Periodontal disease is a chronic infection of the gums and bone that support your teeth. It affects roughly 47% of American adults over age 30, which translates to about 65 million people. The disease starts as simple gum inflammation and, left untreated, can destroy the jawbone and lead to tooth loss.
How It Starts and Progresses
Your mouth contains over 700 species of bacteria. Most are harmless or even helpful, but when bacterial plaque builds up along and below the gumline, it triggers an immune response. Here’s the key detail most people miss: the bacteria themselves do some damage, but it’s actually your body’s own inflammatory response that does most of the destruction. Your immune system, trying to fight the infection, releases chemicals that break down the soft tissue and bone holding your teeth in place.
The disease moves through two distinct phases. The first, gingivitis, is limited to the gums. You’ll notice redness, swelling, and bleeding when you brush or floss. Gingivitis generally doesn’t hurt, which is why many people don’t realize they have it. At this stage, no permanent damage has occurred, and the condition is fully reversible with better oral hygiene.
When gingivitis persists, it can advance into periodontitis. The gums begin pulling away from the teeth, creating gaps called periodontal pockets. Healthy gums fit snugly around teeth with pocket depths of 1 to 3 millimeters. Pockets of 4 to 5 millimeters signal moderate disease, while pockets of 6 millimeters or deeper indicate severe periodontitis. These pockets can eventually exceed 1 centimeter. As the pockets deepen, inflammation attacks the bone and connective tissue anchoring the teeth. Roots become exposed, teeth loosen, and chewing becomes painful.
Signs You Shouldn’t Ignore
Because early periodontal disease is painless, the warning signs are easy to dismiss. Watch for:
- Bleeding gums when brushing, flossing, or sometimes for no obvious reason
- Red, swollen, or tender gums that look puffy compared to healthy pink tissue
- Receding gumline that makes teeth appear longer than they used to
- Persistent bad breath that doesn’t go away after brushing
- Loose or shifting teeth or changes in how your bite feels
- Pain while chewing
- Sensitive teeth, especially near the gumline
Bleeding gums are often the earliest and most common sign. Many people assume it’s normal for gums to bleed during brushing. It isn’t.
Who Is Most at Risk
Smoking is one of the strongest risk factors. Smokers are three times more likely to develop severe periodontal disease than nonsmokers, and smoking also makes the disease harder to treat because it impairs healing. Declines in smoking rates are directly linked to lower periodontitis prevalence at the population level.
Diabetes is another major driver. The relationship goes both directions: diabetes makes periodontal disease worse, and periodontal disease makes blood sugar harder to control. People with type 2 diabetes and severe periodontitis face 3.2 times greater mortality risk compared to those with no or mild gum disease.
Genetics play a real role too. Some people are simply more susceptible to periodontal disease than others, regardless of how well they brush. Other risk factors include age, stress, certain medications that reduce saliva flow, and poor oral hygiene. The disease becomes dramatically more common as you get older: about 70% of adults 65 and over have some form of periodontitis.
Links to Heart Disease and Other Conditions
Periodontal disease doesn’t stay in your mouth. The chronic inflammation and bacteria can enter the bloodstream and affect other parts of your body. Periodontitis is associated with a 19% increase in cardiovascular disease risk overall, and that number climbs to 44% for people 65 and older. A large analysis of 29 studies found that people with periodontal disease had significantly higher odds of developing heart disease, and this association held up even after accounting for other risk factors like smoking, diabetes, and socioeconomic status.
Periodontitis is also linked to adverse pregnancy outcomes, including preterm birth, low birth weight, and preeclampsia. The underlying mechanisms involve both the bacteria themselves and the immune response they provoke spreading beyond the gums.
How It’s Diagnosed
Your dentist checks for periodontal disease by examining each tooth with a thin instrument called a periodontal probe, which measures the depth of the space between your gum and tooth. The probe slides gently into the pocket, and the dentist records the measurement in millimeters. They also check for bleeding, tartar buildup, gum recession, and loose teeth. If periodontitis is suspected, X-rays reveal whether bone loss has occurred and how extensive it is.
Non-Surgical Treatment
The standard first-line treatment is scaling and root planing, often called a “deep cleaning.” During scaling, your dental provider removes plaque and hardened tartar from above and below the gumline. Root planing smooths the root surfaces so the gums can reattach more easily. The procedure typically takes one to four sessions, ranging from 30 minutes to several hours depending on severity. You’ll receive local anesthesia to keep it comfortable.
This approach works well for mild to moderate disease. In clinical trials, eight out of eleven studies found significant improvement in pocket depth after scaling and root planing, with many pockets shrinking back below the 4-millimeter threshold. The treatment is most effective for pockets that were moderately deep (4 millimeters or more) at the start. Shallower pockets showed less dramatic change simply because they had less room to improve.
Surgical Options for Advanced Disease
When deep cleaning alone isn’t enough, several surgical procedures can address the damage. Flap surgery involves folding back the gum tissue to access and thoroughly clean the root surfaces and reshape damaged bone underneath. Once stitched back, the gums fit more snugly around the teeth, eliminating deep pockets where bacteria hide.
Bone grafting rebuilds jawbone that has been destroyed. Graft material, which can come from your own bone, a donor, or synthetic sources, is placed where bone has been lost. It holds the tooth in place and provides a scaffold for your body to regenerate natural bone. A related technique called guided tissue regeneration uses a special membrane placed between the bone and gum tissue to prevent soft tissue from growing into the space where bone needs to reform.
Soft tissue grafts address gum recession. Tissue taken from the roof of your mouth or from a donor source is attached to areas where gums have pulled back, covering exposed roots and preventing further recession. For some patients, a protein-based gel applied to the tooth root can stimulate regrowth of both bone and tissue by mimicking proteins found in developing teeth.
Ongoing Maintenance
Periodontal disease is manageable but not curable in the traditional sense. Once you’ve been treated, you’ll need periodontal maintenance visits, which are more thorough than standard cleanings. These appointments include a full periodontal evaluation, pocket measurements, removal of bacteria from pockets, scaling and root planing as needed, and a review of your home care routine.
The American Academy of Periodontology recommends that most patients with a history of periodontitis start with visits every three months. This frequency reduces the likelihood of the disease progressing compared to less frequent visits. Over time, your periodontist may adjust the schedule based on how well your gums respond. Some patients eventually stretch to longer intervals, while others need to maintain quarterly visits indefinitely.
At home, thorough daily brushing and flossing remain essential. The goal is consistent disruption of bacterial buildup, particularly along the gumline and between teeth where pockets formed. Interdental brushes or water flossers can be especially useful for reaching areas that standard floss misses, particularly around teeth with deeper pockets or recession.