Periodontal Disease
The word periodontal means “around the tooth”. Periodontal disease attacks the gums and the bone that support the teeth. Plaque is a sticky film of food debris, bacteria, and saliva. If plaque is not removed, it turns into calculus (tartar). When plaque and calculus are not removed, they begin to destroy the gums and bone. Periodontal disease is characterized by red, swollen, and bleeding gums.
Four out of five people have periodontal disease and don’t know it! Most people are not aware of it because the disease is usually without obvious symptoms in the early stages.
Not only is it a primary cause of tooth loss, research suggests that there may be a link between periodontal disease and other diseases such as stroke, bacterial pneumonia, diabetes, cardiovascular disease, and increased risk during pregnancy. Researchers are determining if inflammation and bacteria associated with periodontal disease affects these systemic diseases and conditions. Smoking also increases the risk of periodontal disease.
Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease.
Signs and Symptoms of Periodontal Disease
- Bleeding gums – Gums should never bleed, even when you brush vigorously or use dental floss.
- Loose teeth – Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone).
- New spacing between teeth – Caused by bone loss.
- Persistent bad breath – Caused by bacteria in the mouth.
- Pus around the teeth and gums – Sign that there is an infection present.
- Receding gums – Loss of gum around a tooth.
- Red and puffy gums – Gums should never be red or swollen.
- Tenderness or Discomfort – Plaque, calculus, and bacteria irritate the gums and teeth.
The Four Stages of Periodontal Disease
Periodontal disease develops slowly. It usually takes years, and it tends to move through stages. Knowing where you sit on that scale matters, because the earlier stages are reversible with professional care and better home hygiene. The later stages are about stopping further damage and stabilizing what's still there.
Stage 1 is gingivitis. It's the earliest stage, and the only one that's fully reversible. Plaque and bacteria irritate the gum tissue, and you'll typically notice redness, swelling, and bleeding when you brush or floss. The supporting bone hasn't been affected yet. A thorough professional cleaning paired with steady home care will usually clear it up in a few weeks.
Stage 2 is mild periodontitis. When gingivitis isn't treated, the inflammation moves below the gumline. The gums begin to pull away from the tooth surface, forming shallow "pockets" (usually 4–5 mm deep) that trap more plaque. The surrounding bone starts to break down. Treatment at this stage is built around scaling and root planing, a careful deep cleaning below the gumline that removes the bacterial deposits.
Stage 3 is moderate periodontitis. Pockets deepen to 5–6 mm, the bone loss is more obvious, and teeth may show small amounts of movement under pressure. Scaling and root planing is still the foundation, and depending on how the gum tissue responds, we may add localized antibiotic therapy and more frequent maintenance visits.
Stage 4 is advanced periodontitis. Pockets are over 6 mm, a significant amount of bone has been lost, and teeth can become loose or shift position. Treatment at this stage may involve surgical options like pocket reduction, soft-tissue grafting, or guided tissue regeneration. Some teeth may not be savable, in which case your dentist will discuss replacement options like bridges, partial dentures, or implants.
If you're not sure where you sit on this scale, a periodontal exam (included as part of your regular check-up at Trillium) measures the pocket depth around each tooth and gives you a clear picture.
Risk Factors for Periodontal Disease
Anyone can develop periodontal disease, but a handful of factors meaningfully raise the risk. Some are things you can change. Some you can't. Knowing where you sit helps you and your dental team decide how often you should be seen and how aggressively to manage the early signs.
The risk factors you can actually change:
- Inconsistent brushing and flossing. This is by far the most common driver of gum disease.
- Smoking and other tobacco use. It raises the risk and also makes gums respond less well to treatment.
- Poorly controlled diabetes. The relationship runs both ways, so good gum health also supports better glycemic control.
- A diet low in essential nutrients, vitamin C in particular.
- Ongoing stress, which dampens the immune response that fights gum bacteria.
- Tooth grinding or clenching (bruxism), which puts mechanical strain on already-weakened supporting tissue.
- Skipping routine dental visits, so early gingivitis goes unnoticed.
The risk factors you can't change, but that your dental team can plan around:
- A family history of periodontal disease.
- Hormonal changes. Puberty, pregnancy, and menopause all temporarily raise gum sensitivity to plaque.
- Certain medications that reduce saliva flow or cause gum overgrowth, including some blood-pressure drugs, anti-seizure medications, and chemotherapy agents.
- Conditions that affect the immune system, like HIV/AIDS and some autoimmune disorders.
- Age. Risk climbs after 30 and accelerates again after 65.
If more than one of these applies to you, ask your dentist whether you should be seen more often, like every three or four months instead of six.
