Why Do My Gums Hurt Around My Implant?

There is an important difference between a natural tooth and an implant that patients are rarely told about, and it has practical consequences.

A natural tooth has a periodontal ligament — a layer of fibres suspending it in bone, richly supplied with nerves and blood vessels. That ligament tells you when something is wrong. It registers pressure, detects infection early, and produces the tenderness that sends people to the dentist.

An implant has no such ligament. It is fused directly to bone. There is no proprioceptive feedback from the fixture itself, and the blood supply to the surrounding tissue is more limited than around a natural tooth. Problems around an implant therefore tend to announce themselves later and more quietly.

Which means that when the gum around an implant does hurt, it is worth attending to rather than waiting out.

Peri-implant mucositis is inflammation confined to the soft tissue. The gum around the implant is red, swollen and bleeds when brushed or probed, but the supporting bone is unaffected. It is the implant equivalent of gingivitis, and like gingivitis it is generally reversible with thorough cleaning.

It is common. Studies suggest it affects a substantial proportion of implants over time.

Peri-implantitis involves progressive loss of the bone supporting the implant, alongside soft tissue inflammation. It is the implant equivalent of periodontitis, and the parallel extends to the outcome: bone lost is not reliably regained. Untreated, it can lead to loss of the implant.

The relationship between the two is the reason early attention matters. Mucositis is thought to precede peri-implantitis, in the same way gingivitis precedes periodontitis. Not every case progresses — but interrupting it at the mucositis stage is considerably easier than managing it afterwards.

Plaque accumulation. The leading cause. Implant crowns have contours, margins and connections that differ from natural teeth, and some designs are harder to clean than the tooth they replaced. If plaque is not removed daily from around the implant and beneath the crown, inflammation follows.

Residual cement. Where a crown was cemented rather than screw-retained, excess cement can be extruded below the gum margin and left behind. It is difficult to see and difficult to detect, and it acts as a persistent irritant and a surface for bacteria. This is a recognised cause of peri-implant disease and one reason screw-retained restorations are often preferred in accessible sites.

A loose component. If the abutment screw or the prosthetic screw has loosened, micromovement occurs at the connection. This creates a micro-gap that bacteria colonise, and the movement itself irritates the tissue. Symptoms are typically a vague ache, sometimes with a sensation that something is not quite solid. Our article on whether bruxism can cause implant screws to loosen explains one of the main reasons this happens.

Food impaction. An open contact between the implant crown and the adjacent tooth allows food to wedge in repeatedly. Teeth continue to drift slightly throughout adult life while implants do not, so contacts that were tight at fitting can open over the years. This is a common and very fixable cause.

Overload. Excessive or badly directed force — from grinding, from a heavy bite, or from a restoration that is too high — produces both mechanical strain and, over time, bone response around the implant.

Insufficient keratinised tissue. The firm, pale band of gum around teeth and implants is more resistant to brushing trauma and mechanical irritation than the mobile lining mucosa. Where there is little or none around an implant, brushing can be uncomfortable and inflammation is more readily provoked.

Something unrelated nearby. Not every pain in the area originates from the implant. An adjacent tooth with a periodontal problem or a failing root treatment can produce pain that feels as though it comes from the implant. Our article on apical periodontitis covers that presentation.

Early stage, before integration. In the first weeks after placement, some tenderness is expected. Increasing rather than decreasing pain in that period is not, and should be reported. Our article on biological changes after implant placement describes normal healing.

Signs that warrant assessment:

• Bleeding when you brush or clean around the implant. This is the most reliable early indicator and it is not normal, however minor.

• Gum that is red, puffy or shiny compared with the tissue around your other teeth.

• Discomfort on brushing or on biting.

• A persistent bad taste, or a discharge from the gum margin.

• The gum receding around the implant, or the metal collar becoming visible.

• Any sense of movement in the crown.

• A dull ache that comes and goes.

Arrange an urgent appointment if the crown is visibly mobile, if there is facial swelling, if you have a fever, or if there is significant discharge. An implant that is itself mobile has lost integration, and that situation does not recover.

Seek emergency care if swelling is spreading, if you have difficulty swallowing or breathing, or if you feel systemically unwell. In an emergency, call 999 or attend an emergency department.

Probing. Gentle measurement of the depth of the sulcus around the implant, with bleeding recorded. There was historically some reluctance to probe implants; current practice is that careful probing with a light force is appropriate and necessary for monitoring.

Radiographs. Compared against the baseline film taken when the restoration was fitted. This comparison is the basis for distinguishing mucositis from peri-implantitis, since bone level is the defining difference. If you have moved practices, obtaining that original film is genuinely valuable.

Checking the restoration. Testing for loose screws, assessing contacts with adjacent teeth, examining the crown margin for retained cement, and reviewing the emergence profile for cleanability.

