Periodontal disease affects more than half of adults over 30, yet most people have never heard the word 'periodontist'. Here's everything you need to know.
Dr. Anca Laura Constantin
CEO & Co-founder, Periodontist
12 November 2025
8 min read
Periodontal disease is one of the most common chronic conditions worldwide, affecting roughly 50% of adults. It progresses silently and painlessly in its early stages, which is why most people do not know they have it until significant damage has occurred.
Periodontal disease - commonly called gum disease - is one of the most prevalent chronic conditions in the world. According to the European Federation of Periodontology, approximately 50% of adults have some form of gum disease, and roughly 10% have the severe form that can lead to tooth loss. Yet it remains one of the most under-discussed health conditions in primary care.
As a practising periodontist, I see patients every week who have been living with gum disease for years without knowing it. The reason is simple: periodontal disease is largely painless in its early stages. By the time patients notice symptoms - bleeding gums, loose teeth, or receding gum lines - the disease has often been progressing silently for months or years.
This guide is designed to change that. Understanding periodontal disease is the first step to preventing it.
Periodontal disease is a bacterial infection that destroys the tissues supporting the teeth - the gums, periodontal ligament, and alveolar bone. It begins as gingivitis (reversible gum inflammation) and can progress to periodontitis (irreversible bone loss) if untreated.
Your teeth are held in place by a complex support system: the gums (gingiva), the periodontal ligament, and the alveolar bone. Periodontal disease is a bacterial infection that destroys this support system.
It begins with gingivitis - inflammation of the gums caused by bacterial plaque accumulating at the gum line. At this stage, the damage is entirely reversible. With proper brushing, flossing, and a professional clean, your gums can return to full health.
If gingivitis is left untreated, it can progress to periodontitis - a more serious infection where the bacteria move below the gum line, forming "pockets" between the teeth and gums. The body's immune response to this infection causes the destruction of the bone and tissue that hold your teeth in place. This damage is irreversible.
The most severe form, advanced periodontitis, can result in teeth becoming loose, shifting, or needing to be extracted.
Gum disease progresses through four stages: gingivitis (reversible inflammation), mild periodontitis (early bone loss, 4–5mm pockets), moderate periodontitis (significant bone loss, 6–7mm pockets), and advanced periodontitis (severe destruction, tooth mobility, possible tooth loss).
Stage 1 - Gingivitis:
Stage 2 - Mild Periodontitis:
Stage 3 - Moderate Periodontitis:
Stage 4 - Severe Periodontitis:
The primary cause is bacterial plaque that accumulates on teeth and below the gum line. Risk factors include smoking, diabetes, genetic predisposition, hormonal changes, certain medications, and poor oral hygiene.
The primary cause is bacterial plaque - the sticky film that forms on your teeth throughout the day. If plaque is not removed through regular brushing and flossing, it hardens into tartar (calculus), which can only be removed by a dental professional.
However, several factors significantly increase your risk:
Smoking and tobacco use - Smokers are 3–6 times more likely to develop periodontal disease. Smoking impairs the immune response and reduces blood flow to the gums, masking early symptoms.
Diabetes - The relationship between diabetes and periodontal disease is bidirectional. Diabetes increases the risk of gum disease, and severe gum disease makes blood sugar harder to control.
Genetics - Some people are genetically predisposed to periodontal disease. If your parents lost teeth to gum disease, your risk is higher.
Stress - Chronic stress impairs the immune system's ability to fight infection, including the bacteria responsible for gum disease.
Medications - Certain medications, including some antihypertensives, antidepressants, and immunosuppressants, can affect gum health.
Hormonal changes - Pregnancy, puberty, and menopause can make gums more sensitive and susceptible to inflammation.
Periodontal disease is linked to systemic conditions including cardiovascular disease, diabetes, respiratory infections, and adverse pregnancy outcomes. The chronic inflammation in the mouth can affect the entire body.
One of the most important - and least discussed - aspects of periodontal disease is its connection to systemic health. The mouth is not separate from the body. Bacteria from periodontal pockets can enter the bloodstream and contribute to inflammation throughout the body.
Research has established associations between periodontal disease and:
This is why periodontal health is not just a dental issue - it is a whole-body health issue.
Diagnosis involves measuring the depth of gum pockets with a periodontal probe and taking X-rays to assess bone levels. Pockets deeper than 3mm and evidence of bone loss indicate periodontitis.
Diagnosis requires a clinical examination by a dentist or periodontist. The key diagnostic tool is periodontal probing - using a small instrument to measure the depth of the pockets around each tooth. Healthy pockets are 1–3mm. Pockets of 4mm or more indicate disease.
Your dentist will also take X-rays to assess bone levels, and examine your gums for signs of inflammation, recession, and bleeding.
Treatment ranges from professional cleaning and scaling/root planing for early stages, to surgical interventions such as flap surgery and bone grafting for advanced cases. All treatment requires ongoing maintenance.
For gingivitis: A thorough professional clean (scale and polish) combined with improved home care is usually sufficient to reverse gingivitis.
For periodontitis: Treatment involves scaling and root planing (also called a "deep clean") - a procedure where the dental hygienist or periodontist removes bacteria and calculus from below the gum line and smooths the root surfaces to discourage bacterial reattachment.
In more advanced cases, surgical intervention may be required to access deeper pockets, regenerate lost bone, or cover exposed roots.
Maintenance: After active treatment, regular periodontal maintenance appointments (typically every 3–4 months) are essential to prevent recurrence.
Effective home care includes brushing twice daily with a soft-bristled or electric toothbrush, daily interdental cleaning with the correct size brushes, and attending regular professional check-ups every 3–6 months.
The most powerful thing you can do is establish a consistent daily routine:
Technology bridges the gap between dental appointments by translating clinical recommendations into personalised daily habits, providing reminders, and tracking patient progress - giving clinicians visibility into patient engagement.
One of the biggest challenges in periodontal care is the gap between the dental chair and the patient's daily life. A periodontist can perform excellent treatment, but if the patient doesn't maintain their home care routine, the disease will recur.
This is precisely why I co-founded Perioskoup. The app translates clinical recommendations into personalised daily habits, sends gentle reminders, and helps patients track their progress between appointments. It gives clinicians visibility into patient engagement and allows them to send targeted guidance without requiring an additional appointment.
Periodontal disease is manageable. With the right knowledge, the right professional support, and the right daily habits, most patients can maintain their teeth for life. The key is catching it early - and staying consistent.
Dr. Anca Laura Constantin is a practising periodontist based in Bucharest, Romania, and co-founder of Perioskoup. She holds a specialisation in periodontology and has treated hundreds of patients with periodontal disease.
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