Periodontal Disease Progression

August 11, 2022, Marielaina Perrone DDS

Cosmetic Dentist Henderson NV
Cosmetic Dentist Henderson NV
Discussion of the various stages of Periodontal Disease and the treatment for each stage.

 Periodontal disease (or commonly called gum disease) is a very serious and chronic dental infection of the periodontal tissues that can result in the breakdown of the tissue and the loss of bone that surrounds and supports your teeth. This dental infection disease begins when bacteria and plaque form a sticky biofilm on your teeth and causes periodontal tissue inflammation. Periodontal disease will continue a downward progression if not resolved by maintaining proper dental care and hygiene.

Periodontal disease is the leading cause of tooth loss in adults. Scientific studies show that somewhere between 75% and 95% of all adults are suffering from some stage of periodontal disease. Periodontal disease and tooth decay (cavities) are caused by different types of bacteria and are considered two separate and distinct conditions. However, you can suffer from both issues. Poor oral hygiene promotes the risk of both cavities and gum disease.

 Swollen and receding gums open up the more vulnerable areas of the tooth...The root areas are not protected by enamel and can break down quickly to form root decay. On the flip side, in patients with significant tooth decay, the broken down teeth allow for food trap areas that keep periodontal tissue chronically inflamed.

Symptoms of periodontal disease

By paying attention to these warning signs of gum disease, you can monitor your oral health.

-Red, swollen, soft, or bleeding gums
-Gingiva that retracts and separates from the teeth.
-Abnormal tooth hypersensitivity, especially around the gingival line.
-Tooth mobility and pain during chewing
-Bad breath (halitosis)

If you notice any of these symptoms, ask your dentist to evaluate them. 

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Treatment of periodontal disease

If you are diagnosed with gum disease, treatment may vary depending on the severity of your case. Some of these gum disease treatments will include:

-Scaling And Root Planing Therapy. In the early stages of gingival inflammation or gingival disease, nonsurgical treatment may restore periodontal health. Scaling and root planing can sometimes be referred to as advanced cleaning. Scaling is a deep cleaning technique that gently removes plaque and tartar from the above and below the gumline of the teeth. You may be placed on a three-month hygiene schedule following scaling and root planing until your oral health becomes controlled.

The root planing removes plaque and tartar from the root's surface, which is the area of ​​coarse spots that trap and retain bacteria. Once the gums are clean, the gum tissue can begin to heal.

-Periodontal gum surgery. Suppose the periodontal pocketing around your teeth is too deep, and it is difficult to clean your teeth with at-home dental hygiene or regular professional care. In that case, you can also choose a procedure to reduce the pocketing.

During this procedure, the dentist or periodontist makes an incision in the gums to contract the tissue, perform more effective scaling and root scraping under the gum line, and access the roots to clean up bacterial infections. Scaling and root planing helps to reattach the gingival tissue to the bone.

-Gingival graft surgery. As periodontal disease progresses and the gums begin to recede, your dentist may recommend periodontal surgery to reshape the gums or add new tissue to cover the exposed roots of the teeth. During this surgery, periodontists remove tissue from the gums, usually the roof of the mouth, to cover the roots and protect the teeth from tooth decay, bone loss, and even recession.

-Regenerative procedures. If periodontitis destroys the bones that support the teeth, regenerative procedures can help repair the damage. After a periodontist exposes the roots and removes the bacteria, he or she transplants bone into the area around the teeth to stimulate your body to repair lost bone and tissue. Once healed, if you have sufficient bone, you may be a candidate for a dental implant.

 -Tooth Extraction. In the worst cases of chronic periodontitis, bone loss is so severe that it can no longer support the tooth and requires tooth extraction.


Because you cannot completely reverse the effects of periodontitis and the advanced stages of gum disease, the symptoms of gum disease should be identified and addressed as soon as possible. Your dentist should establish a preventive care routine before the gum disease progresses further than it has.

-Practice good oral hygiene with daily brushing and dental floss. If done correctly, remove plaque from your teeth to prevent plaque from accumulating. Also, visit your dentist every six months for professional cleaning to remove plaque and tartar that are out of reach. Your dentist or periodontal specialist may recommend more frequent visits and develop a more aggressive oral health treatment plan if you already have gum disease.

Other Risk Factors Of Gum Disease

-Genetics. Some people are genetically more susceptible to gum disease than others, but that is inevitable. Proper oral care can prevent or control periodontal disease. Your dentist may also recommend orthodontic treatment for misaligned or crooked teeth. Some patients are also born with a weakened immune system which is another factor.

-Bruxism. This habit can exacerbate the symptoms of existing periodontal disease by exerting excessive force on the teeth and accelerating the destruction of gingival tissue and supporting bone. Your dentist can create custom mouthguards to reduce pressure on teeth and support structures.

-Tobacco Use. Smoking makes it harder for the immune system to fight infections, increases the risk of periodontal disease for tobacco users, and increases their resistance to treatment. Smokers collect more tartar in their teeth, develop deeper pockets to hold bacteria, and lose more bone as the gum disease progresses. Stopping smoking is an important step in the prevention and treatment of periodontal disease.

-Medications. Some drugs cause dry mouth, and lack of saliva increases the likelihood of plaque sticking to your teeth. Some medications cause inflammation of the gums and increase the chances of catching plaque.

 -Systemic Disease. Some illnesses can increase the risk of gum disease and make oral health difficult to maintain. Whether it is a disease like diabetes that lowers the immune response or an inflammatory condition such as rheumatoid arthritis, the prevention and treatment of gum disease can be more difficult. It is even more important to have good disease control. Rheumatoid arthritis will also hamper oral hygiene due to decreased dexterity in some patients.

