Periodontal Disease

"Periodontal" means "around the tooth," and periodontal disease affects the gums and bone that support your teeth. It begins with plaque—a sticky film of bacteria, food debris, and saliva. If not removed, plaque hardens into tartar (calculus), which leads to gum inflammation and bone loss.

Periodontal disease often develops silently. In fact, four out of five people have it and don’t know it—early stages are typically painless. The condition is the leading cause of tooth loss in adults and may also be linked to serious health issues, including stroke, diabetes, heart disease, bacterial pneumonia, and pregnancy complications. Smoking also increases your risk.

Periodontal disease is the leading cause of tooth loss among adults in the developed world and should always be promptly treated.

Maintaining good oral hygiene, eating a balanced diet, and visiting your dentist regularly can help prevent periodontal disease and protect your overall health.

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Types of Periodontal Disease

Signs & Symptoms

Diagnosis

Treatment

Maintenance

Common causes

Self-Evaluation

Common types of periodontal disease

There are several types of periodontal disease, each requiring prompt treatment to prevent permanent damage.

GingivitisThe earliest and most common stage of gum disease.Caused by plaque buildup, gingivitis results in red, swollen, and bleeding gums. Certain groups—such as pregnant women, people with diabetes, or those on specific medications—may be more prone to developing it.
Gingivitis is reversible with good oral hygiene and professional cleanings. Your dentist may recommend scaling and root planing, along with medicated rinses or antibiotics to eliminate bacteria and promote healing.

Chronic periodontitisThe most common form of periodontitis, especially in adults over 45.This condition involves slow but ongoing destruction of the gums and bone. You may notice your teeth looking longer as your gums recede.
Although the damage can’t be completely reversed, progression can be managed. Deep cleanings, antimicrobial treatments, and sometimes surgical procedures like pocket reduction or tissue grafts can help preserve your smile.

Aggressive PeriodontitisFast-acting and more severe than chronic forms.Aggressive periodontitis causes rapid loss of bone and gum attachment. It often runs in families and affects younger individuals. Smoking also increases your risk.
This condition usually requires more intensive treatment, including scaling and root planing, antibiotics, and possibly surgery. Laser therapy may also be used to help reduce pocket depth and save affected tissue.

Periodontitis Linked to Systemic ConditionsGum disease caused or worsened by overall health issues.Conditions like heart disease, diabetes, or respiratory illness can increase your risk of developing periodontitis—even if you have minimal plaque.
Managing the underlying health condition is key. Your dentist will work with your healthcare provider to stabilize your health and apply standard periodontal treatments to control the infection.

Necrotizing Periodontal DiseaseA rare but severe form linked to compromised immune systems.This painful and destructive condition causes tissue death in the gums, ligaments, and bone. It’s more common in individuals with HIV, malnutrition, or those under extreme stress or immunosuppression.
Necrotizing periodontal disease requires urgent care. Treatment typically involves a combination of scaling and root planing, antibiotics, antimicrobial rinses, and sometimes coordination with your physician for broader medical care.

Don't ignore the signs! Early diagnosis and professional care are essential to protect your smile and overall health. If you're noticing gum inflammation, bleeding, or loose teeth, schedule a visit with your dentist or periodontist right away.

Signs & symptoms of periodontal disease

There are several forms of periodontal disease, including aggressive, chronic, necrotizing periodontitis, and types associated with systemic conditions. Each has unique symptoms and all require timely treatment to prevent further damage.
Periodontal disease can often progress silently without pain, making regular dental checkups essential. Look out for the following warning signs:

Bleeding gums Bleeding while brushing, flossing, or eating may indicate gum inflammation or infection.

Red, swollen, or tender gums These are signs of inflammation that should not be ignored.

Receding gums/“Longer” teeth Gum recession can make teeth appear longer and expose sensitive areas.

Persistent bad breath (halitosis) Deep gum pockets can trap bacteria and debris, leading to foul odor.

Loose or shifting teeth As bone support weakens, teeth may become mobile or misaligned.

Presence of pus Pus between teeth or along the gumline is a strong sign of active infection.

If you notice any of these symptoms, schedule a dental evaluation. Early treatment is key to protecting your smile.

Diagnosing periodontal disease

Periodontal disease is diagnosed by your dentist or dental hygienist during a periodontal examination, which should be a regular part of every dental check-up.

Using a small instrument called a periodontal probe, the clinician gently measures the depth of the space (sulcus) between your teeth and gums. Healthy pockets are 3 millimeters or less and do not bleed. Deeper pockets can indicate gum disease. As the condition progresses, these pockets typically become deeper.

Your dentist will assess pocket depth, bleeding, inflammation, tooth mobility, and other factors to determine the stage of gum disease, which falls into one of the following categories:

Gingivitis
The earliest stage of gum disease, gingivitis is caused by plaque and toxins that irritate the gums. Gums may appear red, swollen, and bleed easily.

Periodontitis
At this stage, plaque hardens into tartar. Gums begin to recede, forming deeper pockets filled with bacteria and pus. Bleeding and inflammation increase, and slight to moderate bone loss may occur.

Advanced periodontitisIn this severe stage, the supporting structures of the teeth—gums, bone, and ligaments—continue to break down. Teeth may become very loose and could eventually fall out or need to be removed. Moderate to severe bone loss is often present.

Periodontal treatment options

The type and severity of periodontal disease will determine your treatment plan. After evaluating your gums, your dentist or dental hygienist will recommend the most appropriate care.

