Periodontal disease is a bacterial infection of the tissues that support your teeth: the gums, the periodontal ligament, and the underlying bone. It starts quietly, often without pain, and progresses through distinct stages. Left untreated, it leads to bone loss, loose teeth, and eventually tooth loss.
Understanding the stages helps you recognise the warning signs and act before the damage becomes irreversible.
Stage 1: Gingivitis
Plaque-induced gingivitis is gum inflammation without the attachment and bone loss that defines periodontitis. It can often resolve with effective plaque control and appropriate professional care, although persistent inflammation may have another cause and needs assessment.
What you may notice:
- Gums that bleed when you brush or floss
- Gums that appear red or swollen, particularly along the tooth margins
- Occasional bad breath
What is happening: Plaque (a sticky film of bacteria) has accumulated along the gum line, triggering an inflammatory response. The gums become swollen and bleed easily, but the underlying bone remains intact.
Treatment: Professional cleaning to remove plaque and calculus (hardened plaque), followed by improved brushing and flossing at home. Most cases of gingivitis resolve within two to three weeks of proper care.
At Ivy Dental, a professional teeth cleaning includes removal of plaque and calculus from all tooth surfaces, polishing, and personalised hygiene coaching.
Stage 2: Early Periodontitis
If gingivitis is not addressed, the infection can progress below the gum line and begin to attack the bone and ligament that hold teeth in place.
What you may notice:
- Gums pulling away from teeth slightly (early pocket formation)
- Gums bleeding more readily, sometimes spontaneously
- Persistent bad breath that does not resolve with brushing
- Teeth may appear slightly longer as gums recede
What is happening: Bacteria have migrated into the space between the tooth and gum (the periodontal pocket), which has deepened from a healthy 1-3mm to 4-5mm. Early bone loss is occurring, though it may only be visible on dental X-rays.
Treatment: Scaling and root planing (deep cleaning). This is performed under local anaesthetic and involves cleaning below the gum line to remove bacteria, calculus, and infected tissue from the root surfaces. The goal is to create a clean environment that allows the gum tissue to reattach more closely to the tooth.
Treatment is typically performed over two to four appointments, one quadrant (quarter of the mouth) at a time.
Stage 3: Moderate Periodontitis
At this stage, bone loss has progressed further and clinical signs become more apparent.
What you may notice:
- Teeth beginning to feel slightly mobile
- Noticeable gum recession
- Spaces opening between teeth that were previously tight together
- Pus between the gums and teeth
- Pain when chewing in some cases
What is happening: Periodontal pockets have deepened to 5-7mm. Bone loss is moderate, affecting the structural support of the teeth. The inflammatory process is actively destroying tissue.
Treatment: Scaling and root planing remains the foundation. Your dentist may also recommend:
- More frequent maintenance appointments (every three months rather than six)
- Localised antibiotic therapy placed directly into deep pockets
- Reassessment after an initial treatment phase to determine whether surgical intervention is needed
At this stage, the goal shifts from reversing disease to stabilising it and preventing further loss. This is an important distinction. The bone that has been lost will not regenerate on its own. But with consistent treatment and maintenance, the remaining bone can typically be preserved.
Book a gum health assessment. Call Ivy Dental on (07) 3266 7120 or book online.
Stage 4: Advanced Periodontitis
Advanced periodontitis represents significant destruction of the supporting structures of the teeth.
What you may notice:
- Teeth that are visibly loose or shifting position
- Significant gum recession exposing root surfaces
- Difficulty chewing
- Teeth drifting apart or changing alignment
- Abscesses forming in the gum
What is happening: Periodontal pockets are deeper than 7mm. Bone loss is severe, and teeth may have lost more than half their bony support. At this stage, some teeth may not be salvageable.
Treatment: Aggressive treatment typically involves:
- Thorough scaling and root planing
- Possible periodontal surgery to access and clean deep pockets, reshape bone, or place bone grafts
- Extraction of teeth that cannot be maintained
- Planning for tooth replacement (implants, bridges, or dentures)
- Lifelong maintenance at three-monthly intervals
Risk Factors for Periodontal Disease
Some factors increase your susceptibility:
Smoking. The single greatest modifiable risk factor. Smokers are significantly more likely to develop periodontitis and respond less well to treatment. Smoking reduces blood flow to the gums, impairing healing.
Diabetes. Poorly controlled diabetes increases susceptibility to all infections, including periodontal disease. The relationship works both ways, as severe gum disease can make blood sugar harder to control.
Genetics. Some people are genetically more susceptible to aggressive forms of periodontal disease, even with adequate oral hygiene. Family history is relevant.
Stress. Chronic stress suppresses immune function and may contribute to increased inflammation.
Medications. Certain medications (including some blood pressure drugs and anti-seizure medications) can cause gum overgrowth, which makes oral hygiene more difficult.
Hormonal changes. Pregnancy, menopause, and puberty can affect gum sensitivity and inflammation. Read more about dental care during menopause.
The Link Between Gum Disease and General Health
Research has identified associations between periodontal disease and several systemic conditions, including cardiovascular disease, stroke, diabetes complications, and adverse pregnancy outcomes. The exact mechanisms are still being studied, and causation has not been established for all associations. However, the evidence supports that maintaining periodontal health contributes positively to overall health.
How Periodontal Disease Is Diagnosed
Diagnosis involves:
- Periodontal probing. Your dentist or hygienist measures the depth of the pocket around each tooth using a thin, calibrated probe. Healthy pockets measure 1-3mm. Deeper pockets indicate disease.
- X-rays. Dental X-rays reveal the level of bone around each tooth and show areas of bone loss that are not visible clinically.
- Assessment of bleeding, recession, and mobility. These clinical signs are recorded to establish the severity and extent of disease.
This assessment is part of a comprehensive dental check-up at Ivy Dental.
Preventing Periodontal Disease
Prevention is straightforward:
- Brush twice daily with a fluoride toothpaste, paying attention to the gum line
- Floss or use interdental brushes daily to clean between teeth where your toothbrush cannot reach
- Attend regular dental check-ups and professional cleans (typically every six months, or more frequently if your dentist recommends it)
- Do not smoke
- Manage underlying health conditions, particularly diabetes
- Eat a balanced diet and limit sugary snacks and drinks
If you have noticed bleeding gums, persistent bad breath, or any of the symptoms described above, contact Ivy Dental on (07) 3266 7120. Early intervention makes a substantial difference in outcomes.
We see patients seven days a week at our Everton Park and Nundah clinics in north Brisbane.