-Poor Nutrition. Proper nutrition is essential for the immune system and healthy oral function. Severe vitamin C deficiency, commonly known as scurvy, can cause gum bleeding. Poor nutrition is an often overlooked risk factor.

 -Stress Management. Stress weakens the immune system, making it difficult to fight periodontal disease-related infections and reducing the effectiveness of treatment. Hormonal-changing hormones change the environment in the mouth, so events such as puberty, pregnancy, and menopause temporarily increase the risk of periodontal disease.

Other health effects of periodontal disease

Unfortunately, the effects of periodontal disease go beyond your mouth, and researchers are increasingly finding an association between gum disease and your overall health. Some of these health problems are:

-Heart disease. Periodontal disease increases the risk of arterial occlusion and can worsen the condition of the existing heart.
-Stroke. Periodontal disease can also increase the risk of stroke caused by the occlusion of arteries.
-Respiratory disease. Bacteria from the mouth can spread to the lungs, causing lung infections and exacerbating the condition of existing lungs. Immunosuppressed adults with periodontal disease are at increased risk of severe pneumonia.
-Premature birth. Gum disease during pregnancy in immunosuppressed people can increase the likelihood of preterm birth and low birth weight of the baby.
-Diabetes mellitus. Gum disease can make it more difficult for diabetics to control their blood sugar levels than for healthy gums.


The earliest stage of periodontal disease is gingivitis (or simply inflammation of the gum tissues). Gingivitis is the mildest form of periodontal disease. Symptoms include red, swollen (or puffy), and inflamed gums due to plaque-bacteria buildup. The gums may also bleed easily during brushing or eating hard foods.

You can reverse this periodontal disease stage thru proper brushing, flossing, and professional dental care. If the required dental care does not occur, the periodontal disease will progress. Most people with gingivitis do not even know a dental problem exists.

This is a crucial period for the patient, as the condition can be reversed (since the bone and connective tissue that hold the teeth in place have not yet been adversely affected) at this point if it is recognized, diagnosed, and properly treated.

Gingivitis is commonly seen during puberty, pregnancy, times of high stress, and menopause, as raging hormones can make you more prone to inflammation. As for the rest of the population, poor dental hygiene is generally the most common cause, followed by medication and certain medical conditions.

Periodontitis (Advanced Periodontal Disease)

As periodontal disease progresses, it is now becoming harder to treat and control. The difference between gingivitis and periodontitis is that gingivitis only infects the gum tissue that surrounds the teeth. At the same time, the periodontal disease process also invades the bone that provides support and stability for the teeth.

The bacteria eventually invades past the initial gum line area, and destruction begins to the point that gums may begin to separate or pull away from the teeth (taking away support and connective fibers with it). The results are called periodontal pockets. These pockets allow for bacteria to invade below the gum line.

  They eventually become loaded with toxic plaque and bacteria that move and work their way deeper. It begins to erode the bone below the gum line. A patient's bite will be affected (as the teeth shift or loosen) by the lost support, affecting chewing and other daily functions.

Advanced Periodontitis (Advanced Periodontal Disease)

As the periodontal disease process advances further, the fibers and bone supporting the teeth are broken down and destroyed. At least half (50%) of the bone support (if not more) will have broken down at this late stage of periodontal disease. It does not grow back naturally.

Teeth may begin to loosen. Deep root cleanings and surgical intervention are typical at this stage. Further treatment may include cleaning with a periodontal microscope (Perioscope), grafting of tissue, bone, placement of growth factors (Emdogain), periodontal antibiotic regimen (Periostat), placement of antibiotics directly into pockets (Arestin), open periodontal flap surgery, and, possibly even tooth removal.

How Do I Know If I Have Periodontal Disease?

Periodontal disease can happen to a person of any age. It is most common among adults. Remember, if periodontal disease is detected in its earliest stages, it can be reversed, so it is important to see your dentist right away if you notice any of the following symptoms:

-Gums that are red, puffy or inflamed, or tender.
-Gums that bleed easily during routine brushing or flossing.
-Teeth that appear longer due to recession of gum tissue.
-Changes in the way your teeth fit together when you bite or chew.
-Pus coming from between your teeth and gums
-Bad breath odor or a bad taste in your mouth.
What Advanced Treatments Are Available?
-Pocket Reduction Surgery (also called Flap surgery). In this procedure, your periodontist makes tiny incisions in your gum so that a section of gum tissue can be lifted back, exposing the roots for more effective scaling and planing. Because periodontitis often causes bone loss, Your dentist may recontour the underlying bone before the gum tissue is sutured back in place. The procedure generally takes from one to three hours and is performed under local anesthesia.
-Soft tissue grafts. Gum tissue is often lost as part of the periodontal disease process making your teeth appear longer than normal. You may need to have damaged tissue replaced to return your cosmetic appearance to normal. This procedure can help reduce further gum recession, cover exposed roots and give your teeth a more cosmetically pleasing appearance.
-Bone graft. This procedure is needed when periodontitis has destroyed the bone surrounding your tooth. The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone.
-Antibiotics and medicaments - A wide array of antibacterial rinses(Peridex), antibiotics taken in pill form (Periostat), or localized placement directly into the affected pockets(Arestin) can aid in and promote healing of the affected gum tissue.
-Guided tissue regeneration. This allows the regrowth of bone that was destroyed by bacteria. Your dentist places a special piece of biocompatible fabric between the existing bone and your tooth in one approach. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back instead.

By scheduling regular dental examinations, early-stage periodontal disease can be treated before leading to a much more serious condition. If your periodontal disease is more advanced, gum disease will require treatment in the dental office. Periodontal disease can be managed and controlled for most patients. Following a routine of brushing, flossing, and seeing your dentist should be enough for most to keep periodontal disease at bay.

2022 - Cosmetic Dentist Henderson NV


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