Insufficient oral hygiene allows bacteria to build up, forming a sticky film on the teeth called dental plaque. The toxins released by these bacteria damage gum tissue and bone, leading to periodontitis.

Gingivitis is the earliest stage of Periodontal disease and is reversible with good oral hygiene and regular professional cleanings. This includes brushing twice a day, flossing once a day and visiting your dental office on a regular basis.

Stage 1: Gingivitis

The first stage of gum disease is gingivitis, which is the result of a bacterial infection. Bacteria in the mouth normally live in a sticky substance called plaque that covers teeth, but over time the bacteria build up and form hard deposits known as tartar (or calculus). When the bacteria reach high levels in the mouth, they irritate the gums, which become swollen and red. Gingivitis can sometimes go away on its own and may only occur periodically, but if left untreated, it can progress to periodontitis and lead to tooth loss.

When gingivitis is not treated, anaerobic bacteria (such as Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis) colonize deeper pockets of the periodontium, where they secrete toxins that stimulate a chronic inflammatory response in which more and more bone and tissue are destroyed. Gingivitis is reversible with good oral hygiene and regular professional cleanings. It is a common condition that often develops during puberty or early adulthood as a result of hormonal changes, and it can also be caused by medications such as calcium channel blockers or immunosuppressants, and diseases such as diabetes or HIV/AIDS.

Stage 2: Periodontitis

The bacteria in gingivitis have moved below the gum line and begun to attack the ligaments and bone that support your teeth. If left untreated, you will experience increasing amounts of bleeding when brushing and flossing, pus-filled pockets (fistulas), bad breath, and loose teeth as the supporting structures begin to break down.

In this stage, the infection is not reversible and professional treatment is required to halt further damage and promote healing. Treatments may include the use of antibiotics, deep cleaning (scaling and root planing), bone grafting to stimulate growth of new bone, and surgically removing diseased tissue.

Your dentist will assess your condition with a dental probe and take new X-rays to see the extent of the bone loss. Your dentist will also recommend an improved oral hygiene routine and possibly refer you to a periodontist, a specialist in treating gum disease.

Stage 3: Advanced Periodontitis

At this stage, the bacteria have reached below your gums and started to eat away at the bone and tissue that support your teeth. Symptoms at this point include bleeding during brushing, bad breath and pus (infection) around the gum line. If left untreated, the damage to your mouth can become severe.

This is the most advanced stage of periodontitis, and it is also when you are at the highest risk for tooth loss. Severe gum disease is not only painful, but it can also lead to serious health problems such as heart disease and stroke.

Treatments at this stage can include scaling and root planing, which is similar to routine dental cleaning but goes deeper beneath your gums to remove harmful bacteria that your toothbrush or floss can’t reach. Oral antibiotics, which control bacterial infection and reduce inflammation, may be recommended. Gum grafts can be used to replace missing gum tissue and enhance the appearance of your smile.

Stage 4: Advanced Periodontitis

At this stage, if gum disease is left untreated, bacteria start to seep beneath the gum line. As the bacteria move down the roots, they stimulate a chronic inflammatory response that eats away at the soft tissue and bone that support your teeth. This causes the gums to recede or pull away from the teeth, forming pockets that fill with plaque and bacteria. These pockets are harder to reach with your toothbrush and floss, and can cause further infection. You may also notice bad breath, pus around the gum line, and some tooth and bone loss.

The good news is that even in this advanced stage, we can stop further damage with non-surgical treatment. Our dental professionals will perform a procedure called scaling and root planing to remove bacteria-laden tartar from above and below the gum line, as well as smooth out your tooth roots to eliminate bacterial toxins. We may also recommend oral antibiotics to control infection and promote tissue regeneration.