. Papapanou PN et al.Periodontitis: Consensus report of the 2017 World Workshop.Journal of Periodontology, 2018.→ Confirms bone loss as defining feature of periodontitis.

4. British Society of Periodontology (BSP).Basic Periodontal Examination (BPE) guidance.→ Supports BPE 0–4 interpretation and purpose.

5. Lang NP, Bartold PM.Periodontal health.Journal of Periodontology, 2018.→ Supports concepts of stability, maintenance, and disease control.