Gum disease progresses through predictable stages. Catching it early makes treatment simple and reversible; catching it late can mean tooth loss. Here is what each stage looks like.
Stage 1 - Gingivitis (reversible)
Gingivitis is the earliest stage. Plaque builds up at the gum line, gums become inflamed, and they bleed easily when brushed or flossed. Probing depths are still 1-3 mm; no bone loss is visible on X-rays. Other signs: red, swollen gums, mild bad breath, and tenderness when brushing.
Reversible with: a professional cleaning, 2x daily brushing, and daily flossing. Most cases resolve within 2 weeks of consistent home care. No long-term damage if addressed at this stage.
Stage 2 - Early Periodontitis
When gingivitis goes untreated, bacteria spread below the gum line and start dissolving the bone supporting teeth. Probing depths reach 4-5 mm with bleeding. X-rays show 15-30% bone loss. Pockets form between gum and tooth that home care cannot reach.
Treatment: scaling and root planing (deep cleaning) under local anesthesia, plus a transition to perio maintenance every 3-4 months. Bone loss does not reverse, but progression halts.
Stage 3 - Moderate Periodontitis
Probing depths 5-7 mm; bone loss 30-50%; some teeth may be slightly mobile. Recession exposes root surfaces, leading to cold sensitivity. Pus may be visible at the gum line.
Treatment: scaling and root planing, sometimes paired with localized antibiotic placement in deep pockets. Some patients are referred to a periodontist for surgical pocket reduction. Tightly maintained 3-month intervals; aggressive home-care routine including a water flosser and interdental brushes.
Stage 4 - Advanced Periodontitis
Probing depths 7+ mm; bone loss exceeding 50%; significant tooth mobility; possible drifting and gap formation between teeth. Some teeth may already be unsalvageable.
Treatment is multi-pronged: surgical pocket reduction, bone grafting in select sites, possibly extraction and implant replacement, and lifelong intensive maintenance. Most cases are referred to a periodontist. Even at this stage, progression can be halted - but tooth loss is not always preventable.
How we measure your stage at every visit
At every recall, the hygienist measures periodontal probing depths at six points around every tooth, records bleeding on probing, and notes recession. We compare to your prior visit, year over year. These numbers tracked over time are the single best predictor of long-term tooth retention. We also evaluate bone level on X-rays at appropriate intervals. If your numbers shift adversely, we discuss treatment immediately rather than waiting for symptoms.
Frequently asked questions
- Can gum disease be cured?
- Gingivitis can be fully reversed. Once periodontitis develops with bone loss, it is managed but not cured - comparable to managing diabetes. With proper treatment and maintenance, most patients hold stable for life.
- Why do my gums bleed when I floss?
- Bleeding gums signal inflammation. The fix is to floss MORE consistently - most cases resolve within 2 weeks of daily flossing. Persistent bleeding warrants a cleaning and exam.
- Does gum disease cause heart problems?
- There is a strong association between periodontal disease and cardiovascular disease, diabetes complications, and pregnancy outcomes. Treating gum disease may reduce systemic inflammation and improve overall health markers.
- How quickly does gum disease progress?
- Variable - some patients progress slowly over decades, others rapidly. Smokers, diabetics, and patients with genetic predisposition can lose teeth within years if untreated. Regular monitoring catches problems before they become serious.