Do X-Rays Show Gum Disease?

gum disease on an x-ray

If you suspect that you have or have recently been told that you have gum disease you may be wondering if an x-ray will demonstrate this. 

X-rays are used to assess the level of bone holding the teeth in place. As bone loss is associated with advanced gum disease it can be used to help determine how advanced your gum disease is. 

Gum disease is diagnosed via a clinical assessment of your gums along with a family history. Dental X-rays are useful when preparing a treatment plan and monitoring bone levels post-treatment and to help identify if further treatment is required.

This post aims to explain the role of X-rays in the diagnosis, treatment and management of gum disease as well as the types of X-rays used. We also discuss what you can do at home to treat your gum disease. 

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Can You See Gum Diseases On An X-ray?

Gum diseases, or to give it its formal name, periodontal diseases, is the term given to inflammatory conditions that affect the gums (gingivitis) as well as the alveolar bones and other structures under the gum that hold the teeth in place (periodontitis). 

We take a look at which conditions and x-ray shows.

Can Gingivitis Be Seen On An X-ray?  

Gingivitis, the precursor to periodontitis is not shown on an x-ray. Here’s why. 

Gingivitis is the inflammation of the gums. A build-up of plaque bacteria along the gum line triggers this. At this stage, the gums are red and swollen. There’s no loss of bone or irritation of the other structures which support the teeth. As there’s no loss of bone an x-ray does not show gingivitis.

A dentist can see if you have gingivitis by looking at the gum tissue. The gums will be red, or swollen and will bleed when probed. Gingivitis treatment is relatively simple.

When gingivitis is ignored, the bacteria are not effectively disrupted each day the disease will progress.

Can Dentists See Periodontitis On An X-ray?

Periodontitis is a chronic inflammatory condition. It develops when plaque bacteria are not disrupted sufficiently for several weeks. The gums start to pull away from the teeth and periodontal pockets develop. Bacteria and food debris can hide in these pockets. The plaque bacteria and your body’s inflammatory response start to irritate and destroy the alveolar bone and other supporting structures. Leading to bone loss. 

An X-ray shows this bone loss.

I Have Gum Disease – What Are The X-Rays Used For?

When you have gum disease the x-ray is useful in determining how much bone is holding your teeth in place. It reveals the pattern and extent of bone loss. They indicate how advanced your gum disease is and allow the dentist to make a personal treatment plan and monitor the long-term stability of your periodontal health. 

X-rays Diagnose Other Dental Problems

X-rays show more than just the health of the bone. They can diagnose many other problems in your teeth and jaws including 

  • Tooth decay
  • How much bone is covering the tooth root
  • Changes in the bone
  • Abscesses in the tooth root and between the gum and a tooth
  • Cysts and 
  • Some types of tumors. 

Some clients ask if periodontal pockets and gum recession observed in periodontitis are shown on an x-ray. X-rays do not show this.

The information yielded from x-rays allows the dentist to predict if your teeth will fall out due to periodontitis and how to proceed with your treatment. 

I Have Gum Disease – When Will X-rays Be Taken?

At several stages during the diagnosis, treatment and management of periodontal disease x-rays are used. 

X-rays In The Diagnosis of Periodontal Disease

To diagnose periodontal disease, dentists perform a  Basic Periodontal Examination (BPE). A BPE  is a simple and rapid screening tool. It involves using a dental measure to determine 

  • if there is any bleeding on pressure (BOP), 
  • the depth of periodontal pockets (gaps between the teeth and gums – these occur when the gum pulls away from the tooth when inflamed and irritated by the plaque bacteria)
  • the presence of plaque and calculus deposits. 

The results of the BPE will determine if x-rays are required and if further periodontal charts are required. 

Using X-rays To Formulate a Treatment Plan

If your gum disease is advanced you may require a referral to a periodontist. They will usually require a full mouth series of x-rays, that shows all the jawbone supporting your teeth.

This allows the periodontist to decide what kind of treatment you require to disrupt the bacteria which is below the gum line on the tooth roots. 

Treatment options include the following. 

  • Root planing
  • Flap surgery/pocket reduction surgery
  • Bone surgery
  • Bone grafts – to correct any bone loss with the aim of saving the teeth from falling out
  • Tooth extraction – if the bone loss is very severe, the periodontist may recommend that the teeth are extracted. 
  • Gum grafting – if you have significant gum recession a gum graft may be used to cover exposed tooth roots alone or in combination with a bone graft.

Periodontal Maintenance and X-rays

Further x-rays may be taken when your treatment is complete and your periodontitis stable.  These will be used to track changes in bone levels over time allowing the dentist to determine if more complex treatment is required.  

Types of X-rays Used For Gum Disease

There are many different types of x-rays used in dental medicine. They include

Horizontal bitewings

Horizontal bitewing x-rays detect cavities in the teeth and show localized

bone loss and calculus below the gum line. Your dentist may use these x-rays once a year to monitor the level of bone. 

Periapical X-ray

Periapical X-rays are the gold standard x-ray for assessing bone levels as it shows how much bone there is surrounding the tooth roots. 

They are useful to 

  • Assess the prognosis
  • Help assess if there has been any bone loss between the tooth roots
  • Identify possible pain complications

Cone beam CT 

This type of x-ray creates a 3-D image of the bone, teeth, nerves and soft tissues. The machine rotates around your head, capturing images in one single rotation. It produces an accurate and high-quality image that allows dentists to detect problems in the gums and tooth roots.  

Which Type Of X-Ray Is Most Useful For Examining Periodontal Disease?

Whilst more advanced technology will come along in the future. Currently, periapical x-rays are the most useful to help formulate a treatment plan and offer a prognosis. Bitewings are useful annually to monitor for localized bone loss. 

Frequency of X-rays

There is no recommended frequency for how often x-rays. However, some dental experts like to take a complete set of x-rays every 3-5 years and bitewing x-rays annually. 

What Can I Do At Home?

There are simple steps you can take at home to prevent gum disease from progressing. This includes

  • Smoking cessation
  • Eat a healthy, nutrient-rich diet that’s low in sugar and saturated fats
  • Reducing stress
  • Consuming alcohol in moderation
  • Leading a healthy lifestyle and maintaining a healthy weight

Developing good oral hygiene is essential – brushing your teeth twice a day and carefully cleaning the interdental spaces with a gum pocket brush.

Knowledge is power where beating gum disease is concerned. Gum Disease: Solved online education tool arms you with the information to understand why you have gum disease and how you can beat it in only 10 minutes per day at home, without the need for costly and ineffective dental visits.

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Written by Sharon Fyles

Periodontitis Expert & Writer

Sharon Fyles, BSc (Hons, SW), MSc, Dip,  is a Manchester-based expert dental writer specialising in periodontal diseases and their treatment.


Medically Reviewed and Verified by Dr. Gareth Edwards BDS (Hons), MFDS (RCPS Glasgow)

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