Periodontal Disease Stages: Available Treatments & Future Outlook
Nearly half of Americans over the age of 30 have periodontal disease. Chances are you might need to learn a little bit about gum disease.
If you have red, swollen gums, a dental sensitivity to hot or cold, persistent bad breath, or your gums always bleed when you brush, you might have gum disease.
It is critical to understand the stages of gum disease. Different periodontal disease stages determine which treatment options are available or necessary.
For example, Stage I gum disease can usually be treated at home with good oral hygiene practices.
In order to prevent gum disease (or a more advanced stage of gum disease), using a triple-headed toothbrush can help you achieve the ultimate clean.
But the right toothbrush is only one key step. Keep reading to learn more about periodontal disease stages and how to promote oral health.
What is gum/periodontal disease?
Gum disease, also known as periodontal disease, is an epidemic in the world. Poor oral hygiene practices combine with poor dietary habits to endanger your dental health.
Gingivitis is the first stage of gum disease. Typically, this early stage of gum disease includes plaque buildup that leads to bleeding gums and inflammation of the gums.
Later stages of periodontal disease are commonly referred to as periodontitis. However, many use the terms interchangeably.
Individuals can usually reverse their gingivitis with better oral care — including those twice-a-year dental visits everyone should be taking.
Unfortunately, good oral hygiene cannot reverse the advanced stages of periodontal disease. These more advanced forms of gum disease can lead to tooth loss and other health problems.
What are the four periodontal disease stages?
- Stage I: Gingivitis
- Stage II: Early Periodontitis
- Stage III: Moderate Periodontitis
- Stage IV: Advanced Periodontitis
Is periodontal disease reversible? The first stage of gum disease, gingivitis, can be reversed with increased oral hygiene. Later stages of gum disease can be successfully treated by a dental professional, but some symptoms may be irreversible, such as bone loss.
There are certain risk factors which increase your chances of developing gum disease:
- Smoking, chewing — any tobacco products
- Chronic stress
- Type 2 diabetes mellitus
- Hormonal changes (such as during menstruation, pregnancy, and menopause)
- Teeth grinding or clenching
- Medical conditions which affect your immune system, like HIV or leukemia
- Poor nutrition, high-sugar diet
- Vitamin C deficiency
- Certain medications that lead to dry mouth as a side effect
- Genetic disposition towards developing gum disease (family history)
Lower income families are statistically more likely to develop periodontal disease. This is a particularly unfortunate statistic, since treatment can be so expensive without good dental insurance.
Stage I: Gingivitis
What is gingivitis? Gingivitis is the first stage of gum disease, and refers to inflammation of the gums.
Gingivitis is a very commonly recognized word, especially compared to the broader term for gum disease, periodontal disease. Dentists will check for gingivitis at every visit.
You will experience no bone or connective tissue loss at this stage. However, gingivitis still requires your attention.
You need to reverse your gingivitis before it progresses into the more dangerous periodontal disease stages.
Symptoms of Gingivitis
- Sensitive gums that bleed when you brush your teeth or floss
- Inflammation, swelling, and redness
- Your gum tissue starts to recede slightly
- Occasional bad breath
- Your probing depth will be 2-4 millimeters
Probing depth means how deep the pockets are between your gum line and your teeth. A dental professional uses a probing tool to gently check your probing depth — a simple way to diagnose gum disease.
Healthy gums have 1-3 millimeters of probing depth. As your gums recede, the pockets that form are the perfect hiding spot for bacteria to thrive, then turn to plaque and eventually tartar. Deep enough “periodontal pockets”, and the bacteria can infiltrate your bloodstream.
Gingivitis Treatment Options
Healthy oral hygiene and home care of your mouth should improve the health of your teeth.
Make sure you are gently brushing your teeth at a 45 degree angle, for two minutes, every time you eat carbs or sugary foods. Use a non-toxic toothpaste that is proven to fight bacteria. And make sure you are flossing properly every day.
Do not use tobacco products. They can greatly accelerate the degeneration of your teeth and gums.
Prioritize your twice-yearly checkups. Your dentist or periodontist will administer a professional cleaning to get rid of plaque buildup and any tartar that has accumulated.
If you catch gum disease in this early stage, you should be able to avoid the more invasive dental treatments necessary in later stages.
This earliest stage of gum disease can almost always be reversed with correct toothbrushing, flossing, and overall home care.
Gingivitis is reversible. But if left untreated, a dental professional will need to treat you from Stage II onwards.
Stage II: Early Periodontitis
Sometimes grouped with Stage III, early periodontitis is a gradual worsening of symptoms exhibited during gum disease.
In Stage II periodontal disease, your gums become even more susceptible to bleeding. Your gum line starts to recede. Your breath starts to smell.
