Updated on February 7, 2024
4 min read

Stages of Periodontitis (Periodontal Disease)

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What is Periodontal Disease?

Periodontal disease is also called periodontitis or advanced gum disease. It’s an inflammatory disease affecting the gums, bones, and surrounding tissues.

Medically accurate 3d render of periodontitis testing with plaque or tartar buildup

Periodontitis develops from the long-term buildup of dental plaque and hardened tartar (calculus). The calculus is typically located:

  • Beneath the gums (subgingival)
  • Between the gums (interproximal)
  • Along the gum line (equigingival) 

When the gums become irritated, they separate from the teeth and form deep spaces called “periodontal pockets.”

Plaque buildup ultimately leads to the loss of the bone and supporting structures around teeth. This indicates the presence of severe periodontal disease.

Symptoms of Periodontal Disease

The early stages of gum disease are difficult to notice, at least initially. People often don’t feel any pain.

However, there are a few warning signs to be aware of:

  • Red, swollen, or tender gums
  • Inflammation around the teeth
  • Inflammation under the gums
  • Gums that bleed easily
  • Loose teeth 
  • Tooth loss
  • Sensitivity to hot or cold substances
  • Gum recession
  • Pus between the gums and teeth
  • Sudden teeth misalignment (malocclusion) or shifting
  • Lingering bad breath
  • New gaps or spaces between teeth

What Causes Periodontal Disease?

Periodontitis is one of the most common and damaging oral diseases in the U.S. It’s the second leading cause of tooth loss among adults in developed countries; cavities are the leading cause.

Common risk factors of gum disease include:

  • Plaque and tartar
  • Smoking
  • Extreme hormonal changes from pregnancy
  • Uncleaned areas due to crooked teeth
  • Poor nutrition
  • Genetics and family history
  • Stress

Can Certain Medicines Cause Periodontal Disease?

Certain medications can also make you prone to periodontal disease. You may be at risk for periodontal disease if you use medications for:

  • Blood pressure
  • Heart disease
  • Cardiovascular problems
  • To suppress the immune system (e.g., after a transplant)
  • Seizures

Older adults (65+) are also more likely to develop oral diseases as they age. This is especially true if they take medications.

Treatment for Periodontal Disease

Periodontists specialize in detecting and treating gum disease. They can also help in placing dental implants when tooth loss occurs.

Oral hygiene Scaling and root planing performed in 3d render to treat severe tartar buildup

Depending on the severity of gum disease, you will need to receive treatment before the condition worsens. Treatment options for periodontal disease include:

The 4 Stages of Periodontal Disease

Approximately 47.2 percent of adults aged 30 years and older have some form of periodontal disease. Some people call it a “silent” disease because it doesn’t always cause symptoms.8

There are two types of gum disease:

  1. Gingivitis — The mildest and most common form of gum disease that can be cured or reversed early on
  2. Periodontal disease — If gingivitis isn’t treated, it can lead to periodontal disease, a serious form of gum disease that leads to permanent bone loss

The four stages of periodontal disease are:

1. Initial (Irreversible Damage) 

Untreated gingivitis can quickly turn into the initial stage of periodontitis. This begins with plaque and tartar formation.

Once there’s a significant build-up of bacteria, your gums will become inflamed. The initial stage of periodontitis is treated with a deep cleaning called scaling and root planing

Unfortunately, stage one periodontitis is not reversible like gingivitis. However, it can be treated and managed by a periodontist.

2. Moderate (More Noticeable Damage)

Stage two periodontitis is similar to the initial stage; it is irreversible but still manageable. However, unlike the first stage, the damage is now more noticeable. By this stage, the ligaments of the tooth’s root and socket have become more damaged.

3. Severe (Potential for Partial Tooth Loss)

During stage three periodontitis, your teeth will look longer because of severe gum recession. You may also feel your teeth loosen because the gums cannot keep them firmly in place.

At this point, periodontal surgery may be your only choice for treatment. Some teeth cannot be saved, and you may benefit from dentures or dental implants to replace them.

Teeth that are severely diseased during this stage will be extracted to slow the progression of periodontitis. Scaling and root planing and periodontal surgery may be required to treat severe periodontitis.

4. Extreme (Potential for Complete Tooth Loss)

Stage four periodontitis can cause multiple teeth to fall out due to severe and permanent bone loss. People with stage four periodontitis have very limited options.

By this point, the bacteria has begun to infect the supporting bones, gums, and tissues around the mouth. The loss of dental structure loosens the teeth, so they will fall out or need to be extracted.


Periodontal disease is also called periodontitis or advanced gum disease. It’s an inflammatory disease affecting the gums, bones, and surrounding tissues.

There are four periodontal disease stages, beginning with untreated gingivitis. These four stages cause significant damage to your gums and teeth. Unlike gingivitis, periodontal disease is irreversible.

Although there is no way to cure or reverse periodontal disease, it can be slowed down. Periodontists specialize in treating gum disease and can help you mitigate the damage from periodontal disease.

Last updated on February 7, 2024
9 Sources Cited
Last updated on February 7, 2024
All NewMouth content is medically reviewed and fact-checked by a licensed dentist or orthodontist to ensure the information is factual, current, and relevant.

We have strict sourcing guidelines and only cite from current scientific research, such as scholarly articles, dentistry textbooks, government agencies, and medical journals. This also includes information provided by the American Dental Association (ADA), the American Association of Orthodontics (AAO), and the American Academy of Pediatrics (AAP).
  1. Eke, et al. “Prevalence of Periodontitis in Adults in the United States: 2009 and 2010.” Journal of Dental Research, 2012.
  2. Gautam, et al. “Effect of Cigarette Smoking on the Periodontal Health Status: A Comparative, Cross-Sectional Study.” Journal of Indian Society of Periodontology, 2011.
  3. Hollins, C. ”Basic Guide to Dental Procedures.” John Wiley & Sons, Inc., 2015.
  4. National Institutes of Health (NIH). “Periodontal (Gum) Disease: Causes, Symptoms, and Treatments.” NIH Publication, 2013
  5. “Periodontal Disease in Adults (Age 20 to 64).” National Institute of Dental and Craniofacial Research, U.S. Department of Health and Human Services, 2021.
  6. “Periodontitis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 2018
  7. Syrbu, J. “The Complete Pre-Dental Guide to Modern Dentistry.” 2013.
  8. Periodontal Disease, Centers for Disease Control and Prevention (CDC), 2013.
  9. Pregnancy and Oral Health, Centers for Disease Control and Prevention (CDC), 2013.
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