As gum disease progresses, the pockets between your teeth and gums fill with bacteria, plaque, and tartar, which irritate the surrounding tissue. If left untreated, this buildup can damage the gums and the bone that supports your teeth.

Early-stage treatment – gingivitisIf diagnosed in the early stages and no permanent damage has occurred, one or two routine cleanings may be enough. Your dental team will also provide personalized oral hygiene tips to help prevent progression.

Advanced periodontal disease – deep cleaningIf the condition has worsened, a deep cleaning known as scaling and root planing may be necessary. This procedure is typically done one section of the mouth at a time with the area numbed.
● Scaling - Removes plaque, tartar, and bacteria from above and below the gumline.
● Root planing - Smooths the root surfaces to help gums reattach and promote healing.
● Laser treatment – Targets and reduces deep gum pockets with minimal discomfort.
You may also be advised to use prescription mouth rinses, antibiotics, or a specialized electric toothbrush to aid healing and reduce infection.

Surgical treatmentIf deep cleaning doesn’t fully resolve the problem, periodontal surgery may be needed to further reduce pocket depth and make oral hygiene easier. Your dentist may also refer you to a periodontist, a specialist in gum and bone care.
● Tissue and bone grafting – Regenerates lost bone or gum tissue using grafts and membrane techniques.
● Pocket elimination surgery (flap surgery) – Reduces pocket depth and provides access to thoroughly clean the roots.

Caring for your smile after periodontal treatment

Did you know it takes just 24 hours for plaque that isn’t removed to harden into tartar (calculus)? While brushing and flossing at home help, professional cleanings are still essential—especially for those harder-to-reach spots.

After completing periodontal treatment, your dentist and hygienist will likely recommend regular maintenance cleanings—usually every three months. These periodontal cleanings help keep gum disease under control and include checking the depth of gum pockets to ensure they remain healthy. Plaque and tartar will be removed from both above and below the gumline.

Your periodontal maintenance visit may also include:

X-ray reviewTo check for decay, bone loss, cysts, tumors, and root positions.

Evaluation of existing dental work Examining fillings, crowns, and other restorations.

Cavity checkLooking for signs of new tooth decay.

Oral cancer screening Inspecting the lips, cheeks, tongue, throat, and gums for abnormalities.

Home care recommendationsSuggesting tools like electric toothbrushes, special brushes, fluoride products, and rinses.

Teeth polishing Removing stains and plaque not reached by brushing or scaling.

Consistent oral hygiene at home, paired with professional periodontal cleanings, is the key to keeping your gums healthy and preventing future issues.

Common causes of gum disease

Both genetic and lifestyle factors can contribute to gum disease. The good news? Many causes are preventable with proper care.

Poor oral hygieneInadequate brushing, flossing, and skipped dental visits allow plaque and tartar to build up, leading to gum inflammation and eventual bone damage.

Tobacco useSmoking is one of the top risk factors for gum disease, slowing healing and increasing tartar buildup, deep gum pockets, and bone loss.

GeneticsSome people are more prone to gum disease, even with great oral hygiene. Genetic testing can help identify risk and encourage early intervention.

Pregnancy & menopauseHormonal changes can make gums more sensitive and vulnerable to disease, so maintaining good oral hygiene during these times is crucial.

Stress & poor nutritionChronic stress weakens the immune system, and a poor diet can impair gum health, making it harder for the body to fight infection.

Diabetes & medical conditionsDiabetes, heart disease, arthritis, and other health issues can make it more difficult to control gum infections.

Teeth grindingClenching or grinding puts excess pressure on teeth and gums, which can worsen existing gum issues.

MedicationsSome medications, such as birth control pills, steroids, antidepressants, and heart drugs, can affect gum health or increase inflammation.

Periodontal disease self-evaluation

Periodontal (gum) disease is the leading cause of tooth loss in adults—and many people don’t even realize they have it until it reaches an advanced stage. Understanding the warning signs and risk factors can help you take action early and protect your oral health.
Before you begin this self-check, it’s helpful to know:● Women may be at increased risk due to hormonal changes during puberty, pregnancy, and menopause.● Risk increases with age and is higher for smokers, who tend to experience slower healing, deeper gum pockets, and more tartar buildup.
This self-evaluation is not a substitute for professional diagnosis. It's designed to help you recognize common signs and encourage a visit to your dental care provider if needed. Ask yourself the following questions:

Do your gums bleed when brushing or flossing?
Bleeding gums are a common sign of gum disease. If you notice blood during your routine oral care, it could signal inflammation or infection that needs attention.

Do your teeth feel loose or shift position?
As periodontal disease progresses, it weakens the supporting bone and tissues. This can lead to loose or shifting teeth—and eventually tooth loss if untreated.

Do your teeth look longer than before?
This could be due to gum recession, a classic sign of periodontal disease. As gums pull away from the teeth, the teeth may appear longer and more exposed.

Do you have any health conditions such as diabetes, heart disease, or osteoporosis?
These conditions—and the medications used to manage them—can increase your risk of gum disease by making your gums more vulnerable to bacterial infection.

Does gum disease run in your family?
Genetics can play a role. About 30% of people may be genetically predisposed to developing gum disease, even with good oral hygiene. Gum disease can also spread through saliva, increasing risk among close contacts like partners and children.

Have you had gum problems in the past?
If you've experienced previous issues with your gums—like swelling, bleeding, or sensitivity—you may be more likely to develop advanced gum disease later on.

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Dr. Richard McCasland

CREATING BEAUTIFUL SMILES

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