Stages of gum disease

What are the stages of gum disease and what are the symptoms of each stage?

Gum disease, periodontal disease and periodontitis are one and the same. Dentists use the name periodontal disease for gum disease. The common form of chronic gum disease is traditionally divided up into four stages as it progresses, or perhaps, we should say, as it worsens. However, the end point of the forth stage is really a separate fifth stage. The five different stages are discussed below.

Gum disease also has several other distinct forms which are aggressive in nature, and are not characterized by different stages. One form of aggressive gum disease, called early onset or juvenile periodontitis, is relatively rare. It tends to start at puberty. A more detailed description can be found on the Dental Bone Loss page of this website. Another aggressive type that occurs in young adults is known as necrotizing ulcerative gingivitis, or sometimes, acute necrotizing ulcerative gingivitis. At one time, it was called trench mouth. You can read about necrotizing ulcerative gingivitis on the Causes of Sore Gums page.

Briefly, the five stages of gum disease are as follows:

1. The first stage is called gingivitis. Gingivitis is considered to be an infection characterized by inflammation. The inflammation produces bleeding from your gums, which is the most frequently occurring symptom. Your gums will bleed when you are brushing or flossing your teeth and when you are eating. Generally there is no pain.

2. The second stage is called early gum disease or early periodontal disease. At this stage of gum disease, the types of germs associated with infections that destroy living tissue, are always found in the plaque on your teeth, and in your gums. Because the infection is destructive, it breaks apart the connection of your gums to your teeth. Your gums start to separate from your teeth, forming gum pockets or spaces between your teeth and your gums. Your gums may still bleed easily.

3. The third stage is called moderate gum disease. As the disease worsens and your gums become further detached from your teeth, the pockets deepen, because now the bone around your teeth is starting to be destroyed by the infection. Often, this destructive process has very mild symptoms, causing most people to have few, if any, immediate concerns. Sometimes your gums may start to recede, although many times there is no recession. Bleeding from your gums may be less frequent during this stage of gum disease.

4. The forth stage is called advanced gum disease. Eventually, your teeth may become loose because a significant amount of bone supporting them is lost from the gum infection. Your gum pockets may now be almost as deep as the length of the root. You may notice some gum recession. Pain is usually still absent. Bleeding from your gums is variable, because by now the infection is mostly at the bottom of the gum pocket.

At this stage of gum infection, you may begin to wonder if you are going to lose any of your teeth. You may now also realize that you have a bad taste in your mouth or suspect that you have bad breath. The truth is that a degree of unpleasant breath may have been present throughout all the previous stages, without your being aware of it.

5. The last or fifth stage of gum disease is called acute gum disease. It occurs when the chronic, largely painless infection involving any number of teeth in your mouth, becomes an acute and painful gum abscess around one of those teeth. Pus mixed with blood may sometimes be seen draining out at the gum line. Now your gum disease gets your attention.

Depending on any dental treatment and the state of your immune system, your gum infection may fluctuate back and forth between the chronic stage and the acute stage. The painful symptoms of this stage of gum disease may motivate you to seek immediate dental treatment. You may find yourself losing one or more teeth in spite of receiving dental care. From the time that gingivitis, the first stage begins, until the acute final stage rears its offensive symptoms, many years may elapse.

How can I tell if my gums are healthy and I don’t have gum disease?

When your gums are healthy, there is no infection and your gums are firmly attached to your teeth by what is called the periodontal, ligament. Periodontal means around the tooth. The attachment is strong and tight enough to prevent any germs or their toxins from getting through, and any body fluids, like blood, from getting out. You can usually recognize when you have a healthy gum attachment because your gums will be pink, firm, and never bleed or hurt with routine brushing, flossing, or when chewing food.

If I haven’t been to my dentist in awhile, how will I know if I have gum disease?

It’s a good idea to visit your dentist to confirm that your gums are healthy and not at one of the stages of gum disease. The truth is that you might not be able to tell if you have gum disease unless you see your dentist. Self diagnosis is not recommended, as it can lead to false conclusions. With that in mind, some of the common symptoms of gum disease you can observe yourself are listed next, to help you increase your awareness of the condition of your gums.

