What Is Periodontitis (Advanced Gum Disease)?

Editorially reviewed by the Dental.me Editorial Team · Updated July 2026

Periodontitis is advanced gum disease: a bacterial infection that has pushed past the gums and started eating away the bone and ligament that hold your teeth in place. Gingivitis is reversible. The bone loss from periodontitis is not. It’s the number-one cause of tooth loss in adults, and in its early stages it usually doesn’t hurt at all.

That last part is what makes it sneaky. You can have moderate periodontitis right now and feel completely fine. No throbbing, no obvious cavity, maybe a little pink in the sink when you floss that you’ve trained yourself to shrug off. Underneath, the foundation your teeth stand on is quietly washing away. By the time a tooth actually feels loose, most of the damage is behind you.

Here’s what’s going on under the gumline, how to catch it before it costs you a tooth, and what real treatment looks like.

What causes periodontitis?

It starts with plaque, the soft sticky film of bacteria that reappears on your teeth every single day. Brush and floss it off and you’re fine. Leave it a couple of days and it hardens into tartar (dentists call it calculus), and no amount of brushing gets that off. Tartar parks itself along and under the gumline and keeps the bacteria fed.

Your immune system answers that bacterial load with inflammation. At the gingivitis stage the gums go red, puffy, and bleed easily, but nothing structural is gone yet. Let the inflammation run, though, and it turns destructive. The gums peel away from the teeth and form pockets. Bacteria move into those pockets, and your body’s own inflammatory response starts dismantling the bone and connective tissue anchoring the tooth. That handoff, from reversible gum inflammation to permanent bone loss, is the exact line between gingivitis and periodontitis.

A few things pour gasoline on it:

• Smoking and vaping — the single biggest risk factor you can actually control. Smokers get worse disease and heal poorly after treatment.
• Diabetes — poorly controlled blood sugar and gum disease each make the other worse.
• Genetics — some people are just more susceptible, even with a solid brushing routine.
• Hormonal shifts — pregnancy and menopause can crank up the gum response.
• Certain medications that dry out saliva or cause the gums to overgrow.
• Grinding and clenching, which don’t cause the infection but pile mechanical stress onto already-weakened support.

What are the stages of periodontitis?

Dentists grade severity by two things: pocket depth (measured in millimeters with a thin probe) and how much bone has vanished on your X-rays. Healthy pockets run about 1 to 3 mm. Once they go deeper than that, you physically cannot reach the bottom of them at home, no matter how heroic your brushing.

Roughly how it progresses:

The one thing to take away: you can’t brush lost bone back into place. Treatment stops the disease and stabilizes what’s still there. Which is exactly why catching it at 4 mm instead of 7 mm changes the whole story.

What are the warning signs of periodontitis?

Since early periodontitis rarely hurts, you’re watching for the quiet tells instead:

• Gums that bleed when you brush or floss. Healthy gums don’t bleed. This is the earliest sign and the one people talk themselves out of.
• Bad breath that keeps coming back, or a bad taste that survives brushing.
• Gums pulling back so teeth start to look longer, or new sensitivity right at the gumline.
• Red, swollen, or tender gums instead of firm and pink.
• Teeth that feel loose, have drifted, or a bite that suddenly feels off.
• Pus between the gum and tooth, or a gum abscess.

Loose teeth and a shifting bite are late signs. If those are on your list, skip waiting for your next routine cleaning and get seen now.

How is periodontitis treated?

Treatment scales with how far the disease has gone, but the goal never changes: clear out the bacterial reservoir, shrink the pockets, stop the bone loss.

Deep cleaning (scaling and root planing). This is the workhorse for early to moderate disease. Your provider clears tartar and bacteria from below the gumline and smooths the root surfaces so the gums can reattach. It’s usually done over one or two visits with local anesthetic. Typical US ranges run about $150–$400 per quadrant, so a full mouth often lands around $600–$1,600, depending on where you live and how much buildup there is.

