The bacteria in plaque cause infection and inflammation, which destroys gum tissue and bone. If untreated, this can lead to loose teeth and jawbone loss. A sticky film of bacteria and food called plaque can irritate and inflame gum tissue, causing gingivitis. Gingivitis is the very early stage of periodontal disease and can be reversed with regular professional dental cleanings and careful home oral care.

Nonsurgical treatment includes scaling and root planing (removing infected tooth roots) and antibiotics. Regular dental visits and good oral hygiene help prevent future damage.

Gum Inflammation

Gingivitis is characterized by red, swollen and tender gums that bleed easily when brushing. You may also have pus around the gum line. This is a sign that bacteria have penetrated below the gums and damaged the bones and tissue that hold your teeth in place.

Left untreated, gum disease progresses to periodontitis. This is when the bacteria destroy the ligaments and soft tissues that support your teeth, resulting in deep pockets between the teeth and gums where bacteria hide, sensitivity and even tooth loss. Persistent bad breath is another symptom of this advanced stage of gum disease. Smoking also slows the healing process, making it more difficult to treat periodontitis. A genetic predisposition and certain health conditions, like diabetes, also contribute to the development of gum disease.

Plaque Buildup

When starches and sugars in food mix with bacteria in your mouth, it creates a sticky film called plaque. Brushing and flossing remove this film, but if you don’t remove it regularly, it will harden into tartar (also known as calculus). Calculus can only be removed by a dental professional using special tools.

In the early stage of gum disease, gingivitis develops. In this stage, the gums are red and swollen and may bleed while brushing. The teeth might feel a little loose, but the bone and tissue that hold the teeth in place are still intact. Gingivitis is reversible at this stage with regular oral care.

If gum disease isn’t treated, it progresses to periodontitis. In this stage, the infection has seeped under the gums and into the bones that support the teeth. The gums pull away from the teeth, creating pockets that fill with food, plaque and bacteria. The bacterial toxins damage the ligaments and bones that hold the teeth in place, causing them to become loose and fall out.

Pockets Between the Teeth

Pockets between the teeth are a sign of periodontal disease. When healthy, the gums fit snugly around each tooth and do not leave spaces that collect plaque and bacteria. However, in advanced cases of gum disease, the gum tissue pulls away from the tooth, forming a gap that collects food particles and bacteria. Over time the bacterial infection damages the surrounding tissues and bone, leaving exposed tooth roots and pockets.

Typically, pockets measuring four millimeters or deeper are a sign of severe gum disease. Those who have these pockets may have a harder time cleaning their teeth thoroughly with a toothbrush, and will likely need to visit the dentist for more intensive treatment.

Those with deep pockets can often have them reduced through professional cleanings (called scaling and root planing) combined with aggressive oral hygiene at home. In some cases, more extensive treatments such as flap surgery and tissue grafting can help restore damaged tissues and reduce pockets.

Bone Loss

If gum disease progresses to periodontitis, the bone and tissue that support your teeth will be destroyed. You will likely experience severe pain while chewing, loose teeth and bad breath (halitosis). Other health problems like heart disease, diabetes and stroke are also linked to periodontitis.

Gingivitis, the first stage of gum disease, is reversible with good oral hygiene, including daily brushing and regular dental cleanings. Treatment for early periodontitis may include scaling and root planing, a procedure where your dentist or dental hygienist removes tartar under your gums and smoothes the surface of your roots to make it harder for bacteria to grow. Antibacterial medicines may also be used.

Advanced periodontitis is characterized by deep pockets, gum recession and loose teeth. Treatment options include root coverage with a gum graft, where tissue from the top of your mouth or another source is sewed to cover exposed tooth roots, and guided tissue regeneration, which uses biocompatible material to encourage your natural bone to grow back.