COMMON CONDITIONS

Periodontitis

Periodontitis is a serious gum infection that damages the soft tissue and, without treatment, destroys the bone that supports your teeth. It is the leading cause of tooth loss in adults and has been linked to several systemic health conditions including heart disease, stroke, and diabetes.

(pair-ee-oh-don-TY-tis)

Also known as: Advanced gum disease, Periodontal disease

This article is for educational purposes and is not medical advice. Consult Dr. Durrett, Dr. Wilson, Dr. Danielle Durrett, or Dr. Vasconez for diagnosis and treatment specific to your situation.

Quick Facts

alsoCalled:: Advanced gum disease, periodontal disease
primaryCause:: Untreated gingivitis allowing bacterial infection to spread below the gumline
commonSymptoms:: Receding gums, deep pockets between teeth and gums, loose teeth, persistent bad breath
diagnosis:: Periodontal probing, dental X-rays, comprehensive exam
primaryTreatment:: Scaling and root planing, adjunctive antibiotics, surgery in severe cases
prevention:: Treat gingivitis promptly, maintain excellent oral hygiene, regular dental visits
reversible:: No — damage is permanent, but progression can be stopped

Overview

Periodontitis is what gingivitis becomes when left untreated. While gingivitis affects only the soft gum tissue and is fully reversible, periodontitis involves the deeper structures that anchor teeth — the periodontal ligament, the cementum covering tooth roots, and the alveolar bone surrounding tooth sockets. Once these structures are damaged, the damage is permanent. According to the Centers for Disease Control and Prevention, periodontitis affects approximately 47% of American adults over age 30, and the prevalence rises sharply with age, affecting more than 70% of adults over 65. Despite how common it is, periodontitis is often called a silent disease because it can progress for years without obvious symptoms. By the time a patient notices something is wrong, significant damage may have already occurred. The good news is that with appropriate treatment, periodontitis can be controlled. Modern dentistry offers several effective approaches, including thorough nonsurgical gum therapy that Lakeview Family Dentistry uses to treat moderate gum disease conservatively. Understanding periodontitis — and acting early at the first signs — is essential to preventing tooth loss.

How periodontitis develops

Periodontitis develops in stages over months and years. It begins as gingivitis, when plaque accumulates along the gumline and triggers inflammation. If gingivitis is not treated, the inflammation continues and worsens. The body's immune response begins damaging the tissues it's trying to protect. Plaque hardens into tartar (calculus), which the body cannot remove and which provides a constant source of bacterial irritation. Over time, the gum tissue begins pulling away from the teeth, creating small spaces called periodontal pockets. These pockets fill with more bacteria, plaque, and tartar, which is difficult or impossible to clean at home. The infection deepens, attacking the periodontal ligaments that connect tooth roots to bone, and eventually the alveolar bone itself begins to dissolve. As bone is lost, the teeth gradually lose their anchoring support. They may begin to feel loose, shift position, or fall out entirely. The process is slow and silent, which is why regular dental exams are so important — your dentist can detect periodontitis long before you notice it yourself.

Causes and risk factors

The fundamental cause of periodontitis is bacterial infection from untreated gingivitis, but many factors influence whether and how severely an individual develops the disease. Poor oral hygiene is the primary modifiable risk factor. Smoking is the second most important: smokers are up to seven times more likely to develop periodontitis than non-smokers, and their disease progresses faster and responds less well to treatment. Diabetes significantly increases periodontitis risk, particularly when blood sugar is poorly controlled. The relationship is bidirectional — periodontitis also makes diabetes harder to control. Genetics plays a substantial role. Research suggests that 30% to 50% of periodontitis risk is genetic, meaning some people develop severe disease despite good oral hygiene while others have healthy gums with relatively poor habits. Hormonal changes during pregnancy, puberty, menopause, and menstruation affect gum health. Stress impairs immune function and worsens inflammation. Certain medications cause gum overgrowth or dry mouth, both of which increase risk. Other systemic conditions including HIV/AIDS, leukemia, and autoimmune diseases compromise the body's ability to fight gum infection. Crooked teeth, ill-fitting bridges, and food traps make plaque harder to remove. Nutritional deficiencies, particularly of vitamin C, can compromise gum tissue health.

Signs and symptoms

Periodontitis symptoms often go unnoticed in early stages, which is what makes the disease so destructive. Watch for swollen, bright red, or purplish gums that feel tender to the touch. Gums that bleed easily during brushing or flossing — or even spontaneously. Pink-tinged toothbrush or saliva after brushing. Receding gums that make your teeth look longer than they used to. Increased space between teeth that wasn't there before. Loose or shifting teeth. Pain when chewing. Persistent bad breath or a bad taste in your mouth that doesn't go away with brushing. Pus between teeth and gums. Changes in how your teeth fit together when you bite. If you notice any of these symptoms, schedule an appointment with Lakeview Family Dentistry promptly. The earlier periodontitis is treated, the more tooth structure and bone we can preserve.

