Skip to Content

What is the last stage of gingivitis?

Gingivitis is a mild form of gum disease that causes inflammation of the gums. There are four stages of gingivitis, with the last stage being advanced gingivitis. Advanced gingivitis is characterized by significant gum inflammation, bleeding, receding gums, and deepened periodontal pockets. If left untreated, advanced gingivitis can progress to periodontitis, the more serious form of gum disease. Periodontitis can lead to loose teeth, abscesses, and even tooth loss if not properly treated.

What causes gingivitis?

Gingivitis is caused by plaque, a sticky film of bacteria that constantly forms on the teeth. When plaque accumulates on the teeth, it irritates the gums and causes inflammation. The bacteria in plaque produce toxins that inflame the gums. Poor oral hygiene is the primary cause of plaque buildup. Not brushing and flossing properly allows plaque to build up along the gumline over time. Other factors like smoking, genetics, underlying health conditions, medications, pregnancy, and stress can also contribute to gum inflammation.

What are the stages of gingivitis?

There are four progressive stages of gingivitis:

Stage 1: Mild Gingivitis

In the initial, mild stage, some redness and swelling occurs in parts of the gums. You may notice some minor bleeding when brushing and flossing. At this early stage, gingivitis is reversible with improved oral hygiene.

Stage 2: Moderate Gingivitis

As gingivitis progresses to the moderate stage, gum inflammation and irritation increases. Gums appear puffy and more reddened. Bleeding may be more noticeable when brushing and flossing. Plaque and calculus deposits are more visible along the gumline. Professional cleaning is required to remove plaque and calculus at this stage.

Stage 3: Severe Gingivitis

Severe gingivitis produces noticeable symptoms. Gum tissue appears swollen and discolored. Bleeding is spontaneous, without any provocation when brushing or flossing. Halitosis (bad breath) frequently occurs. Gums begin to recede from the teeth and pockets form, providing more space for bacteria to flourish.

Stage 4: Advanced Gingivitis

In the advanced stage of gingivitis, gum inflammation is significant. Gums are fiery red and bleed easily with minimal stimulation. Gum recession is apparent, making teeth look longer. Pockets between the teeth and gums deepen due to tissue damage. Pus may drain from the enlarged pockets. Bone loss and periodontal damage may occur. At this stage, professional deep cleaning and medication is required to get gingivitis under control.

Signs and symptoms of advanced gingivitis

Here are some of the key signs and symptoms of advanced gingivitis:

  • Very red, swollen, and sensitive gums
  • Gums bleed frequently with brushing, flossing, and eating
  • Halitosis (bad breath) is common
  • Receding gums resulting in “long teeth” appearance
  • Deep periodontal pockets around teeth
  • Pus discharge from gum pockets
  • Loose teeth or shifting of teeth
  • Tartar and plaque deposits on teeth

Risk factors for advanced gingivitis

There are certain risk factors that can increase susceptibility to advanced gingivitis:

  • Poor oral hygiene habits
  • Smoking/tobacco use
  • Genetic predisposition
  • Stress
  • Hormonal changes in girls/women
  • Medications such as oral contraceptives, antidepressants, blood pressure meds
  • Poor nutrition
  • Underlying diseases like diabetes and HIV/AIDS
  • Crooked teeth or dental restorations that trap plaque
  • Mouth breathing
  • Clenching and grinding teeth

Complications of advanced gingivitis

Advanced gingivitis can lead to further oral health problems if treatment is not received in a timely manner:

  • Periodontitis – damage to deeper periodontal tissues and supporting bone
  • Tooth decay – increased risk due to gum recession
  • Tooth loss – from severe bone loss or abscess formation
  • Systemic inflammation – elevated C-reactive protein levels
  • Respiratory infection – bacteria can be aspirated into lungs
  • Cardiovascular disease – oral bacteria enter bloodstream
  • Diabetes complications – more difficult to control blood sugar
  • Premature or low birth weight babies in pregnant women

Diagnosing advanced gingivitis

Advanced gingivitis is diagnosed through a comprehensive oral exam by a dentist or periodontist. They will check for signs and symptoms including:

  • Visual exam of gum tissue – note inflammation, recession, pockets
  • Probing depths – check depth of pockets with instrument
  • Bleeding – check if gums bleed upon stimulation
  • Plaque and tartar – examine buildup on teeth
  • Loose teeth – check for shifting teeth
  • X-rays – evaluate bone loss around teeth

Treatment for advanced gingivitis

Treatment for advanced gingivitis involves a multi-pronged approach:

Professional Cleaning

A deep professional cleaning is done to thoroughly remove plaque, calculus, and bacteria above and below the gumline. Root planing may be done to smooth root surfaces.


Medications may be prescribed to control infection and help the gums heal. These may include antibiotics, oral rinses like chlorhexidine, or oral gels.


In some cases, flap surgery or bone grafting may be needed to regain lost bone or gum tissue.

Continue Home Care

Strict oral hygiene must be maintained with daily brushing and flossing to keep gingivitis from returning.

Treatment Purpose
Professional cleaning Remove plaque and calculus
Medications Control infection and inflammation
Surgery Regain lost bone or gum tissue
Ongoing home care Prevent recurrence of gingivitis

Prevention of advanced gingivitis

Preventing gingivitis from progressing to the advanced stage requires:

  • Brushing twice daily with fluoride toothpaste
  • Daily flossing to remove plaque from between teeth
  • Using antibacterial mouthwash
  • Replacing worn toothbrush every 3-4 months
  • Seeing a dentist for cleanings and exams every 6 months
  • Quitting smoking and tobacco use
  • Eating a balanced diet low in sugar
  • Managing health conditions such as diabetes
  • Using gum stimulators if susceptible to gingivitis


Advanced gingivitis is the last stage of gum disease before it progresses to periodontitis. It is characterized by severe gum inflammation, bleeding, recession, and deepened pockets around teeth. If left untreated, advanced gingivitis can lead to irreversible damage including tooth and bone loss. Preventing gingivitis from becoming advanced involves diligent oral hygiene, professional cleanings, managing health conditions, and eliminating risk factors like smoking. With appropriate treatment and ongoing prevention, advanced gingivitis can be stopped and gum health restored.