Antibiotics. Sometimes a localized antibiotic gets placed straight into a deep pocket, or an oral course is prescribed alongside the cleaning.

Ongoing maintenance. After a deep cleaning, most people shift to cleanings every three to four months instead of every six. This isn’t an upsell. The bacteria recolonize those pockets, and the tighter schedule is the thing keeping the disease from starting over.

Surgery, for advanced cases. When pockets stay deep even after a deep cleaning, a periodontist may do flap surgery to open up and clean the roots, or bone and tissue grafting to rebuild support in specific spots. Gum grafts can cover exposed roots. Surgical pricing swings widely, commonly $600–$3,000+ per procedure area as typical US ranges.

These are typical cited US ranges, not quotes. What you actually pay depends on your location, your provider, and your insurance. Plenty of dental plans cover a real chunk of deep cleaning and periodontal maintenance, for the simple reason that keeping a tooth is cheaper than replacing one.

Can periodontitis be cured?

Not cured in the sense of erasing it. Periodontitis is a chronic condition, closer to high blood pressure than to a cavity. What you can do, absolutely, is stop it cold and hold it stable for the rest of your life. People who commit to treatment, keep up their home care, and quit smoking routinely keep their teeth. The bone that’s already gone won’t grow back on its own, but the disease doesn’t have to claim one more millimeter.

Here’s the comparison that actually matters: a stabilized mouth with slightly shorter gums beats a mouth that keeps shedding bone until teeth drop out. Managing it well is a genuine win, not a consolation prize.

Who treats gum disease — a dentist or a specialist?

General dentists diagnose and handle most early and moderate periodontitis, deep cleanings included. For the harder stuff — surgery, grafting, or implants where bone has already been lost — you’ll often get referred to a periodontist, a dentist with three extra years of training focused on the gums and the structures that hold teeth in. Straightforward case? Your regular dentist can run it. Pockets that stay deep or teeth that already wobble? A specialist earns their fee.

Not sure where to begin? A general dentist near you can do the exam, take the measurements, and tell you straight whether you need a referral.

Frequently asked questions

Is periodontitis the same as gingivitis?

No. Gingivitis is inflammation of the gums only, and it’s fully reversible with good cleaning. Periodontitis is what gingivitis becomes when it’s left untreated — the infection reaches the bone and causes permanent loss of support. Every case of periodontitis started as gingivitis, which is why treating bleeding gums early matters so much.

Does periodontitis hurt?

Usually not in the early and moderate stages, which is exactly why it’s so often missed. Pain, abscesses, and loose teeth tend to show up late, once significant damage has occurred. Bleeding gums are a far earlier warning than pain.

Can I reverse periodontitis at home?

You can’t reverse the bone loss, and you can’t remove hardened tartar below the gumline with a brush or floss. Home care is essential for keeping the disease from getting worse, but stopping active periodontitis requires professional cleaning below the gumline. Think of home care as maintenance, not the cure.

Is gum disease linked to other health problems?

Research has connected periodontitis with heart disease, diabetes, and other conditions, largely through chronic inflammation. Diabetes in particular has a well-established two-way relationship with gum disease. Managing your gums is part of managing overall health, though a physician and dentist should guide the specifics for you.

How often should I get checked if I’ve had periodontitis?

Most people who’ve been treated move to periodontal maintenance every three to four months rather than the standard six. Your provider sets the interval based on how deep your pockets are and how stable they stay.

Will I lose my teeth?

Not necessarily. Untreated advanced periodontitis is the top cause of adult tooth loss, but people who get diagnosed and stick with treatment routinely keep their teeth for decades. The earlier you act, the more teeth you keep.

This article is general information, not dental advice. Only a dentist’s in-person exam and measurements can accurately assess your gums and what treatment you need.

Ready to get checked? Find a trusted periodontist or general dentist near you in the Dental.me directory, ranked independently by the Dental.me Score.