We know the importance of brushing and flossing regularly and visiting the dentist twice per year. But do you know why we do these things? You may think good oral hygiene is to prevent cavities from forming in your teeth. But that’s only half the story.

Good oral hygiene is necessary to prevent the stages of periodontal disease, also known as gum disease. However, up to 80% of adults in the U.S. have experienced gum disease in some form at one point in their life.

The stages of periodontal disease include two main types of gum disease—gingivitis and periodontitis. Gingivitis is the mildest stage of periodontal disease. Periodontitis is more severe and has four stages of progression.

Periodontal Disease Defined

Periodontal disease is an infection in your mouth involving your gums, jaw bones, and other connective tissues that keep your teeth in place. There are several stages of periodontal disease that progressively get worse if not treated and can result in the loss of teeth.

Gingivitis vs. Periodontitis: What’s the Difference?

The stages of periodontal disease include both gingivitis and periodontitis. Gingivitis is an early stage of gum disease, and with proper care, you can prevent it from getting worse and even reverse it.

When gingivitis has progressed, it is called periodontitis. This means the infection has continued to deeper levels of your gum tissues and bone. With periodontitis, the gums pull away from the teeth, and the bone that holds your teeth begins to decay.

It’s vital to treat gingivitis as soon as it develops. Gingivitis is reversible with good oral care because there is no permanent damage yet to your teeth, gums, or connective tissues.

However, if gingivitis goes untreated and periodontitis develops, there is no way to naturally repair the damage. There is no cure for periodontitis, but it can be treated.

Causes of Periodontal Disease and Risk Factors

Gum disease is caused by bacteria.

When you don’t take care of your mouth properly, plaque will develop. Plaque is a sticky layer of bacteria that is constantly building up on your teeth. Brushing and flossing can remove plaque, but only if you take care of it every day.

If not removed within a few days, the plaque will harden and is called tartar which must be professionally scraped off. Tartar makes it hard to clean your teeth well. It can lead to even more bacteria forming on your teeth, especially below the gum line, which you can’t reach.

In addition to improper oral hygiene, there are several risk factors for developing periodontal disease.

• Tobacco and nicotine use
• Alcohol consumption
• Age
• Genetics
• Diabetes
• Obesity
• Metabolic syndrome
• Osteoporosis

Of these, nicotine use is the most significant risk factor. Nicotine—in all forms, including smoking, smokeless tobacco, and vaping—increases your risk of developing periodontitis. Cigarette smokers increase their risk of periodontitis by 85% over non-smokers.

Warning Signs of the Early Stages of Periodontal Disease

In the early stages of periodontal disease, there are several symptoms to look out for. If these are present, you may have gingivitis or periodontitis, and you need to get checked out by your biological dentist.

• Red or swollen gums
• Pain or tenderness in your gums or other parts of your mouth
• Gums that bleed
• Receding gums
• Loose teeth
• Bad breath
• Shifting teeth that change the way they fit together

We’ll go more in-depth next about the stages of periodontal disease, but if you start to notice your gums are red instead of pink and are swollen or puffy and bleed when you brush, it’s time to act. You likely have gingivitis, which can be cured.

Stages of Periodontal Disease: An Explanation

An internet search about the stages of periodontal disease may leave you with more questions than answers. Four stages or five? Or even just three? And what about gingivitis?

The confusion lies in how dentists stage—or classify the severity of—periodontal disease. In 2017, a new framework was developed for determining the progression of periodontitis. There are now four stages of periodontitis, from initial to very severe.

Remember, however, periodontitis and gingivitis are included together in periodontal disease. While technically, there are five stages of periodontal disease, it is easier to think of gingivitis as one separate stage that can lead to the four stages of periodontitis.

Gingivitis

The stages of periodontal disease begin with gingivitis.

Gingivitis is identified as an inflammation of the gums. Bacteria—from plaque build-up—infects your gums and makes them look puffy or swollen and red instead of their usual pink. Your gums may also feel tender and may bleed when you eat, brush, or floss.

Gingivitis is mostly caused by poor oral health habits. The good news is that you can reverse gingivitis in just a couple of weeks. Brush your teeth twice per day with a natural toothpaste. Be sure to clean between teeth to remove food and plaque. And visit your dentist regularly for cleanings.

Periodontitis

The four later stages of periodontal disease are collectively known as periodontitis.

Untreated gingivitis advances to periodontitis, which is not reversible. All stages of periodontitis involve gum tissue pulling away from the teeth and possible bone loss. In the more severe stages, teeth may have already fallen out.

In the next sections, we’ll review the four stages of periodontitis. The more advanced stages of periodontal disease must be professionally treated. A biological dentist will emphasize whole-body health and focus on preventing problems and conservative treatments. They are a great place to start during the early stages of periodontal disease.