As your gums disconnect from your teeth, you may be able to wiggle your teeth at this stage of gum disease.
Symptoms of Early Periodontitis
- Gum tissue bleed easily
- Loose teeth
- Bad breath
- Redness and swelling of the gums increase
- Your probing depth will be 4-5 millimeters
Early Periodontitis Treatment Options
At this point, a dental professional will need to treat your early periodontitis. A one-two punch of scaling and root planing might do the trick.
- Scaling — This is when your dentist or periodontist “scales” or removes plaque and tartar from your teeth and gums, including in your deepening gum pockets.
- Root planing — This process smooths abnormalities on the roots of your teeth. This should make it more difficult for plaque to live there.
A dentist may prescribe antibiotics, to deal with the harmful bacteria in your gums and on your teeth. They may recommend an antibiotic mouthwash, gel, or pill.
Daily oral hygiene is still important, to make sure your gum disease does not worsen.
Have you quit tobacco products yet? If not, it is time. Tobacco will ruin your oral health — if it hasn’t already.
If you have gum disease at Stage II, you cannot reverse it by yourself. A dental professional will need to treat this early form of gum disease.
But treatments are often effective at this stage. And there is little lasting damage.
Stage III: Moderate Periodontitis
What is Stage 3 gum disease? The third stage of gum disease is moderate periodontitis. Your gums are always red and inflamed.
Health problems outside your mouth start to occur. This is because moderate periodontal disease triggers a persistent immune response that affects your whole body. Although your immune system is meant to help your body, prolonged immune responses can cause harmful inflammation.
Some sources will combine Stage III with either Stage II or IV, since the progression is mainly a worsening of symptoms, not necessarily new symptoms.
Symptoms of Moderate Periodontitis
- Loose teeth
- Tooth loss (up to four teeth)
- Persistent bad breath
- Shifts in how your teeth fit together when you bite
- Supporting bone structures (like your jaw) start to wither away
- The soft tissue that supports your teeth starts to deteriorate
- Your probing depth will be 6-7 millimeters
Moderate Periodontitis Treatment Options
Your dentist may choose to do a scaling or root planing. But the periodontitis might have progressed to the point where some symptoms are irreversible.
One surgery a dentist might perform is called flap surgery. This is when you are put under anesthesia, your gums are lifted away from your teeth, and the roots of your teeth are cleaned extensively. Your gums are sutured back in place, and the surgery is complete.
Flap surgery is helpful if inflammation resides outside the reach of a toothbrush and floss.
There is some irreversible damage, such as to your jawbone. But a dental professional can still treat your gum disease and save you from further bone loss, among other symptoms that can get worse.
You may have lost some teeth by now, but it can get worse. Seek treatment before your gum disease progresses and worsens.
Stage IV: Advanced Periodontitis
At this point, bacteria in your gums constantly invade your bloodstream. Advanced periodontitis can cause 50-90% bone loss and severe pain when chewing.
By Stage IV, the bones that support the teeth, such as the jawbone, are deteriorating.
Can advanced periodontal disease be reversed? In one respect, Stage IV is reversible with aggressive treatment. There are several symptoms, however, that cannot be fixed.
On the other hand, many dentists would say that advanced periodontitis is not curable, only manageable — since the bacteria are so ingrained in your gums, and now bloodstream.
On top of life-changing dental health problems, other issues will start to arise throughout your body for two reasons:
- Your immune system causes inflammation, which is meant to be short-term. However, since your gum disease has progressed so far, your immune system is triggering long-term inflammation, which can lead to all sorts of medical conditions.
- The bacteria from your gums have penetrated your bloodstream, spreading to every corner of your body. This can cause infection.
Symptoms of Advanced Periodontitis
- Can lead to heart disease
- May lead to low birth weight when you are pregnant with gum disease
- Major bone loss, soft tissue loss
- Tooth loss (often more than five teeth at this point)
- Loose teeth, drifting teeth
- Large shifts in your bite
- Extreme pain when you chew
- Constant swelling
- Gums filled with pus
- Severe persistent bad breath
- Foul taste in your mouth
- High sensitivity to heat and cold
- Your probing depth will be greater than 7 millimeters
Advanced Periodontitis Treatment Options
What is the best treatment for periodontal disease? At this later stage, the most invasive and expensive procedures are required.
During flap surgery (which I mentioned under Stage III), a dental surgeon may administer bone grafting, a somewhat costly procedure that regenerates lost bone structure.
In some cases, a dental professional may need to remove some of your teeth to prevent the gum disease from spreading.
The most advanced stage of gum disease is a pretty bleak place to find yourself. Dental professionals will do what they can to stop the progression of the gum disease, but many of the symptoms of advanced periodontitis are irreversible, such as tooth loss and jawbone deterioration.
