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Healthy periodontal tissues are essential to maintaining attachment, stability, and retention of teeth. The concept of ‘health’ is problematic however and includes both physical and psycho-social characteristics. The challenge for bioarchaeologists is defining what physical expression begins to affect an individual’s well-being. Here we apply a lifecourse approach to the measurement of periodontal tissue depth (CEJ-AC) at M1 in a prehistoric sample (N = 162) from the American Southwest to test the hypothesis that age and sex differences bear the greatest impact on the expression of periodontitis. CEJ-AC at M1 increased significantly (p<.001) across age stages from 1.5 ±0.5mm (15-20yo) to 4.25 ±0.25mm in the old age group (40-50yo). Occlusal surface wear and alveolar crest (AC) resorption were considerably variable (non-significant) between sexes; however, tooth loss at M1 is more than double among females compared to males in the final decades 40-50yo and 50-60yo. Results support the hypothesis that periodontal tissue loss differentially affects females across the lifecourse. Bacterial infection, chronic gingivitis, and bony resorption cause the physical symptoms of periodontal disease but may not be accompanied by pain or altered functionality. The outcome of the disease process is tooth loss, which can affect functionality and quality of life. Periodontal ‘health’ is therefore best interpreted in bioarchaeological samples around the point that alveolar recession results in tooth loss and altered functionality.