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. Thus, 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.

However, periodontitis 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, and over time, periodontitis.

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

Stage 1Unremoved Plaque and Tartar

Mouths acquire bacteria, mucus, and other particles over time that develop into white or off-white dental plaque. Flossing and brushing regularly helps remove plaque on the surfaces of teeth. However, when plaque isn’t removed completely, it turns into hardened tartar (calculus), which can only be removed by a dental hygienist during professional teeth cleanings. So, if you neglect these teeth cleanings and the plaque or tartar isn’t removed, gingivitis forms.

Stage 2Gingivitis Formation

The long-term buildup of plaque and tartar causes inflamed, red, and swollen gums. This results in gingivitis, which is a mild form of gum disease that can be cured with regular brushing, flossing, and professional teeth cleanings. However, if you do not receive treatment for this disease, periodontitis typically forms.

Stage 3Periodontitis Formation

Periodontitis is the advanced form of gum disease caused by untreated gingivitis. It leads to inflammation around the teeth and also eventually causes permanent bone loss. 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 and damaging oral diseases in America. In fact, periodontal disease is the second leading cause of tooth loss among adults in developed countries, while cavities are the leading 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:

single tooth covered in plaque graphic
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.

smoking and dental health graphic

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

pregnancy and hormonal changes

Due to extreme hormonal changes during pregnancy, roughly 60 to 75 percent of pregnant women develop gingivitis. The disease can also be transferred from mother to baby, which may lead to low birth weight or preterm birth.

medication bottle with three pills graphic
Medications, Age, and Health Concerns

Some medications people take 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. This is especially true if they take medications.

three crooked teeth with one overlapping another tooth
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.

candy and nutritional dental health graphic
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.

dna helix graphic
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.

side profile of head with stressed brain graphic

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 least at first. This is because people often do not feel any pain. Although, there are a few warning signs to be aware of. For example, the most common indicators of periodontitis include:

  • Red, swollen, or tender gums
  • Inflammation around the teeth, which can also extend under the gums
  • Bleeding gums, typically while brushing
  • Loose or sensitive teeth when consuming hot or cold substances
  • Gum recession, which is when the gums pull away from the teeth
  • Pus between the gums and teeth
  • Sudden teeth misalignment, also called malocclusion
  • Lingering bad breath, which may not disappear after brushing
  • 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. Depending on the severity of gum disease, you will need to receive treatment before the condition gets worse. In particular, common treatment options for periodontal disease, which is advanced gum disease, include:

removing plaque and tartar stuck above and below the gums, a treatment for periodontal disease
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 dentist 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.

pocket reduction periodontal surgery
Periodontal Surgery

Periodontal surgery, also known as gum surgery, treats severe cases of gingivitis and periodontitis.

Surgical Options

There are also three types of periodontal surgeries available, 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.