Periodontal Health
Gum Disease Treatment
The leading cause of tooth loss in adults — and one of the most preventable. Early detection and treatment can prevent that outcome.
Caught early, it is reversible
Gingivitis, the earliest form of gum disease, develops from plaque accumulation. Gums become inflamed, red, and swollen, and bleed easily during brushing or flossing. Critically, there is no bone loss at this stage.
With professional cleaning and improved home care, gingivitis can be fully reversed.
Periodontitis emerges when gingivitis goes untreated. The infection spreads below the gumline, forming pockets where bacteria destroy the supporting bone and connective tissue. This leads to gum recession, tooth mobility, and eventually tooth loss. Bone that has been lost does not grow back on its own.
Signs to watch for
Bleeding gums
Blood in the sink during brushing or flossing is not normal, and is often the first sign.
Red or swollen tissue
Healthy gums are firm and pale pink. Inflammation shows as redness, puffiness, and tenderness.
Gum recession
Teeth appear longer as gum tissue pulls away, often with new sensitivity at the root surface.
Persistent bad breath
Bacteria in periodontal pockets produce odour that brushing does not resolve.
Loose or shifting teeth
Movement means the supporting bone has already been compromised.
Bite changes or pus
A change in how your teeth meet, or discharge between gum and tooth, signals active infection.
Why regular exams matter
Gum disease often progresses without pain or obvious symptoms. Many patients feel nothing until teeth begin to loosen — by which point significant bone has already been lost. Regular professional exams catch the disease while it is still reversible.
How we treat it
Diagnosis
We measure pocket depth around every tooth and assess bone levels radiographically to establish exactly how far the disease has progressed.
Active Treatment
Scaling and root planing remove bacterial deposits from below the gumline. Laser therapy is used to decontaminate deeper pockets where indicated.
Maintenance
Professional cleanings every three to four months, combined with consistent home care, keep the disease from returning.
What it actually is
Gum disease is inflammation caused by the film of bacteria that forms on teeth every day. It comes in two forms, and the difference between them is the whole story.
Gingivitis is inflammation of the gum only. The gums are red, puffy, and bleed when brushed. Nothing underneath has been damaged, and it is completely reversible — clean the plaque off properly and keep it off, and the gum returns to normal within a couple of weeks.
Periodontitis is what happens when that inflammation reaches the bone holding the teeth in. The body's response to the bacteria starts dissolving that bone. A space opens between tooth and gum — a pocket — which is deeper, harder to clean, and a better home for the bacteria that caused it. That is the loop the disease runs in.
The bone does not grow back on its own. This is the part patients find hardest to hear, and it is why the timing of treatment matters so much: treatment stops further loss and it can shrink the pockets, but it works with the support you still have rather than restoring what has gone.
What “stage” and “grade” mean
If you have been given a stage and a grade, they are answering two different questions. Dentists worldwide have used this system since 2017, and it is more useful than the old mild / moderate / severe labels because it separates how much damage there is from how fast it is happening.
Stage is how much has already been lost, from I through IV. It takes account of bone loss, pocket depth, teeth already lost to the disease, and how complicated putting things right would be. Stage does not go backwards — it is a record of damage, not of current activity.
Grade is how fast it is moving, from A through C, judged against your age and adjusted for smoking and for diabetes control. Grade is the part that can change, and it is the part you have most influence over.
So Stage III Grade B and Stage III Grade C describe the same amount of damage with very different outlooks, and they get treated with different urgency.
Why it gets this far before anyone notices
Because it rarely hurts. That is the single most important thing to understand about periodontitis, and the reason it is the leading cause of tooth loss in adults rather than decay.
What people do notice tends to get explained away. Blood in the sink is put down to brushing too hard. Gums creeping back is put down to age. A bad taste is put down to something eaten. Teeth looking longer is barely noticed at all, because it happens over years and you see your own face every day.
By the time a tooth moves, a good deal of its support is gone. Which is why the measurement at a check-up matters more than how the gums feel: pocket depths at six points around every tooth, and a record of which ones bleed. That is a number you can compare year on year. A feeling is not.