The most common, chronic gum disease features and symptoms you can easily recognize are:

  • Heavy plaque accumulations around your teeth, especially at the gum line. Plaque is a cream colored sticky substance on your teeth that is loaded with germs. If you scrape some of it off and hold it near your nose, it has an unpleasant odor.
  • Tarter and stains around your teeth, especially at the gum line. Tarter is hardened or calcified plaque.
  • Bleeding gums, especially when you brush or floss your teeth, or when you eat.
  • Red looking gums at the gum line and between your teeth.
  • Swollen, puffy gums at the gum line and between your teeth.
  • Teeth that are becoming loose or are already loose. Spaces that develop between your teeth that weren’t there before are a sign of your teeth becoming loose.
  • Persistent mouth odor or bad breath, especially if a mouth rinse or mints don’t help.
  • Mild recession of your gums. Recession alone is not a sign of gum disease.
  • One or more of the above and lack of pain. However, if your chronic gum disease evolves into an acute gum abscess around a tooth, you will have pain.

Reading the rest of this article is highly recommended if you want to learn how to make your gums as healthy as possible.

In each of the different stages, what causes gum disease?

You have gum disease when your gums are infected with germs. This is true regardless of the stage of your gum disease. In other words, gum disease is caused by an external force, i.e. germs or bacteria, over which you have little or no control.This traditional view of gum disease is generally supported by and taught by dental schools. F

or example, an article on periodontitis in a medical information website reviewed by the Columbia University College of Dental Medicine clearly states that, “Periodontitis is caused by a bacterial infection.”. The article then goes on to discuss treatment options that are typically provided by traditional dentists, which also implies that the only practical solution you have for dealing with your gum disease is to visit your dentist for treatment.

The holistic view is that germs, including bacteria, viruses and yeasts organisms, can only infect and hurt you if you let them do this. For this to happen, the germs need a weakened immune system, and an acidic body state, which favors the growth of germs associated with infections. You have already created these negative conditions in your body if you have been eating the standard American diet of processed foods loaded with chemicals, and living the sedentary, inactive lifestyle that often goes with it.

Your gums and your teeth are both affected by your relative state of health or lack of health. When the tissues in your body are in an acidic condition and your immune system is not vigorous and robust, your immune system won’t be strong enough to prevent germs from growing around your teeth, and the germs will infect your gums. In other words, you are responsible for causing your gum disease. The good news is that this also means you are in control, because you can change your body, which gives you the ability to stop gum disease at any time.

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How is the first stage of gum disease different from the other stages?

Regardless of which view you chose to accept, at the first stage of gum disease, called gingivitis, there are no gum pockets. Your gums are attached to your teeth, even though they are already infected from germs. The germs come from dental plaque, a soft, germ laden deposit that accumulates on your teeth. Your infected gums will usually bleed just from brushing your teeth or eating.

You may have noticed that your gums are red and swollen or puffy, a sign of the distinctive inflammation of gingivitis. Sometimes, you may notice that your breath will have a bad odor which doesn’t seem to be helped by breath mints or a mouth wash. Surprisingly, you won’t have any associated pain.

Please be aware that certain medical conditions can produce symptoms similar to those of gingivitis. A classic example is scurvy, or gross vitamin C deficiency. Only a dentist can diagnosis and confirm that you have gum disease and that your gum disease is still at the stage of gingivitis.

How else is gingivitis different from all the other stages?

Gingivitis is different from the other stages of gum disease because with proper nutritional intervention and improved hygiene for your teeth and gums, the symptoms of gingivitis can be completely reversed. The bleeding when you brush or eat will stop, the redness and swelling in your gums will vanish and any mouth odor will be eliminated.

The key to successfully healing gingivitis is daily specialized whole food nutritional support with organic or all natural supplements and whole food supplements that directly promote and strengthen your immune system. A strong immune system protects you from infection and will overcome an existing infection in your gums.

Most dentists and hygienists will only recommend improving your oral hygiene to help stop gingivitis. They rarely provide any kind of nutritional advice. While it is true that visiting your dentist for a professional cleaning by a hygienist is always beneficial and highly recommended, without daily, high quality, effective nutritional supplementation, the benefits of improved oral hygiene to stop gingivitis will only be temporary. That’s why dental hygienists always recommend you return periodically for cleanings.​

How do dentists or hygienists diagnose gingivitis or other stages of periodontal disease in your mouth?

Your dentist or hygienist looks for gum disease by gently probing and measuring the depth of the normally small space between your gums and your teeth at the gum line. They do this with a special dental instrument called a periodontal probe. The normal depth of the space between your tooth and gums is generally between one to three millimeters, which is about an eighth of an inch. If the measured depth falls in this range, and your gums bleed when they are gently probed, this is the symptom of infection that dentists use to diagnosis gingivitis, the first stage of gum disease. Even if you have been seeing your dentist or dental hygienist regularly, finding out that you have gum disease may come as a surprise, since gum disease is usually painless.

