The Complete Guide to Periodontal Disease
I am confident this is the most complete and comprehensive guide you will find on the internet regarding periodontal disease.
In this guide, I will share with you my knowledge, life-changing stories, and experiences around periodontal disease and treatment.
My name is Dr. Kamran Haghighat, B.D.S., M.S., P.C., and founder of Portland Perio Implant Center --- which is one of the leading periodontal centers in Portland.
So if you're searching to learn as much as you can about periodontal disease, you will find value in my comprehensive guide.
DR. KAMRAN HAGHIGHAT
Board Certified, American Board of Periodontology
B.D.S., M.S., P.C.
Gingivitis vs. Periodontitis: What's The Difference?
What Is Periodontitis?
What Is A Periodontist?
Stages of Gum Disease
How Does Gum Disease Develop?
What Healthy Gums Look Like
Gum Disease & Heart Disease
Gum Disease Treatment
Health Risks of Gum Disease
What is Gum Disease?
Gum disease is the infection and inflammation of gums and underlying support structures in the periodontium, such as the alveolar jaw bone, as a result of bacteria, fungi, or other pathogens.
Gum disease according to Google Trends is near its peak popularity in regards to search terms on the Internet.
Pathology of Gum Disease
While there are many potential pathogens responsible for individual cases of gum disease, by and large, the vast majority of gum disease cases, from early-stage gingivitis to advanced-stage periodontitis, are the result of bacterial action.
Typically this occurs in three distinct stages with corresponding characteristics.
In early-stage gum disease, also known as gingivitis, the buildup of plaque and a microbial biofilm along the gum line leads to inflammation, swelling, redness, and mild sensitivity.
Once bacteria penetrates beneath the gum line, gum disease can become periodontitis or an infection deep within the soft tissues that can attack the underlying periodontal bones.
The typical progression from gingivitis to periodontitis is characterized by the gradual recession of the gums, making dental roots more vulnerable to infection and the development of gum pockets, which can develop into abscesses.
The health implications of gum disease are many and varied and affect not only the teeth and mouth but the body as a whole.
Within the mouth, untreated gum disease will eventually progress into severe, advanced-stage periodontitis. Bone destruction and complete edentulism are common at this late stage of the disease. The disfiguration and damage of the gums and soft tissues can have destructive health effects on the entire mouth, compromise a person’s ability to eat, chew, and speak, and also have many severe psychological effects on self-confidence and self-esteem.
Gum disease also has far-reaching health consequences outside the mouth itself. Periodontal infections can directly spread into the bloodstream via the periodontium resulting in sepsis and potentially fatal septic shock.
Gum disease is also implicated as either a co-factor, exacerbating condition, or direct cause of a variety of systemic human disorders from diabetes to heart disease.
Gum Disease Conditions
Bacteria associated with periodontal gum disease, for example, have been found on the heart valves of those diagnosed with gum disease, and are responsible for endocarditis.
Other conditions associated with gum disease:
While gum disease is often associated with the mouth and teeth, the condition has far-reaching effects and severe consequences. However, it is mostly a preventable disease. With a rigorous oral hygiene routine and appropriate professional attention from a certified periodontist or periodontal specialist, periodontal gum disease can be cured or even reversed in some cases. Cosmetic damage from moderate to severe cases of gum disease can often be remedied with cosmetic dentistry procedures such as periodontal implants to replace lost teeth.
Types of Gum Disease
Gum disease is an umbrella term that is often used to describe an infection of the gums, soft tissues, and sometimes, the periodontal bone itself. However, the precise severity, location, and general conditions of pathology will differ from one case to another. As a result, treatments and therapies must often be tailored to match each patient's individualized oral conditions.
To make sense of the general diagnosis of gum disease, it is helpful to categorize the disease into 4 distinct stages of gum disease:
Stage 1: Gingivitis
Inflammation of the gingiva (gums) and bone loss.
Stage 2: Early Periodontitis
Inflammation of the gingiva and the surrounding tissues that results in early bone loss.
Stage 3: Moderate Periodontitis
Inflammation of the gingiva and the surrounding tissues that results in moderate bone loss.
Stage 4: Advanced Periodontitis
Inflammation of the gums and the surrounding tissues that results in severe bone loss.
This helps describe the progressive nature of the disease.
Gum disease can also be categorized into 5 different types depending on specific characteristics of the disease. One patient’s periodontal disease, for example, may be highly invasive and spread rapidly throughout the jaw. Another patient’s gum disease may manifest as a series of highly localized and contained abscesses. The goal in this chapter is to help you make sense of gum disease in its varying forms.
4 Stages of Gum Disease (Periodontal Disease)
One of the most effective ways to categorize periodontal disease is to do so chronologically. Each chronological “stage” of the disease can be easily and readily defined with specific characteristics including signs and symptoms. However, it is important to note that the three stages we describe do not have distinct borders. Patients can, for example, experience symptoms of early-stage gum disease (gingivitis) while also displaying signs of moderate gum disease. These descriptions are general in nature and not intended for patients to self-diagnose.
When in doubt, the best way to confirm a suspicion of gum disease is to visit your local dental clinic for a professional checkup. A dentist or periodontist will be able to tell you instantly whether or not you have gum disease and how advanced it is, as well as treatments and procedures to combat it.