If these aggressive treatment options can’t save your gums and teeth, your teeth might have to be taken out.
Potential Complications of Periodontitis
We already discussed bone loss, loose teeth, and tooth loss as symptoms. But other long-lasting complications exist when gum disease is left untreated.
Advanced stages of periodontitis mess with your immune system and leak bacteria into your bloodstream, both of which lead to systemic health problems.
Heart disease is probably the most life-threatening complication of periodontitis. Gum disease may raise the risk of heart disease by as much as 20%, according to a 2010 scientific review.
Respiratory disease has been linked to gum disease. A case-control study from 2018 observed that more respiratory disease patients have gum disease than those without respiratory disease.
You risk for developing type 2 diabetes increases in later periodontal disease stages. “Mounting evidence” supports the claim that diabetes and periodontitis are interconnected.
Low birth weight is a perennial problem in maternity wards. Recent research confirms that gum disease “can be considered a risk for adverse pregnancy outcome,” such as low birth weight.
A 2017 study found women with periodontitis are more than three times as likely to deliver a newborn with low weight, and more than three times as likely to deliver prematurely.
Preeclampsia is when a birth mother has high blood pressure, and perhaps protein in her urine. This can harm the infant’s liver and kidney function, leading to blood clots, pulmonary edema, seizures, and possibly even death.
Unfortunately, there is also an established scientific link between preeclampsia and gum disease.
How To Prevent Gum Disease
It is obviously important to stop gingivitis from progressing into the more advanced periodontal disease stages. But how can you prevent advanced periodontitis?
Three-headed toothbrushes are a relatively new invention. The three heads of a sonic toothbrush can reach angles your wrist can turn to reach.
A 2018 systematic review showed that, when someone brushed their own teeth, three-headed toothbrushes worked marginally better than single-headed toothbrushes. However, the triple-headed toothbrush was significantly more effective at plaque removal when a caregiver brushed the person’s teeth.
This 2011 study reveals how effective triple-headed toothbrushes are for everyday people. Although a dentist could similarly brush a child’s teeth with both a conventional and a triple-headed toothbrush, the child’s mother removed more bacterial plaque with a triple-headed toothbrush.
Antibacterial toothpaste is designed to kill the harmful bacteria in your mouth, on your teeth, and hiding in your gums. Left unchecked, that bacteria will form plaque and eventually tartar.
However, there are some ingredients to avoid in toothpaste:
- Sodium lauryl sulfate (SLS) has been linked to canker sores.
- Titanium dioxide nanoparticles can penetrate your gums and prove toxic to your brain. They may also cause cancer.
- Propylene glycol is the primary ingredient in antifreeze, used to soften some toothpastes. Prolonged use may result in damage to the nervous system, heart, and liver.
- Triclosan (only present in Colgate by now) is already forbidden by the FDA in mouthwash. But research paid for by Colgate says that triclosan is beneficial!
- Artificial colors, such as Yellow #5 which is under review by the FDA, may lead to all sorts of health problems with prolonged exposure.
Flossing (correctly) every day is important to oral hygiene. Flossing can stop you from developing gingivitis, or progressing from Stage I to Stage II.
Mouthwash is another potential saving grace when you are trying to prevent gum disease. Mouthwash after brushing can be especially effective.
A balanced diet can prevent the progression of periodontal disease stages. Depriving the harmful bacteria in your mouth of sugar and other carbs gives the bacteria nothing to feed on. Low-sugar diets and balanced nutrition may be just what you need to jumpstart your oral health.
Stress reduction is a pleasant method of preventing the worsening of your gum disease. Yoga has been shown to accelerate gum disease treatment. Removing your daily stress may just remove the root cause of your periodontal disease.
