Periodontal Disease: A Complete Guide to Gum Disease, Stages, and Treatment

Periodontal disease is a chronic inflammatory disease of the tissues that hold teeth in place: the gums, the ligament that attaches each tooth to the bone, and the jawbone itself. It begins with dental plaque, the sticky bacterial film that forms on teeth every day. When plaque is not removed, it hardens into tartar (calculus) along and below the gumline, and the gums respond with inflammation.

The National Institute of Dental and Craniofacial Research describes two broad phases. Gingivitis is inflammation limited to the gums: they may look red, feel tender, or bleed when you brush. Gingivitis can usually be reversed with professional cleaning and good daily home care because the supporting bone has not yet been lost.

Periodontitis is the stage at which the inflammation has damaged the attachment between gum and tooth. The gum pulls away to form pockets, those pockets collect more bacteria, and the bone around the tooth is gradually lost. Lost bone does not grow back on its own, which is why periodontitis is managed rather than simply cured: treatment aims to stop progression, reduce pocket depth, and, in selected cases, regenerate some of what was lost.

Periodontitis is one of the most common chronic conditions in American adults. According to the Centers for Disease Control and Prevention, about 4 in 10 U.S. adults aged 30 or older had some level of periodontitis in national surveys from 2009–2014. The proportion rises with age: about 60% of adults 65 or older had periodontitis in the same period. Among current smokers aged 30 or older, the figure was about 62%.

The full-mouth examination study behind those figures, Eke et al. (2018), estimated that 42.2% of dentate adults aged 30 or older had periodontitis and 7.8% had severe disease. These are population estimates from specific survey years, not a prediction for any individual. Our periodontal disease statistics guide explains what the numbers do and do not tell you about Los Angeles.

Bacterial plaque is the starting point, but people respond to the same plaque very differently. That is why two patients with similar brushing habits can have very different gum health. The CDC lists these risk factors:

• Smoking or other tobacco use
• Diabetes
• Poor oral hygiene
• Medications with oral side effects, such as reduced saliva
• Stress
• Genetics and family history
• Crooked teeth, bite problems, or teeth grinding
• Systemic conditions that affect the immune response
• Hormonal changes
• Poor nutrition or obesity

Smoking and diabetes matter enough that the current classification system uses them to adjust a patient's grade, the periodontist's estimate of how quickly the disease is likely to progress. Both can also slow healing after treatment, so they are discussed as part of any treatment plan.

Gum disease is often painless until it is advanced, which is one reason it goes unnoticed. Signs worth having evaluated include:

• Red, swollen, or tender gums
• Bleeding when brushing or flossing
• Gums that have pulled back, making teeth look longer
• Persistent bad breath or a bad taste
• Teeth that feel loose or have shifted
• Sensitive teeth or pain when chewing
• A change in how your teeth fit together when you bite

Bleeding gums on their own can be gingivitis rather than periodontitis. Telling the two apart requires measuring the attachment around each tooth and, when indicated, looking at the bone on X-rays. The guide to gum disease stages and symptoms covers what each sign can mean.

Since the 2017 World Workshop, co-presented by the American Academy of Periodontology and the European Federation of Periodontology, periodontitis has been described with a stage (how much damage has occurred and how complex it will be to manage) and a grade (how quickly it is progressing). The table below summarizes the staging criteria from the AAP's staging and grading chart.

Staging is a professional diagnosis, not something to self-assess. It matters to you because the stage and grade shape the treatment plan: an early, slowly progressing case may respond to non-surgical care, while an advanced case may need surgery, regeneration, or tooth replacement planning.

A comprehensive periodontal evaluation measures the space between gum and tooth at several points around every tooth with a small probe, notes bleeding, recession, and mobility, checks the bite, and reviews your medical history and risk factors. X-rays show bone levels that cannot be seen in the mouth; three-dimensional imaging is reserved for situations such as complex implant planning.

The result is a written diagnosis and plan: which areas need treatment now, which can be monitored, the options for each, and what each will cost. The first periodontist appointment guide walks through the visit step by step.

Periodontal care generally starts with the most conservative approach likely to control the disease and adds more involved treatment only where it is needed. A plan often combines several of the steps below.

For a side-by-side overview of non-surgical and surgical options, read how to treat gum disease.

The CDC notes that untreated periodontitis can make other chronic conditions, such as diabetes, worse. The relationship with heart disease is an association rather than proven cause and effect: in December 2025 the American Heart Association stated that although periodontal disease contributes to chronic inflammation associated with atherosclerotic cardiovascular disease, a cause-and-effect relationship has not been confirmed, and there is no direct evidence that periodontal treatment prevents cardiovascular disease.

That nuance matters. Treating gum disease is worthwhile for your teeth and comfort on its own merits, and it is especially important if you have diabetes. The gum disease and overall health guide reviews the evidence in more detail.

After active treatment, periodontitis is kept under control with periodontal maintenance: professional cleanings and re-measurement at intervals your periodontist sets according to your stage, grade, and response to treatment. Many patients alternate visits between the periodontist and their general dentist.

• Brush twice a day and clean between teeth every day
• Keep maintenance appointments, even when nothing hurts
• Stop smoking, which is one of the strongest modifiable risk factors
• Work with your physician on blood sugar control if you have diabetes
• Report new bleeding, swelling, or looseness promptly

The cost of periodontal treatment depends on the stage of disease, how many areas need care, and which procedures are involved. Sterling provides costs in writing as part of the treatment plan rather than quoting a generic fee. Sterling is in-network with Aetna, Delta Dental, Guardian, and Humana, reviews benefits before treatment begins, and offers payment plans through CareCredit, Lending Club, and Cherry.

For typical price ranges and what drives them, see deep cleaning cost, LANAP cost, and insurance and financing.

A periodontist is a dentist who completed additional specialty training in gum disease, the supporting bone, and dental implants. Consider a specialist evaluation if your dentist has measured deep pockets, if bleeding or recession persists after cleanings, if teeth feel loose, or if you are planning implants and have a history of gum disease. What to look for in a periodontist explains credentials such as board certification.

Sterling Periodontics & Implantology is led by Dr. Mohamed Khaled, DDS, MSD, a Diplomate of the American Board of Periodontology, at 9301 Wilshire Boulevard, Suite 407, Beverly Hills. Call (310) 278-3666 or request a consultation.