How do I know if I have other stages of gum disease?

The answer depends on whether you go to a dentist or not. If you don’t see a dentist regularly, then you may not know you have gum disease in any of its various stages. Most people are unaware of any infection in their gums, and may never find out until they notice that some of their teeth are becoming loose or changing position, with spaces developing between them. Sometimes you may become aware of bad breath that isn’t helped with mints or a mouth rinse, or in some cases, there may be some visible gum recession. Of course, it the infection becomes acute and painful, that will usually wake you up to something being wrong.

On the other hand, if you are seeing your dentist, or if you now decide to go, expect your dentist or their hygienist to regularly inspect your gums with a periodontal probe. Your dentist or hygienist will inform you if your gums are already infected and you have gum disease. If your dentist or hygienist finds one or more spaces between your teeth and your gums that are deeper than the normal one to three millimeters, and bleeding has occurred during probing, then your gums are infected beyond the gingivitis stage. It also means that in these places your gums are not only infected with germs, they have already become detached from your teeth. The separation of your gums from your teeth creates a space called a gum pocket, which is filled with plaque, germs and tartar. You may have more than one tooth where this has happened.

Please look at the Supplements page for information on nutritional support designed to keep your gums healthy.

As just stated, if you have infected gum pockets, the gum infection is no longer at the gingivitis stage. Depending on the degree of separation of your gums from your teeth, which is determined by the depth of the infected gum pockets, gum disease is classified as either at the early, moderate or advanced stage. Infected gum pockets always bleed when probed. As a general rule of thumb, infected pocket depths of four to five millimeters indicate an early stage, and six to seven millimeters, a moderate stage. Some dentists believe a seven millimeter pocket means advanced gum disease. Virtually all dentists would consider infected pocket depths of eight millimeters or more as a diagnostic sign of advanced gum disease.

If x-rays are taken, they will usually reveal some amount of bone destruction, with the loss of jaw bone directly around the roots of your teeth with gum disease, especially if the gum infection is at the moderate or advanced stage.

Ask your dentist or hygienist for their assessment of the degree of infection of your gums. As you will read next, when your body is truly healthy, it is possible to have gum pockets that are not infected and do not bleed when probed. Make sure that your dentist or hygienist tells you whether or not your gums bleed when probed.

If my gum infection is beyond the gingivitis stage what can I do to heal my gums?

The most efficient way to heal your gums is with a combined approach of appropriate dental treatment that includes natural substances to kill germs, such as ozone gas, meticulous home hygiene, and effective all natural supplementation. A holistic dentist is more likely to offer this kind of treatment and not use antibiotics. To find a holistic or biological dentist, go to the website of the International Academy of Oral Medicine and Toxicology (IAOMT) and click on the “Find an IAOMT Dentist/Physician” link on the home page.

What you can expect from this method is to have healthy teeth and gums with infection free gum pockets that do not bleed and will remain that way as long as your immune system is very strong and your mouth hygiene is reasonably adequate. Daily supplementation with the all natural supplementation program recommended on this website is critical and essential for boosting the strength of your immune system and keeping your gums in a healthy state.

Why will I still have gum pockets if my gums are healed?

Unlike gingivitis, some of the symptoms of the other stages of gum disease cannot be fully reversed by your body’s innate natural healing capability. Even if the infection, and the separation of your gums from your teeth caused by the infection, is stopped, it is highly unlikely that any gum line recession will improve, or that healing will reduce the depth of your gum pockets by much more than one or two millimeters. This is because the gum infection has destroyed much of the living bone and a layer of tissue called cementum that normally surrounds the roots or your teeth. Without the cementum and bone that were destroyed by the infection, reattachment of your gums to your tooth at the original level is not possible. However, the healed gum pockets will not bleed when probed. Neither will your gums bleed when you brush and floss. The bone around your teeth will gain strength and teeth that were loose, will frequently tighten up. As an added bonus, you won’t have bad breath.

See Dr. Gilbert’s supplement based nutritional program for boosting the strength of your immune system.

Although the strength and health of your immune system is more important for healthy gums than your oral hygiene, please clean your teeth and gums daily, as you have been shown by your dental hygienist. Rinsing with an all natural mouth rinse that kills germs is an extremely effective way of eliminating mouth odor. To obtain an all natural mouth rinse that kills germs, ask your dentist or hygienist to order Tooth and Gum Tonic® from the Dental Herb Company or to arrange for it to be shipped directly to you. Their website is

Why should I be concerned if my gum disease has reached the advanced stage?

