Periodontitis (Advanced Gum Disease)

How gum disease progresses

1. Gingivitis: plaque, a sticky film of bacteria, builds up along the gumline. The gums become red, swollen and bleed easily. No bone is lost and it is fully reversible.
2. Periodontitis: inflammation spreads below the gumline. The gum detaches from the tooth, forming pockets where bacteria thrive. The body's immune response, together with bacterial toxins, breaks down the ligament and bone that hold the tooth.
3. Advanced periodontitis: deep pockets, major bone loss, loose and drifting teeth, and tooth loss.

Hardened plaque (tartar or calculus) can only be removed by a dental professional.

Gingivitis vs periodontitis

Stages and grades

The American Academy of Periodontology classifies periodontitis by:

• stage (I to IV): severity and complexity, based on attachment and bone loss and tooth loss
• grade (A to C): rate of progression, considering smoking and diabetes

Symptoms

• red, swollen or tender gums
• bleeding gums when brushing, flossing or eating
• receding gums and teeth that look longer
• spaces opening between teeth
• persistent bad breath or a bad taste
• pus between teeth and gums
• loose, shifting or separating teeth
• a change in how teeth fit together, or how dentures fit
• pain when chewing

Periodontitis is often painless until it is advanced, which is why regular dental checkups matter.

Causes and risk factors

• poor plaque control: the main cause
• smoking and vaping: one of the strongest risk factors, worsening disease and reducing treatment response
• diabetes: poorly controlled blood sugar increases risk and severity, and periodontitis makes blood sugar harder to control
• genetics and family history
• hormonal changes in pregnancy, puberty and menopause
• dry mouth from medicines or conditions such as Sjögren's
• medicines that cause gum overgrowth
• stress and poor nutrition, including vitamin C deficiency
• weakened immunity, such as HIV or chemotherapy
• crooked teeth or poorly fitting restorations that trap plaque

Links with general health

Periodontitis is associated with:

• diabetes (a two-way relationship)
• heart disease and stroke
• rheumatoid arthritis
• pregnancy complications such as preterm birth and low birth weight
• chronic kidney disease
• respiratory infections in older adults

Treating gum disease improves blood sugar control in people with diabetes. For other conditions, the link is clear, but whether treating gums prevents them is still being studied.

Diagnosis

A dentist or periodontist will:

• measure pocket depths around each tooth with a small probe
• check gum recession, bleeding and tooth mobility
• take dental X-rays to assess bone loss
• review medical history, smoking and diabetes control

Treatment

Non-surgical treatment

• scaling and root planing (deep cleaning): removing tartar and bacteria from tooth surfaces and roots below the gumline, usually under local anesthetic
• improved home care: brushing twice daily, cleaning between teeth daily with interdental brushes or floss
• antimicrobial mouth rinses
• local antibiotics placed into pockets, or oral antibiotics for aggressive disease
• stopping smoking and controlling diabetes

Surgical treatment

For deep pockets that persist after deep cleaning:

• flap surgery to clean roots and reduce pockets
• bone and tissue grafts or guided tissue regeneration to rebuild support
• gum grafts for recession
• dental implants or bridges to replace lost teeth

Maintenance

Periodontal maintenance cleanings, often every 3 to 4 months, are essential because periodontitis can return.

Outlook

Bone lost to periodontitis does not grow back on its own, but with treatment and consistent care, most people can stop the disease from progressing and keep their teeth for life.

Frequently asked questions

What is periodontitis?

Periodontitis is a serious gum infection in which bacteria and inflammation destroy the gum attachment and the bone that holds teeth in place. It develops from untreated gingivitis and can lead to loose teeth and tooth loss.

What are the signs of periodontitis?

Signs include bleeding, red or swollen gums, receding gums, persistent bad breath, pus between teeth and gums, gaps forming between teeth, loose teeth and changes in your bite. It is often painless until advanced.

Can periodontitis be reversed?

The bone and attachment already lost cannot be fully reversed, though some can be rebuilt with regenerative surgery. Treatment can stop the disease progressing. Gingivitis, the earlier stage, is fully reversible with good cleaning.

How is periodontitis treated?

The main treatment is scaling and root planing, a deep cleaning below the gumline, plus better daily brushing and cleaning between teeth. Antibiotics, gum surgery, grafts and regular maintenance cleanings every 3 to 4 months may be needed.

Is periodontitis linked to heart disease?

Studies show people with periodontitis have higher rates of heart disease and stroke, likely partly due to shared risk factors and inflammation. It is not proven that treating gums prevents heart disease, but good oral health is part of overall health.