Left untreated, gingivitis can lead to the development of a more serious form of periodontal disease, periodontitis.  Over time, bacterial plaque can spread and grow below the gum line and calcify to form calculus (tartar).  Bacterial toxins emitted from the plaque irritate the gums.  

The toxins stimulate the immune system to create a chronic inflammatory response.  Essentially, during the chronic inflammatory response, the body turns on itself, breaking down and destroying the tissues and bone that support the teeth.  By this point, gums begin to separate from the teeth, forming periodontal pockets (spaces between gums and teeth) that become infected with periodontal pathogens.  

As the disease progresses, more gum becomes infected, the bone is destroyed down the length of the tooth and the periodontal pockets deepen.  Often, this destructive process has little to no symptoms.  Eventually, the patient becomes aware something is wrong when teeth begin to shift or become loose.  By this point, if the disease has severely affected the bone, the teeth may have to be removed.

The most common forms of periodontitis include:

Chronic periodontitis, the predominant form, results in various stages of inflammation within the supporting tissues of the teeth, accompanied by progressive attachment and bone loss.  It is most prevalent in adults, but can occur at any age.  Progression of bone loss usually occurs slowly, but periods of rapid progression can occur.

Periodontitis as a manifestation of systemic diseases most often occurs among younger patients. Systemic conditions associated with this form of periodontitis include heart disease, respiratory disease, and diabetes.

Aggressive periodontitis mostly occurs in young patients who are otherwise clinically healthy.  Common feature include rapid bone destruction and is usually found among many members of the same family. 

Necrotizing periodontal disease is a severe infection characterized by necrosis of gingival tissues, periodontal ligament and supporting bone.  These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.

What are the Signs and Symptoms of Periodontitis?

  • Inflamed (swollen) gums, gum swelling recurs
  • Gums are fiery red, sometimes purple (cyanotic)
  • Gums are tender or hurt to touch
  • Gum recession, making teeth look longer
  • Extra spaces appear between the teeth, teeth shifting
  • Pus may appear between the teeth and gums
  • Bleeding when brushing, flossing or eating
  • Halitosis (bad breath) that won’t go away
  • Loose teeth
  • Sore in the mouth
  • A change in partial denture fit
  • A change in the bite (the way your teeth come together)
Healthy Gums


 Gums of pink and firm with no sign of bleeding

Gingivitis - Gum Disease


 Gums are slightly reddish and may be swollen, bleeding while brushing and flossing.

Mild Periodontitis - Gum Disease


Initial bone loss observed, gums are puffy and begin to separated from the teeth.  Gums bleed easily.

Moderate Periodontitis - Gum Disease


Gums begin to recede, puffy and bleed easily.  Some teeth begin to be slightly loose.

Severe Periodontitis - Gum Disease


Gums are puffy, bleed spontaneously with evidence of pus oozing from the pocket.  Teeth may be very loose due to bone loss.

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