Healthy Gums

  • Healthy gums are pink and firm.
  • They don't bleed when brushed or flossed. 
  • The space between the gums and the teeth, called the sulcus, is 1 to 3 millimeters deep. (One millimeter is about the same thickness as a dime.)

Periodontal disease, a chronic bacterial infection, can affect one or many of your teeth. The disease has four stages: 

  • gingivitis, 
  • early periodontitis, 
  • moderate periodontitis and 
  • advanced periodontitis. 

Approximately 50% of adults have gingivitis, 35%have early to moderate periodontitis and 7% to 15% have advanced periodontitis.

Early (Mild) Periodontitis

Initially, this may go unnoticed by most people. The symptoms of gingivitis typically worsen. The gums may be slightly more tender and can have a greater tendency to bleed. Periodontal pockets will measure in the range of 3 to 5 millimeters. (One millimetre is about the same thickness as a dime.)

What can be done: 

Once periodontitis has set in, good oral hygiene should remain top priority, but specific periodontal treatments will be needed. For mild periodontitis, a conservative, non surgical approach can still be used to get the disease under control.

  • The first step is scaling and root planing, a deep cleaning technique. Scaling and root planing remove plaque and calculus (tartar) from under the gum line and smooth any bumps or rough a reason the tooth roots, where plaque tends to accumulate.
  • In some cases, antibiotics are used in combination with scaling and root planing. Antibiotics to treat periodontal disease can be swallowed as a pill or applied in gel, powder or chip form and placed directly into the affected area of the mouth.
  • When scaling and root planing and/or antibiotic treatment are not successful, periodontal surgery may be needed.

Important: Unlike in gingivitis, the effects of periodontitis are not always reversible. Even if the disease is brought under control, it is a chronic condition that can always resurface if oral hygiene becomes lax. It's important that people diagnosed with Periodontist diligently follow up on their Periodontist' recommendations.

Moderate Periodontitis

Although periodontitis usually progresses slowly, it can worsen in bursts. Therefore, if mild periodontitis goes untreated, more bone and connecting fibers can be destroyed. In addition,it is important to note that recent studies suggest a link between periodontal health and overall health.

What happens: The inflammatory response to the bacteria in your plaque continues to wreak havoc on the connective tissue and bone around the teeth. The pockets around teeth deepen as more tissue is destroyed.


  • Gums may become even more red and puffy and bleed easily. 
  • Because there is a greater amount of tissue destruction, teeth may begin to loosen. 
  • Teeth may start to hurt when you chew or become more sensitive to hot or cold. 
  • Pockets measure 5 to 7 millimeters. (One millimeter is about the same thickness as a dime.)

What can be done: 

  • Mild to moderate periodontitis typically responds to scaling and root planing and the use of antibiotics. 
  • In some cases, more extensive treatment may be needed, including a different antibiotic or several courses of antibiotics. 
  • If antibiotic treatment fails, the next step is usually periodontal surgery to reshape the gums or encourage new growth of the bone that has been lost because of periodontal disease.
  • If periodontal disease has destroyed the fibers and bone that support the teeth in the jaw, the teeth may become loose. If this happens, the loose teeth may have to be splinted to other teeth to stabilize them.

Advanced Periodontitis

What happens: Bone and connective tissues continue to be destroyed.


The symptoms are similar to those of moderate periodontitis, but worse. 

  • Teeth can become very loose and it may hurt to bite or chew. 
  • Because the teeth are so loosely connected to the underlying bone, they may reposition themselves in the mouth. 
  • Pressing on the gums may produce pus, a sure sign of a severe infection.
  • Pockets measure more than 7 millimeters. (One millimeter is about the same thickness as a dime.)

What can be done: 

  • This stage of the disease will require surgical treatment, such as periodontal pocket reduction surgery or bone regeneration. During periodontal pocket reduction surgery, the gum tissue is folded back, the disease-causing bacteria are removed, the tooth roots are smoothed, and the gums are secured back in place. This helps the gum tissue to reattach to healthy bone. 
  • A bone regenerative procedure also involves folding back the gum tissue. Then, bone grafts or tissue-stimulating proteins are placed where the bone has been destroyed. This helps to encourage the body's natural ability to regrow the lost bone and tissue.
  • Loose teeth may be splinted to stabilize them. Extremely loose and/or painful teeth may need to be extracted.