Stages and severity

Periodontitis is classified into stages and grades based on severity and progression rate. Stage I is initial periodontitis, with up to 15% bone loss around teeth and pocket depths of 4 millimeters or less. Stage II is moderate periodontitis, with 15% to 33% bone loss and pocket depths up to 5 millimeters. Stage III is severe periodontitis with potential for additional tooth loss, with bone loss extending to the middle of tooth roots and pocket depths of 6 millimeters or more. Stage IV is severe periodontitis with potential for loss of the dentition itself, with extensive bone loss, deep pockets, tooth mobility, and complications affecting bite and chewing function. Periodontitis is also graded A through C based on how quickly it's progressing — Grade A is slow progression, Grade B is moderate, and Grade C is rapid. Higher stage and grade indicate more aggressive treatment is needed.

The connection to whole-body health

Periodontitis is not just an oral health issue. Research over the past two decades has established strong links between gum disease and several serious medical conditions. The chronic inflammation and bacteria associated with periodontitis can spread throughout the body via the bloodstream. People with periodontitis have higher rates of cardiovascular disease, including heart attacks and strokes. While research is still clarifying whether periodontitis directly causes heart disease or shares common risk factors, the association is well-documented. People with diabetes are more likely to develop periodontitis, and treating periodontitis often improves blood sugar control. Pregnant women with periodontitis have higher rates of preterm birth and low-birth-weight babies. Periodontitis has been associated with respiratory diseases including pneumonia, particularly in elderly patients, as oral bacteria can be aspirated into the lungs. Recent research has explored connections to Alzheimer's disease, rheumatoid arthritis, and certain cancers. While these connections don't prove that gum disease causes these conditions, they underscore that oral health is integral to overall health.

Diagnosis

Diagnosing periodontitis requires a comprehensive periodontal evaluation. The dentist or hygienist uses a periodontal probe to measure the depth of the space between each tooth and the surrounding gum, recording measurements at six points around every tooth. Pockets deeper than 3 millimeters indicate problems. Bleeding on probing is recorded, as it's a key sign of active inflammation. Dental X-rays show whether bone loss has occurred and how much. In advanced cases, the X-ray patterns can reveal whether bone loss is horizontal or vertical, which affects treatment options. Tooth mobility is assessed by gently rocking each tooth. The dentist evaluates gum recession and attachment loss. Other findings noted include the presence of pus, food impaction sites, and ill-fitting restorations contributing to disease. At Lakeview Family Dentistry, we use 3D digital imaging when needed to evaluate complex cases with greater precision than traditional X-rays.

Treatment

Treatment depends on disease severity. For early to moderate periodontitis, non-surgical treatment is usually effective. Scaling and root planing (sometimes called a deep cleaning) is the foundation of non-surgical periodontal therapy. Under local anesthesia, the dentist or hygienist removes plaque and tartar from above and below the gumline, and smooths the tooth root surfaces to discourage bacterial recolonization. The procedure is typically performed in quadrants over multiple appointments. Adjunctive therapies include locally applied antibiotics placed in deep pockets, antimicrobial mouth rinses, and host modulation therapy with prescription medications that help control the inflammatory response. At Lakeview Family Dentistry, our nonsurgical gum therapy program combines scaling and root planing with locally applied antibiotics and tailored home-care recommendations to halt and reverse early to moderate disease without surgery. For more advanced cases, traditional periodontal surgery may be required, and we refer patients to trusted local periodontists. Surgical options can include flap surgery to access and clean deeper deposits, bone grafts to regenerate lost bone, soft tissue grafts to cover exposed roots, and guided tissue regeneration to encourage tissue regrowth. After active treatment, patients require lifelong periodontal maintenance — typically professional cleanings every three to four months — to prevent disease recurrence.

Prevention

Preventing periodontitis means preventing or promptly treating gingivitis. The fundamentals are the same: thorough daily oral hygiene with twice-daily brushing and daily flossing, regular professional cleanings, and prompt attention to any signs of gum problems. Don't smoke or use tobacco. Manage diabetes and other systemic conditions. Eat a balanced diet rich in vitamin C and other gum-supporting nutrients. Manage stress. Visit Lakeview Family Dentistry every six months — or more frequently if you have a history of gum disease — for comprehensive cleaning and evaluation. If you're at higher risk due to family history, smoking, diabetes, or other factors, your dentist may recommend more aggressive preventive measures including antimicrobial rinses, prescription toothpaste, or more frequent cleanings.

References & Further Reading

Medically reviewed by the doctors at Lakeview Family Dentistry.
Last reviewed: 2026-05-12