How Periodontal Disease Is Treated
Periodontal treatment has one goal: stop active infection, close down the pockets that trap plaque, and stabilize the gum and bone that's still there. What the right approach actually looks like depends on the stage of disease, your overall health, and how your tissue responds along the way. We start with the least invasive option the clinical findings will support, and only escalate if it's needed.
Most people start with non-surgical care. The core procedure is scaling and root planing, a careful ultrasonic and hand-instrument cleaning that removes plaque and tartar from below the gumline and smooths the root surfaces so the tissue can re-attach. We may place localized antibiotic therapy in deeper pockets at the same visit. Four to six weeks later you come back for a re-evaluation, so we can actually measure the response.
Once active disease is under control, you move into a periodontal maintenance schedule. That usually means a recare visit every three or four months instead of every six. These visits focus on any deeper sites that need extra attention, re-measure the pocket depths, and walk you through home-care techniques for the areas that aren't yet stable.
If non-surgical care doesn't fully resolve the pockets, a number of surgical procedures may be on the table. The options include pocket reduction surgery, soft-tissue grafting for receding gums, and regenerative procedures that encourage new bone or attachment to form. We talk through the reasons, the alternatives, and what to expect in detail before recommending surgery, and we coordinate care with a certified periodontist when a referral is the right call for your case.
If teeth have shifted or been lost to advanced disease, restorative work like fillings, crowns, bridges, partial dentures, or implants comes later, after the gum and bone underneath are stable. That way the new restorations are sitting on a healthy foundation.
Preventing Periodontal Disease
Most periodontal disease is preventable. Consistent home care plus timely professional cleanings will keep most people in the gingivitis-or-better range for life, even with some of the non-modifiable risk factors above.
A practical daily routine looks like this:
- Brush twice a day for two minutes with a soft-bristled toothbrush. Angle the bristles toward the gumline so they sweep plaque out from the gum margin, not just across the tooth surface.
- Floss once a day. If floss is awkward for you, an interdental brush or water flosser works too. The point is to clear plaque from between teeth where the brush can't reach.
- An antimicrobial mouth rinse can help if your dentist or hygienist suggests one for your situation.
- If you use tobacco, ask us about cessation resources. Gum tissue starts responding differently within weeks of quitting.
- If you have diabetes, keep blood sugar well controlled and share your most recent A1C with us so we can coordinate the timing of treatment.
- See us at least every six months, and more often if you fall into the risk groups above. Most periodontal problems are simple and inexpensive to fix when they're caught at a routine cleaning.
If you have not had a periodontal screening recently, book a comprehensive exam at Trillium Dental Centre. We measure pocket depths, take any x-rays we need, and give you a clear picture of where your gums actually stand, along with a plan to keep them healthy.
Periodontal Disease — Frequently Asked Questions
Can periodontal disease be cured?
Gingivitis, the earliest stage, is reversible with professional cleaning and better home care. Once the disease has moved into periodontitis and bone has been lost, the goal shifts from cure to control. We can stop active disease, recover some lost attachment in a lot of cases, and keep things stable with maintenance therapy. Bone that's already been lost generally does not fully grow back without surgical help.
How do I know if I have gum disease?
The usual signs are red, swollen, or tender gums; bleeding when you brush or floss; persistent bad breath; gums pulling away from the teeth; teeth that feel loose or have shifted position; and a change in how your teeth fit together when you bite. Early gum disease often has no symptoms at all, which is why we screen for it at every check-up.
Is gum disease contagious?
The bacteria linked to periodontal disease can move from person to person through saliva, like when utensils are shared, but transfer on its own doesn't cause disease. Your immune response and home-care habits matter at least as much. Family members of someone with periodontal disease should still be screened regularly.
Does scaling and root planing hurt?
Most people tolerate scaling and root planing well, especially with local anesthetic. We tailor the plan to your comfort. Areas with deeper pockets typically get numbed; lighter areas often only need a topical numbing gel. You may notice some sensitivity to cold for a few days afterward, and it usually settles on its own.
How often should I be seen if I have a history of gum disease?
If you've been treated for periodontitis, we usually recommend a periodontal maintenance visit every three to four months, instead of the standard six-month recall. This schedule reflects how quickly bacteria can recolonize the pockets, and it's well-supported in the periodontal literature. Once your tissue stabilizes, that interval can sometimes be stretched out.
Will my dental insurance cover periodontal treatment?
Most extended dental plans cover scaling, root planing, and periodontal maintenance under basic or preventive benefits, often at 70%–100% of the eligible amount. Surgical procedures usually fall under major restorative benefits at a lower percentage. Trillium Dental Centre follows the current ODA Suggested Fee Guide, submits insurance claims directly where the plan allows, and gives you a written estimate before treatment so you can see what's covered.