Cutting out tobacco products is key to oral health. Check out this brief list of health complications that tobacco brings with it:
- Accelerates progression of periodontal disease stages
- Decreases success rate of gum disease treatments
- Yellowed teeth
- Cavities, tooth loss
- Increased risk of lung disease, including cancer
- Increased risk of oral cancer
- Eke, P. I., Dye, B. A., Wei, L., Thornton-Evans, G. O., & Genco, R. J. (2012). Prevalence of periodontitis in adults in the United States: 2009 and 2010. Journal of dental research, 91(10), 914-920. Full Text: https://journals.sagepub.com/doi/abs/10.1177/0022034512457373
- Azrak, B., Barfaraz, B., Krieter, G., & Willershausen, B. (2004). Effectiveness of a three-headed toothbrush in pre-school children. Oral health & preventive dentistry, 2(2). Abstract: https://www.ncbi.nlm.nih.gov/pubmed/15646943
- Obulareddy, V. T., Chava, V. K., & Nagarakanti, S. (2018). Association of stress, salivary cortisol, and chronic periodontitis: A clinico-biochemical study. Contemporary clinical dentistry, 9(Suppl 2), S299. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169263/
- Jafri, Z., Bhardwaj, A., Sawai, M., & Sultan, N. (2015). Influence of female sex hormones on periodontium: A case series. Journal of natural science, biology, and medicine, 6(Suppl 1), S146. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4630749/
- Leao, J. C., Ribeiro, C., Carvalho, A. A., Frezzini, C., & Porter, S. (2009). Oral complications of HIV disease. Clinics, 64(5), 459-470. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2694251/
- Song, I. S., Han, K., Ko, Y., Park, Y. G., Ryu, J. J., & Park, J. B. (2016). Associations between the consumption of carbonated beverages and periodontal disease: The 2008–2010 Korea national health and nutrition examination survey. Medicine, 95(28). Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4956829/
- da Silva, M. K., de Carvalho, A. C. G., Alves, E. H. P., da Silva, F. R. P., Pessoa, L. D. S., & Vasconcelos, D. F. P. (2017). Genetic factors and the risk of periodontitis development: findings from a systematic review composed of 13 studies of meta-analysis with 71,531 participants. International journal of dentistry, 2017. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424192/
- Cepeda, M. S., Weinstein, R., Blacketer, C., & Lynch, M. C. (2017). Association of flossing/inter?dental cleaning and periodontitis in adults. Journal of clinical periodontology, 44(9), 866-871. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5601277/
- Dhadse, P., Gattani, D., & Mishra, R. (2010). The link between periodontal disease and cardiovascular disease: How far we have come in last two decades?. Journal of Indian Society of Periodontology, 14(3), 148. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3100856/
- Parashar, P., Parashar, A., Saraswat, N., Pani, P., Pani, N., & Joshi, S. (2018). Relationship between respiratory and periodontal health in adults: A case–control study. Journal of International Society of Preventive & Community Dentistry, 8(6), 560. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6280567/
- Nazir, M. A., AlGhamdi, L., AlKadi, M., AlBeajan, N., AlRashoudi, L., & AlHussan, M. (2018). The burden of diabetes, its oral complications and their prevention and management. Open access Macedonian journal of medical sciences, 6(8), 1545. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6108795/
- Meqa, K., Dragidella, F., Disha, M., & Sllamniku-Dalipi, Z. (2017). The association between periodontal disease and preterm low birthweight in Kosovo. Acta Stomatologica Croatica, 51(1), 33-40. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506254/
- Jaiman, G., Nayak, P. A., Sharma, S., & Nagpal, K. (2018). Maternal periodontal disease and preeclampsia in Jaipur population. Journal of Indian Society of Periodontology, 22(1), 50. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855271/
- Kalf?Scholte, S. M., Van der Weijden, G. A., Bakker, E. W. P., & Slot, D. E. (2018). Plaque removal with triple?headed vs single?headed manual toothbrushes—a systematic review—. International journal of dental hygiene, 16(1), 13-23. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/28544459
- Oliveira, L. B., Zardetto, C. G. D. C., de Oliveira Rocha, R., Rodrigues, C. R. M. D., & Wanderley, M. T. (2011). Effectiveness of triple-headed toothbrushes and the influence of the person who performs the toothbrushing on biofilm removal. Oral health & preventive dentistry, 9(2). Abstract: https://www.ncbi.nlm.nih.gov/pubmed/21842016
- Herlofson, B. B., & Barkvoll, P. (1996). The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers. Acta Odontologica Scandinavica, 54(3), 150-153. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/8811135
- IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. (2010). Carbon black, titanium dioxide, and talc. IARC monographs on the evaluation of carcinogenic risks to humans, 93, 1. Full text: https://www.ncbi.nlm.nih.gov/books/NBK326521/
- Lim, T. Y., Poole, R. L., & Pageler, N. M. (2014). Propylene glycol toxicity in children. The Journal of Pediatric Pharmacology and Therapeutics, 19(4), 277-282. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4341412/
- Sudhanshu, A., Sharma, U., Vadiraja, H. S., Rana, R. K., & Singhal, R. (2017). Impact of yoga on periodontal disease and stress management. International journal of yoga, 10(3), 121. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793006/
- Warnakulasuriya, S., Dietrich, T., Bornstein, M. M., Peidró, E. C., Preshaw, P. M., Walter, C., … & Bergström, J. (2010). Oral health risks of tobacco use and effects of cessation. International dental journal, 60(1), 7-30. Full text: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.849.2257&rep=rep1&type=pdf