Early-stage gum disease, also commonly referred to as gingivitis, is characterized by visible redness, swelling, and bleeding in the gums as well as minor discomfort in some situations. Sure signs of gingivitis include bleeding when brushing or sensitivity when flossing.
Chronologically, gingivitis constitutes the earliest form of gum disease and is the easiest and most effective stage of the disease to treat. Damage incurred can be reversed with no permanent scarring or signs of damage. However, if left untreated, early-stage gum disease can progress over time into middle and late-stage gum disease which becomes more difficult to treat or reverse the damage.
Stage 3 gum disease occurs when gingivitis progresses into full-blown gum disease. By this stage, damage to the gums is both visible and permanent. Delamination of the gums from the underlying periodontal bone is apparent and often characterized by gum recession or the formation of gum pockets beneath the gum line.
Gum pockets are small areas of interstitial space formed when the gum tissues have detached, as a direct result of bacterial action, from the dental bone. The presence of gum pockets is particularly troublesome as they are difficult to clean and readily trap both bacteria and food debris. Over time, the gum pockets can become infected and lead to advanced-stage periodontitis.
Advanced-stage or late-stage gum disease, also known as periodontitis, occurs when oral infections have migrated deep into the soft tissues and are actively attacking the periodontal bone beneath.
Advanced periodontal disease is characterized by bone loss, tooth loss, necrotic tissues, and severe gum recession.
Symptoms include extreme dental pain, loose teeth, facial swelling, bleeding, fever, blood infections, abscesses, and the drainage of pus into the oral cavity.
Advanced-stage periodontal disease often results in complete edentulism or total tooth loss.
5 Types of Gum Disease
Gum disease can also be categorized into 5 different types depending on specific characteristics of the disease. One patient’s periodontal disease, for example, may be highly invasive and spread rapidly throughout the jaw. Another patient’s gum disease may manifest as a series of highly localized and contained abscesses.
Gingivitis, or early stage gum disease, is a widespread and pervasive form of gum disease that affects all ages, races, and genders. Gingivitis is, however, considered distinct from periodontitis which encompasses the middle-stage and advanced-stage forms of the disease.
Symptoms characteristic of gingivitis include redness and swelling in the gums and bleeding when brushing or flossing. Despite these symptoms, gingivitis rarely produces discomfort in most people except for minor sensitivity. This can lead many to a sense of complacency and lackluster response toward treatment.
Unlike middle-stage and advanced-stage periodontitis, gingivitis is highly treatable and the damage induced can be readily reversed with professional cleanings and good at-home oral care.
Once gum disease progresses beyond the early stages of gingivitis, treatment and repair of the gums become much more difficult and expensive to correct.
Formerly known as Adult Periodontal Disease, chronic gum disease is characterized by a slow rate of progression and is a natural extension of untreated gingivitis.
Gingivitis will often transition to chronic gum disease over time. Similarly, the destructive potential of the disease cannot be readily ascertained until it is too late and many years if not decades after the initial onset of the disease.
Chronic gum disease is highly prevalent in the general population and is the most common form of gum disease in adults. Despite being a constant, long-term disease, chronic periodontal disease is treatable and can be cured with proper professional care and good personal oral hygiene.
However, unlike gingivitis, some damage to the gums and teeth caused by chronic gum disease, such as gum recession, cannot be reversed by merely eliminating the disease.
Sometimes periodontal disease can be the result of and tied to other systemic conditions. These related medical conditions are known as cofactors. Common cofactors that directly increase a person’s risk of developing advanced periodontal disease include heart and blood conditions, lung diseases, and especially, type II diabetes. Other common cofactors include oral cancer and osteoporosis.
Periodontitis that is related to systemic diseases, such as diabetes, often begins at a much younger age than other forms of periodontal disease. Furthermore, systemic periodontitis can be extremely difficult to treat as control and containment of the disease requires control of other systemic cofactors.
Malignant, or aggressive, periodontitis is characterized by the rapid spread of destructive infectious agents and the subsequent destruction of underlying periodontal bone in clinically healthy patients.
Symptoms of this type of aggressive and highly damaging periodontitis include rapid jaw bone loss, the detachment of periodontal ligaments, edentulism, and the development of deep tissue abscesses.
Previously known as “Early-onset Periodontitis (EOP),” aggressive periodontitis often affects young people who are otherwise clinically healthy, which gave clinicians trouble for some time on how to classify the disease.
To help articulate aggressive forms of periodontal disease further, the disease can be subdivided into Localized Aggressive Periodontitis (LAP) and Generalized Aggressive Periodontitis (GAP). The distinguishing difference between these two subcategories is that LAP only affects one or two teeth while Generalize Aggressive Periodontitis affects three or more teeth.
While exceedingly rare, tissue-destroying necrotizing periodontitis is fast-moving, highly destructive and often affects the periodontal ligaments (PDL) that attach teeth to the bone. Necrotizing forms of periodontitis are characterized by tissue death in the gums, in the ligaments, and in the alveolar bone within which the teeth sit.
Necrotizing periodontitis is commonly associated with smokers and those with suppressed immune systems such as patients with HIV or those with chronic systemic stress. Due to its association with severe medical conditions, such as HIV, necrotizing periodontitis is not easily treated and requires highly specialized medical support and the treatment of underlying cofactors.