The 4 Stages of Gum Disease

Gingivitis is the first stage of gum disease representing the mildest form of periodontal disease. Gingivitis is an inflammation of the gums characterized by redness, swelling, and sometimes bleeding during brushing or probing.

The gums become irritated by the toxins produced by the bacteria of dental plaque and tartar that have accumulated on teeth and gums as a result of poor oral hygiene. Gums get inflamed, loosening their attachment to the tooth and exposing previously covered enamel. The space between the gum and tooth (sulcus) gets deeper, forming a periodontal pocket. The depth of pockets is about 1-4mm when measured during periodontal probing.

At this early stage of gum disease, damage can be reversed with proper dental hygiene, since the teeth are still firmly planted in their sockets without any bone or connective tissue damage. Gingivitis may have only mild or no symptoms, but if left uncontrolled, it can progress to a more advanced stage of gum disease called periodontitis. Gingivitis may persist for years before the inflammatory process becomes destructive. Tooth scaling, root planing and improved oral hygiene are common treatments for gingivitis.

The main characteristics of this stage of gum disease are:

• the condition is reversible
• there is no permanent loss of jaw bone around teeth

Gingivitis can not be easily distinguished from early periodontitis with a simple visual examination. In order to determine the exact stage of gum disease, the dentist has to perform a periodontal examination (probing).

Periodontitis is the more dangerous form of periodontal disease. Infection and inflammation has spread to the bone supporting the teeth. When gum disease has progressed to the periodontitis stage, the supporting bone and fibers that hold the teeth in place start to get irreversibly damaged. The stages of periodontitis are defined as early, moderate, and advanced. The main factor for the classification to a certain stage of the disease is the degree of destruction of the supporting bone.

In the initial stage of periodontitis plaque bacteria continue to penetrate deeper between the teeth and gums. The environment becomes suitable for the establishment of anaerobic bacteria under the gums. Gingival pockets are formed below the gumline.

• Greater inflammation and swelling of the gums
• Gums begin to separate from teeth below the cemento-enamel junction
• Gum bleeding when probing or brushing
• Pocket depth up to 4-6mm
• Infection reaches bone - Slight bone loss
• Unpleasant breath or taste
• Subgingival accumulation of plaque and calculus

Treatment of early periodontitis includes tooth scaling and root planing accompanied by improved oral hygiene. Despite the bone damage, the amount of bone loss in this stage of periodontal disease is minor so that usually no additional treatment is required.

The surrounding connective tissues and alveolar bone become are seriously infected. Bacterial toxins and the body's enzymes fighting the infection break down the bone and connective tissue that hold teeth in place. First signs of tooth mobility appear due to bone loss.

• Gums recession – teeth appear longer
• Root surface exposed - sensitivity - root decay
• Persistent bad breath
• Bleeding gums
• Pocket depth of 6-7mm
• Moderate bone loss (20 - 50%)
• Periodontal abscesses may develop
• Teeth may begin to loosen, drift and look separated

Moderate periodontitis is one of the most critical stages of periodontal disease, because some ‘damage control’ is yet possible before the condition reaches a phase when teeth can not be saved. Surgical treatments of gum disease can stop the progress of the disease but the damage is not reversible.

This final stage of periodontal disease is characterized by severe infection, loosening teeth and tooth loss.

• Constant bad breath and bad taste
• Spontaneous gums bleeding
• Sensitive teeth due to exposed roots
• Pocket depth over 7mm
• Pus drainage in the mouth due to periodontal abscesses
• Severe bone loss (more than 50%)
• Teeth drifting out of place
• Teeth become loose or fall out

Teeth become so mobile and the bone loss so severe that in many cases they can not be saved and have to be extracted. In other cases, teeth extraction is necessary in order to clear the infection. The advanced stage of periodontitis can be reached in some cases without intense visible alerting symptoms despite the severe underlying bone damage.

Extensive periodontal gum surgery that includes soft and hard tissue grafting are necessary in a treatment effort to save the affected teeth. Unfortunately the prognosis is not good if the condition has reached to this advanced stages of periodontal disease.

Early to moderate stages of periodontal disease may not always be associated with pain, bleeding, or other obvious symptoms and signs. Regular visits to your dentist are essential for detecting any early signs of gum disease before it has progressed to the most dangerous stages of the disease.