dental instruments and oral health

What is Periodontal Disease?

When the gums become irritated, they separate from the teeth and form deep spaces called “periodontal pockets.” Dental plaque moves into these pockets, which are too deep to clean with a toothbrush. Ultimately, the build-up of subgingival plaque leads to the loss of the surrounding jawbone and soft tissues, which is an indicator of severe periodontal disease. PD doesn’t always cause symptoms. Some people call it a “silent” disease because many do not experience symptoms.

“One out of every two American adults over 30 have periodontal disease.”

Stages of Periodontal Disease

Gum disease begins with plaque and tartar formation. The buildup of bacteria eventually leads to gingivitis or periodontitis.

If left untreated, periodontal disease can result in permanent bone loss and tooth loss.

Stage 1Unremoved Plaque and Tartar

Over time, mouths acquire bacteria, mucus, and other particles that develop into white to off-white dental plaque. Flossing and brushing regularly helps get rid of plaque. Although, when plaque isn’t removed completely, it turns into hardened “tartar” that can only be removed by a dentist or dental hygienist during professional teeth cleanings. When plaque or tartar isn’t removed, gingivitis can form.

Stage 2Gingivitis Formation

Gingivitis is caused by the long-term buildup of plaque and tartar that causes inflamed, red, and swollen gums. Gingivitis is a mild form of gum disease that can be cured with regular brushing, flossing, and professional teeth cleanings. If the disease is left untreated, periodontitis typically forms.

Stage 3Periodontitis Formation

Periodontitis is a type of periodontal (gum) disease caused by untreated gingivitis and leads to inflammation around teeth. In addition to inflammation, periodontitis results in the gums pulling away from the teeth and the formation of “pockets” that become infected.

Stage 4 Possible Tooth Loss / Oral Health Problems

If periodontitis is left untreated, the supporting bones, gums, and tissues become infected. The loss of dental structure results in loose teeth that eventually have to be extracted.

Causes and Risk Factors

Periodontitis is one of the most common oral diseases in America. The primary cause of tooth loss among adults in developed countries is dental caries, while periodontal disease is the second cause.

“47 percent of adults have mild, moderate, or severe periodontal disease. The prevalence rates in adults over 65 years of age are 70 percent.”

Common risk factors of gum disease include:

Plaque and Tartar

The primary cause of periodontal disease is plaque and tartar buildup. Plaque can be removed easily with consistent daily brushing and flossing. Although, when it is not removed completely, the gums become inflamed and irritated over time. Plaque buildup is always the cause of PD. The factors listed below contribute to the disease.


Current tobacco smokers are more prone to periodontitis than former smokers and non-smokers. Those who have never smoked tobacco have the lowest risk of developing gum disease.


Due to extreme hormonal changes during pregnancy, roughly 60 to 75 percent of pregnant women develop gingivitis. If gingivitis is left untreated, it can turn into periodontal disease, which affects the supporting tissues of teeth. The disease can be transferred from mother to baby, which may lead to low birth weight or preterm birth.

Medications, Age, and Health Concerns

Some medications that are taken for blood pressure, heart disease, cardiovascular problems, bacterial pneumonia, seizures, or immunosuppressant drugs can predispose you to periodontal disease with long-term use. Elderly people (65+) are also more susceptible to developing oral diseases as they age, especially if they take medications.

Crooked Teeth

People with misaligned or crooked teeth have a higher chance of developing gum disease. This is because crooked teeth are harder to clean, brush, and floss regularly.

Poor Nutrition

Poor nutrition does not cause periodontal disease directly. Although, eating sugary and processed foods results in more buildup of dental plaque and cavities. Without proper brushing, cleaning, and flossing, gum disease may develop later on.

Genetics and Family History

Genetics plays a part in the development of gum disease. In fact, up to 30 percent of the American population may be predisposed to periodontitis if previous family members were affected by it.


Long-term stress may lead to gum disease because inflammation typically increases when stress levels are high.


The early stages of gum disease are difficult to notice at first because there is often no pain associated with it. Although, there are a few warning signs to be aware of. The most common indicators of periodontitis include:

  • Red, swollen, or tender gums
  • Inflammation around the teeth and under the gums
  • Bleeding gums
  • Loose or sensitive teeth
  • Gums that pull away from the teeth
  • Lingering bad breath throughout the day
  • Pus between the gums and teeth
  • Sudden misalignment in teeth or bite
  • Partial dentures that do not fit properly anymore


Even if a person brushes and flosses regularly, all of the plaque may not be removed, especially at and below the gumline.

The most effective way to prevent periodontitis is to visit a dentist regularly for professional teeth cleanings and checkups.

The beginning stages of gum disease often go unnoticed and minimal symptoms exist. Although, dentists are able to catch the disease early (gingivitis) with routine checkups, which results in a lower chance of severe periodontal disease or tooth loss.

Treatment Types

Periodontists specialize in the prevention, diagnosis, and treatment of gum diseases and the surrounding tissues of teeth. Common types of treatments and procedures for periodontal disease include:

Scaling and Root Planing

Scaling and root planing is used to remove plaque and calculus (tartar) above and below the gums. During the procedure, a dental professional carefully cleans the tooth’s root to remove plaque and tartar below the gums (subgingival). Then they smooth the roots to remove any remaining toxins and bacteria.

Periodontal Surgery

Periodontal surgery, also known as gum surgery, is commonly used to treat severe cases of gingivitis and periodontitis.

There are three main types of surgeries, including:

Flap Surgery — also referred to as pocket reduction therapy, this surgery is used to remove bacteria living under the gums. During the procedure, a periodontist lifts the gums back using small instruments and removes the tartar, plaque, and bacteria. Some space between the tooth and gums is also eliminated during the surgery, which reduces the chance of further damage.

Bone Grafting — When the bone around a tooth’s root is damaged, bone grafts are necessary. During the surgery, the damaged bone is replaced with another bone from the patient’s body, a donated bone, or an artificial bone.

Gum and Tissue Grafting — gum recession, which occurs when the gum tissues around teeth wear away, causes exposed tooth roots. This makes the teeth look longer than they are and results in gum recession. Periodontists use gum graft surgery to cover the exposed roots and protect teeth from decay.