You should be concerned when you start having symptoms of the advanced stage of gum disease, because this means that you are at risk of losing teeth. At the advanced stage of gum disease there are usually significant deposits of tarter or calculus on your teeth and infected gum pockets that have become more than seven millimeters deep. Sometimes the infected pockets may be almost as deep as the length of the root of your tooth.

You may notice that some of your teeth are changing position, with spaces developing between them. Wherever there has happened, some of the bone around the teeth has been destroyed by the infection and adjacent bone is already starting to soften and weaken. This causes your teeth to become loose and separate from each other. If nothing is done to limit the infection, it is only a matter of time before the infection will become irreversible, and you will lose teeth.

Why does the chronic stage of gum disease sometimes change to an acute and painful stage?

The worst case scenario is when your immune system is so over burdened by toxic stresses, including the toxins from germs, that the germs in your infected gums can over whelm your immune system. Some examples of toxic stresses, besides those form germs, are medical conditions like diabetes and AIDS, or chemical insults like synthetic additives in the processed foods most people eat every day.

You can then end up with the symptoms of a painful gum abscess. By this time the nerve in your tooth is also infected, because the germs in your infected gums can pass through tiny pores in the root, called dentinal tubules, and into the nerve. Your tooth has become infected internally and externally, surrounded by abscessed, infected tissue which has replaced the jaw bone destroyed by the gum infection. Sometimes you will see pus and blood oozing from the gum margin of the painful tooth.

Now your advanced gum disease has arrived at the final acute stage of periodontal disease. Even if prompt dental treatment, usually with antibiotics, is able to reverse the acute symptoms so that they become painless and chronic once more, the acute stage will typically make its ugly head appear again sometime after using up the prescribed antibiotics. Worse yet is the fact that this can happen to more than one tooth in your mouth.

With such severely infected teeth in your jaw bone, your body can no longer successfully heal your jaw bone. Teeth with end stage gum disease are like a foreign body in your mouth. The likelihood of saving your teeth isn’t very promising. You ultimately lose teeth, either by having them removed by a dentist, or they come out, usually when you are eating. Not a desired outcome for most people.

What can I do to save my teeth from the ravages and damaging effects of gum disease?

Brushing and floss your teeth. Brushing and flossing regularly is helpful because it reduces the number of germs on the teeth and under the gums. The primary benefit of brushing and flossing is to remove germ filled plaque, thus making your breath smell better. Reducing plaque also helps your fillings last longer.

Visit your dentist for a thorough professional cleaning by a dental hygienist. If gum treatment is recommended by your dentist, and your dentist is traditional, consider changing to a holistic dentist, as you are more likely to receive treatment that focuses on eliminating the germs associated with gum infection without using antibiotics. To find a holistic or biological dentist, go to the website of the International Academy of Oral Medicine and Toxicology (IAOMT) and click on the “Find a Dentist” link on the home page.

If you are diabetic, seek medical care. There is strong scientific evidence that people who are diabetic have a greater likelihood of getting gum disease.

If you have ‘silver’ fillings, seriously consider having them removed by an IAOMT accredited dentist. Silver fillings contain large amounts of toxic mercury. You may be at greater risk for gum disease because mercury is known to cause bleeding gums, one of the signs of periodontal disease. To find an accredited IAOMT dentist, go to the IAOMT website and click on the “Find a Dentist” link on the home page.
Make your immune system as strong as possible. Just as a poorly functioning immune system is unable to adequately cope with the germs in your gums, a vibrantly healthy immune system will be able to protect you from any gum infection.

How do you make your immune system as strong as possible?

You can make your immune system stronger by following a healthy life style. This means:

  • Consuming the right kinds of foods and drinks, including fruits and vegetables and other foods that are organic, whole grain, unprocessed or raw, and contain no added sugars, chemicals or synthetic ingredients of any kind.
  • Exercising regularly.
  • Avoiding as many environmental toxins as possible.
  • ​Adding all natural, organic and whole food supplements to your diet.

If you are motivated enough to do all these things, you will produce a slightly alkaline, health promoting internal environment in your body and you will make your immune system very strong. Since gum disease is an infection, you also improve your ability fight any gum infection and make your gums healthier. Isn’t that what you want?