Occlusal assessment. Checking how the implant crown meets the opposing teeth, both in straight closure and in lateral movement. Implants do not have the slight give of a natural tooth, so a crown that is fractionally high is loaded disproportionately.

Reviewing your cleaning. Not as a criticism but because it is diagnostically useful. Where plaque is accumulating shows what is not being reached, and that often points to a design or access problem rather than to effort.

For mucositis. Professional cleaning around the implant using instruments that will not damage the implant surface, removal of any retained cement, correction of restoration contours where they obstruct cleaning, and revision of your cleaning technique. Antimicrobial rinses may be used short-term. Where the cause is addressed, the tissue generally responds well.

For peri-implantitis. More involved. Non-surgical debridement with decontamination of the exposed implant surface may be attempted first. Where bone loss is significant, surgical access is often needed to clean the surface thoroughly under direct vision. Depending on the shape of the defect, the aim may be regenerative — attempting to rebuild bone with grafting materials — or resective, reshaping the tissues to create a cleanable contour.

Outcomes vary, and treatment is less predictable than for peri-implant mucositis. Where bone loss is advanced, removal of the implant may be the appropriate recommendation. Our article on whether a failed implant can be replaced explains what follows.

For mechanical problems. A loose screw is retightened to the manufacturer's specified torque, after checking why it loosened — because a screw that loosens repeatedly indicates an underlying loading problem. An open contact is closed by adding to the crown or replacing it. A high crown is adjusted.

• Clean around the implant daily and specifically. A soft brush, plus interdental brushes sized to fit the spaces. Our note on using an electric toothbrush on an implant covers technique.

• Clean beneath the crown. Superfloss, floss threaders or an interdental brush passed under the pontic where applicable. This is the area most commonly missed.

• Consider a water flosser. Useful as an adjunct, particularly around bridges and full arch work. Our water flosser guide covers the options.

• Keep to your maintenance appointments. Implants require a monitoring schedule, typically more frequent than routine check-ups. Our article on All-on-4 maintenance sets out what this involves for full arch cases.

• Stop smoking. Smoking is among the strongest risk factors for peri-implant disease. Our article on implants for smokers covers the evidence.

• Treat grinding. A night guard protects both the components and the bone. See our night guards page.

• Manage dry mouth. Reduced saliva alters the oral environment and increases plaque retention. Our article on dry mouth and implant failure explains why.

Is some discomfort normal around an implant?

In the healing period after surgery, yes — tenderness that gradually settles over days to weeks is expected. Once an implant is integrated and restored, it should be entirely comfortable. Pain in a long-established implant is a sign that something has changed, not a normal variation.

Can peri-implantitis be reversed?

The inflammation can be brought under control, and progression can often be halted. Bone that has already been lost is not reliably regained, although regenerative techniques can rebuild some defects depending on their shape. This is why the earlier stage, peri-implant mucositis, is the point at which intervention is most effective.

My gums bleed a little around the implant but it does not hurt. Should I worry?

Bleeding is the earlier and more reliable sign, and it typically precedes pain. It is worth having assessed rather than monitored at home, because distinguishing mucositis from early peri-implantitis requires probing and a radiographic comparison.

Could my implant be rejected?

Implants are not rejected in an immunological sense. What occurs is failure of integration — either early, where bone does not form a connection with the surface, or late, where infection or overload causes progressive bone loss around an implant that had integrated successfully. Our article on implants becoming infected years later covers the late presentation.

Does the shape of the gum around the implant matter?

It does, both aesthetically and functionally. Adequate keratinised tissue makes cleaning more comfortable and the tissue more resilient, and the emergence profile of the crown determines how accessible the margin is. Our article on whether gum shape affects implant results explores this.

I have had the implant for eight years with no problems. Why now?

Peri-implant disease frequently presents years after placement. Contributory changes include contacts opening as adjacent teeth drift, restorations wearing, general health changes, new medications causing dry mouth, and gradual drift in cleaning routines. Time since placement does not confer immunity.

If the gum around an implant is sore, bleeding, swollen or simply different from how it usually feels, arrange an assessment rather than waiting to see whether it settles. The absence of the early warning system that natural teeth provide is precisely why implant problems benefit from being investigated promptly.

Bring your implant record card if you have one, and details of when the implant was placed and by whom. The original radiograph is the reference point against which current bone levels are judged.

You can contact our team to arrange an appointment at our Wimpole Street practice. Our dental implants and gum disease treatment pages explain what is involved.

This article provides general information and does not constitute individual dental advice. The cause of pain around an implant can only be determined following clinical examination and radiographic assessment. Treatment outcomes for peri-implant disease vary between individuals, and bone loss that has already occurred may not be recoverable. If you have facial swelling, fever, difficulty swallowing or breathing, seek urgent care immediately; in an emergency call 999 or attend an emergency department. Wimpole Dental is regulated by the Care Quality Commission, and our clinicians are registered with the General Dental Council.

Next review due: 27 August 2027