"My gums bleed, but it doesn't hurt, so it's probably nothing." We hear this sentence often in our clinic, and it usually means the first sign of gum bone loss has been missed. The jawbone that holds the teeth in place disappears quietly as gum disease advances, and many people only notice when their teeth start to feel loose. Yet when it is diagnosed early, bone loss can be stopped and the teeth can be kept for many years.
What Is Gum Bone Loss?
Teeth stay firmly in the jaw thanks to the alveolar bone that surrounds their roots. The gum is the tissue that covers this bone and protects it. Gum bone loss (alveolar bone loss) is the gradual reduction of this supporting bone.
Its most common cause is periodontitis, the advanced form of gum disease. Bacterial plaque on the teeth first inflames the gums (gingivitis). Left untreated, the inflammation spreads deeper, gaps called periodontal pockets form between the tooth and the gum, and the body's response to this infection breaks down the bone that holds the tooth. According to the World Health Organization, severe periodontal disease affects about one in five adults worldwide.
Causes and Risk Factors
- Plaque and tartar: Plaque that is not removed regularly hardens into tartar and keeps the inflammation going.
- Smoking: Markedly raises the risk of gum disease, slows healing and masks bleeding, so the disease is noticed later.
- Diabetes: Poorly controlled diabetes speeds up gum disease, and gum inflammation can make blood sugar harder to control.
- Genetics: The risk is higher if family members lost teeth at a young age.
- Clenching and grinding: Does not cause bone loss on its own, but can speed it up around inflamed teeth.
- Poorly fitting fillings, crowns and dentures: Create areas that are hard to clean and collect plaque.
- Tooth loss: After an extraction, the bone in that area no longer receives chewing forces and slowly shrinks, which can affect future implant planning.
Signs of Bone Loss
Gum bone loss is usually painless, which is why it is called a "silent disease". We recommend an examination if you notice any of the following:
- Gums that bleed when you brush or floss
- Persistent bad breath or a bad taste in the mouth
- Red, swollen or receding gums
- Teeth that look longer, or new gaps between teeth
- Loose or shifting teeth
- A change in the way your teeth fit together when you bite
- Pus at the gum line
Gum recession and bone loss often occur together. For the causes and treatment of recession, see our article on gum recession.
How Is Bone Loss Diagnosed?
During the examination, the depth of the pocket around each tooth is measured with a thin, graduated instrument (a periodontal probe). In healthy gums this depth does not exceed a few millimetres. X-rays then show the bone level, and if needed a 3D scan (CBCT) shows the shape and extent of the bone loss in more detail. This tells us which treatment is suitable.
Treatment for Gum Bone Loss
The first goal of treatment is to stop the infection that causes the bone loss. After that, in suitable cases, part of the lost bone can be regained. Treatment usually proceeds in stages:
1. Deep Cleaning (Scaling and Root Planing)
Under local anaesthesia, tartar and plaque are removed from inside the gum pockets and the root surfaces are smoothed. In many mild to moderate cases, this gum disease treatment is enough to bring the inflammation under control. A few weeks later the pockets are measured again to check healing.
2. Surgical Treatment (Flap Surgery)
If deep pockets remain after cleaning, the gum is gently opened in a minor procedure so the root surfaces can be cleaned under direct vision, reaching infection that instruments cannot reach otherwise.
3. Bone Grafting and Regenerative Treatment
When the shape of the defect allows it, bone grafts, barrier membranes and biomaterials that support tissue regeneration are used to help new bone form. This bone loss treatment works best for vertical (angular) defects on one side of a tooth. The new bone takes several months to mature.
4. Regular Periodontal Maintenance
Periodontitis can be brought under control with treatment, but it needs follow-up. After treatment, check-ups and professional cleaning are usually scheduled every 3–6 months. This regular care is the most effective way to keep bone loss from starting again.
Can I Get Implants If I Have Bone Loss?
Yes, in most cases. If there is not enough bone where a tooth is missing, bone grafting is done before or together with the implant, and in the upper back jaw the sinus floor can be raised when needed. Gum disease must be treated before implant placement, though; otherwise similar bone loss can develop around the implant. Read our dental implant guide for details.
How to Prevent Bone Loss
- Brush twice a day with a soft-bristled brush, including the gum line.
- Clean between your teeth every day with floss or interdental brushes.
- See your dentist for a check-up and professional cleaning at least twice a year.
- Quit smoking; it is one of the most important things you can do for your gums.
- If you have diabetes, keep your blood sugar under control and tell your dentist about it.
- Don't accept bleeding gums as "normal"; bleeding is the earliest sign of inflammation.
Frequently Asked Questions
Can lost bone grow back?
Lost bone does not grow back on its own. Depending on the shape of the defect, however, part of it can be regained with bone grafting and regenerative treatment. The first priority of treatment is to stop the bone loss from progressing.
Can teeth with bone loss be saved?
Most teeth diagnosed at an early or moderate stage can be kept for many years with the right treatment and regular maintenance. In advanced cases where very little bone support is left, some teeth may need to be extracted. That is why early diagnosis matters so much.
Is treatment for gum bone loss painful?
Cleaning and surgical procedures are done under local anaesthesia, so you feel no pain during treatment. Mild tenderness or swelling for a few days afterwards is possible and is usually managed with simple painkillers.
Is bone loss a normal part of ageing?
No. Bone loss is more common in older people because they have been exposed to gum disease for longer, but it is not a natural result of ageing. With good oral hygiene and regular check-ups, healthy gums and bone levels can be maintained into old age.
Is gum disease contagious?
The bacteria that cause gum disease can be passed on through saliva, but whether the disease develops depends largely on oral hygiene, the immune response and risk factors such as smoking and diabetes. If someone in the family has gum disease, it is worth having the others checked too.
Book an Appointment at DUODENT
If you have noticed bleeding or receding gums or loose teeth, we recommend an examination to catch gum bone loss at an early stage. You can request a periodontal examination at our clinic in Atasehir, Istanbul through our contact page. Phone: +90 216 766 73 86 | WhatsApp: +90 505 766 73 86. You can learn more about the author, periodontist Dr. Dt. Ayse Saatman Yildiz, on her profile page.
This article is for general information only and is not medical advice. Please consult a dentist about your personal health situation.