It is also common, and getting more so. Statistics Canada's 2022–2024 Canadian Health Measures Survey — the first clinical oral-health measurements taken here in more than fifteen years — found 83% of adults aged 20 to 79 had gums that bled on probing at one tooth or more, and just over a third had pocketing of 4 mm or deeper, against one adult in five in 2007–2009.
What makes it more likely, and what you can do about each
Plaque starts it, but plaque alone does not explain why two people with similar habits end up in very different places.
- Smoking and vaping. The largest modifiable risk factor by some distance. Smoking also masks the disease — it constricts the blood vessels, so the gums bleed less and look healthier than they are, right up until teeth loosen. Stopping changes the outlook more than anything else on this list.
- Diabetes. The relationship runs both ways. Poorly controlled blood sugar makes periodontitis worse, and untreated periodontitis makes blood sugar harder to control. Treating the gums is part of managing the diabetes, not separate from it.
- Genetics and family history. Some people mount a stronger inflammatory response to the same amount of plaque. You cannot change this, but knowing it changes how closely you should be monitored.
- Dry mouth. Whether from medication, radiotherapy or a condition, less saliva means less natural clearance. See dry mouth.
- Stress, and what comes with it. Partly direct, partly because home care and appointments are the first things to go.
- Plaque traps. An overhanging filling, a rough crown margin, crowded teeth that floss will not pass. These are fixable, and fixing them is part of treatment rather than an afterthought.
- Hormonal change. Pregnancy and menopause both alter how gums respond to the same plaque — see dental care during pregnancy.
What happens after a diagnosis
A proper periodontal assessment first: pocket depths charted at six points around every tooth, bleeding recorded site by site, and radiographs to show the bone level. That produces the stage and grade, and it is the baseline everything afterwards is measured against.
Then the active course of treatment, which runs in steps and is re-measured rather than assumed to have worked. Then maintenance, which continues.
If teeth have already loosened, or some cannot be kept, those are separate conversations — see loose teeth and tooth loss from gum disease.
Gum treatment runs in three parts
Periodontitis is a chronic condition, so the course does not finish — it changes shape. Knowing which part you are in makes the rest of it make sense.
You are here
1. Gum disease
The condition itself — what it is, what you would notice, and what decides how serious it is.
2. Periodontal treatment
The active course. Cleaning below the gum line, re-measuring, and treating whatever has not responded.
3. Periodontal maintenance
What follows, indefinitely. Usually every three months, because that is how fast the bacteria return.
Common questions
Can gum disease be cured?+
Gingivitis can — it is fully reversible with proper cleaning. Periodontitis cannot be cured, but it can be controlled, which in practice means stopped. The bone already lost does not come back on its own, so treatment is about keeping what remains and preventing further loss.
Is bleeding when I brush normal?+
No. Healthy gums do not bleed, in the same way that healthy skin does not bleed when you wash. Bleeding means inflammation, and inflammation means the plaque is not being removed from that spot. It is the earliest sign you get and the easiest stage to deal with.
Will my gums grow back?+
Gum that has receded does not return on its own, and neither does the bone underneath. Some of the apparent recession after treatment is actually the swelling going down, which can make teeth look longer before they look better. Where recession causes sensitivity or continues to worsen, gum grafting is an option.
Does gum disease affect the rest of my health?+
There is a well-established two-way relationship with diabetes: each makes the other harder to control, and treating the gums measurably helps blood sugar control. Associations with heart disease and other conditions have been studied extensively, but association is not the same as cause, and we would rather say that plainly than overstate it.
How do I know what stage I am?+
Ask, and ask to see the chart. The numbers around each tooth are pocket depths in millimetres, and the marked sites are the ones that bled. It is your record and it is far more informative than being told your gums “look a bit inflamed”.
Concerned about your gums?
If your gums bleed, or it has been a while since your last periodontal assessment, book a diagnostic exam. Markham, ON — (905) 479-7777.