However, with severe or very severe periodontitis, you need more aggressive treatment. Seek out a biological periodontist who will not just perform the needed surgery but will also do so in a holistic, whole-body way. Biological practitioners avoid the use of mercury, fluoride, and other harmful chemicals and take a comprehensive view of your health.

Stage I: Initial Periodontitis

The first stage of periodontitis is treatable without surgery. The gums have begun to pull away from the teeth, and there is some bone loss, but you have not yet lost any teeth.

The spaces that develop between the gums and the teeth are called pockets. In this first stage, the pockets are not that deep but still collect bacteria and cause hard-to-reach plaque to develop.

Treatment includes teaching the patient how to correctly brush and floss daily so plaque won’t build up. The dentist will also thoroughly remove plaque and tartar with a technique called scaling.

At this point, if the treatment is successful and you maintain good oral habits, you most likely will have no worries about losing any teeth.

Stage II: Moderate Periodontitis

The second stage of periodontitis is similar to the first, but the gums have further pulled away from the teeth, and the pockets are deeper. There is more bone loss, but no lost teeth yet.

Treatment for this second stage is also much like the first and begins with teaching proper home care. However, surgery may be required depending on how deep the pockets go and the ability to clean the teeth and their roots.

Again, with successful treatment, you’ll most likely not lose any teeth.

Stage III: Severe Periodontitis

Once your gums have pulled away from your teeth significantly, and the pockets are very deep, your periodontitis is considered to be severe. There is bone loss extending down the roots of the tooth. If you have lost fewer than five teeth, you are at stage III.

Treatment becomes more complex at stage III, and you’ll need to visit a specialist. Surgery is necessary for treatment, and you may need additional surgery to rebuild your gums. Additionally, implant surgery to replace any lost teeth becomes more complicated.

Stage IV: Very Severe Periodontitis

Once you have lost five or more teeth as a result of periodontitis, you are classified as stage IV. You’ll have significant loss of the bone that holds your teeth in place. This very severe stage will require multiple interventions to repair your teeth and gums.

How to Prevent Gingivitis and Periodontitis

Preventing all stages of periodontal disease is critical for your overall health. Not only do you want to keep all your natural teeth, but the bacterial infection of your gums can also enter your bloodstream and spread to other parts of your body.

Having periodontitis increases your risk of developing many other diseases, including:

• Alzheimer’s disease
• Cardiovascular disease
• Diabetes and insulin resistance
• Colorectal and oral cancer
• Gastrointestinal diseases
• Respiratory infections and pneumonia

So, how do you prevent the different stages of periodontal disease?

Here are five tips for preventing gum disease:

Tip 1: Brush twice a day.

This age-old advice is solid. Brushing removes plaque from your teeth and keeps the plaque from hardening and becoming tartar. Brushing twice per day keeps your teeth and gums healthy. Choose a toothbrush with soft bristles and use a natural toothpaste.

Tip 2: Clean between teeth.

It’s important to keep the spaces between your teeth free from food and plaque. Flossing has long been the recommended way to get in between your teeth. But many people don’t floss because it can be difficult.

An alternative that is gaining in popularity is to use a tiny brush called an interdental brush. Evidence is beginning to show that interdental brushes may be more effective than floss.

Tip 3: Visit the dentist regularly.

Ideally twice per year, but at least once each year, have your teeth cleaned professionally and your mouth examined by the dentist. The dental hygienist and dentist will be able to detect problems at their earliest and help prevent them from becoming worse.

Tip 4: Eat a healthy diet.

What you eat affects your teeth. Nutrition has a major role in the overall health of your mouth. Choose foods that are high in Vitamins B, C, D, E, and K. Vitamins C and E, in particular, are necessary for healthy gums and may help prevent gingivitis. Vitamin C is found in many fruits and dark green leafy vegetables. Vitamin E is found in oils such as sunflower and safflower, and in seeds and nuts, and some fruits and vegetables.

Tip 5: Quit smoking.

Tobacco use and nicotine greatly increase your risk for all stages of periodontal disease, beginning with gingivitis. No matter the method, if you smoke cigarettes, cigars, or pipes, chew tobacco, or use e-cigarettes (vaping), you’re at risk.

The Stages of Periodontal Disease: Putting it All Together

Whether you count the stages of periodontal disease as four or five, it’s important to remember that only the first one—gingivitis—is reversible. Once you’ve progressed to periodontitis, it’s treatable but not curable.

Ideally, you want to prevent all stages of periodontal disease with a great oral health routine. A holistic lifestyle and healthy habits will keep you smiling for years to come.

If you need more oral health care advice, check out our guide to the best oral care strategy.