Signs Your Dental Implant Is Infected, and What Happens Next

If the gum around your implant bleeds when you brush or looks puffy, it's worth a closer look, even if nothing hurts. That's how a dental implant infection usually starts. Here's what the signs are, why an implant can lose bone with very little pain, and what happens once we find it.

How do I know if my dental implant is infected?

These are the signs people tend to notice, roughly from earliest to latest:

• The gum around the implant bleeds when you brush or floss.
• The gum looks red or swollen next to the gum around your natural teeth.
• You notice pus, or a bad taste that keeps coming back from that spot.
• The gum pulls back, so the crown looks longer or a little metal shows.
• The crown feels loose or shifts when you bite.

In 2017 a world workshop of gum researchers agreed on how dentists should define an infection around an implant. Their consensus report, led by Tord Berglundh, names three findings. The gum bleeds or leaks pus when it's gently probed, the pockets are deeper than at earlier exams, and X-rays show bone loss. Pain isn't on that list.

Why doesn't an infected implant always hurt?

A natural tooth isn't fixed straight into the bone. A thin cushion of fibers, called the periodontal ligament, holds the root in its socket, and there's a nerve inside the tooth. An implant has neither. The same report notes that the tissue around an implant has no ligament, and that no fibers attach into the implant surface.

That changes two things. The first is that an implant has no nerve inside it to ache the way a tooth with a deep cavity does. The second is that the gum around an implant seals against the metal without being anchored into it. The report also notes that the tissue just above the bone has less blood supply than the same spot around a tooth.

So the seal at the gumline is the main barrier between the bacteria and the bone. Once bacteria get under it, the damage can work its way down quietly. Bleeding and puffiness at the gum may be the only warning you get before bone starts to go.

Is a dental implant infection the same as gum disease?

It works the same way and follows the same two stages. Plaque, the sticky film of bacteria that builds up every day, collects where the crown meets the gum, and the gum swells and bleeds.

The first stage is called peri-implant mucositis. Only the gum is inflamed, and the bone is still where it should be. The consensus report says this stage can resolve once plaque control starts again. The signs may take more than three weeks to settle, and you can think of this stage as the implant version of gingivitis.

The second stage is peri-implantitis. The inflammation has reached the bone, and the bone around the implant is shrinking. Without treatment, the report says, it "seems to progress in a non-linear and accelerating pattern". The data it reviewed suggest it moves faster than gum disease around natural teeth.

Lost bone doesn't grow back on its own, and our post on whether gum disease can be reversed explains the same line for natural teeth.

Who is more likely to get an infection around an implant?

The report found strong evidence for three risks: past severe gum disease, poor plaque control, and no regular maintenance care after the implant is placed.

You may have read that smoking and diabetes belong on that list. The report calls the evidence on those two inconclusive for peri-implantitis, though both may affect how inflamed the gum gets in the first stage.

If you've had severe gum disease before, the evidence puts you in the higher-risk group. That makes your gum health visits after the implant goes in especially important. Those maintenance visits are typically every three to four months.

What does cleaning around an implant need to reach?

The weak point is the line where the crown meets the gum, and the narrow space just under it. Plaque collects there the same way it does on a natural tooth. A toothbrush angled toward the gumline cleans the outside surfaces. Floss wrapped around the crown, or a small brush between the teeth, cleans the sides. Ask us which one fits the space around your implant.

Home care keeps the area clean, but it can't tell you whether the bone is holding. At a checkup, the gum around the implant can be checked for bleeding and pocket depth. X-rays show the bone level, and comparing them with earlier ones shows whether it has changed. That comparison can show bone loss well before you'd ever feel the crown move.

For how long implants tend to last and what shortens their life, see our post on how long dental implants last.

What happens next if your implant is infected?

What happens next depends on which stage of infection we find.

If only the gum is inflamed, the plan centers on the plaque. That means a professional cleaning around the implant and changes to how you clean it at home. Then we check that the bleeding has stopped, which can take a few weeks.

If bone has already been lost, the plan depends on how much. Treatment aims to clean the implant surface below the gum and stop the loss. Some cases need surgery to reach that surface, and some implants have lost too much bone to keep. I place and restore dental implants here, and I'll show you what your X-rays show. If your case calls for surgery, we'll go over what it involves and whether a referral makes sense.

This is why the early visit matters: inflamed gum can settle down once the plaque is gone. Bone lost around an implant doesn't grow back on its own, and the implant depends on that bone to stay put.

When should you call right away?

Call as soon as you notice pus, swelling, or a crown that moves. Our emergency visits page explains how we handle urgent problems, and we do our best to see urgent patients the same day. If swelling spreads quickly, or you have trouble swallowing or breathing, go to an emergency room. Those can be signs of an infection spreading beyond the mouth.

If the gum around your implant has been bleeding, call us at (412) 462-3095 or use our contact page.