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Types of Periodontal Disease

Periodontal disease can refer to any condition that affects the gums and other structures supporting your teeth. However, bacteria cause the most common forms of periodontal disease. These bacteria grow in a film called dental plaque that sticks on the tooth surfaces next to the gums. The bacteria can infect the gums and cause inflammation. The disease can spread and destroy the gums, ligament and bone around the teeth.

The mildest form of infection is gingivitis. It affects only the gums. It can be found in up to 90% of the population. More severe gum disease (periodontitis) damages the other structures that support the tooth. This can lead to tooth loss.

There are several types of periodontal disease.

In 2017, the American Academy of Periodontology introduced a new classification scheme for periodontal conditions.

A) Periodontal health, Gingival diseases and conditions (including gingivitis)

B) Periodontitis

C) Periodontitis as a manifestation of systemic disease (diseases of the body)

Periodontitis is further categorized by Stages (based on severity) and Grades (based on risk of rapid progression) as well.

Gingivitis

Gingivitis is the mildest form of periodontal disease. It is caused by bacteria in plaque, which produce substances that can harm the gums. Gingivitis is quite common. Almost 3 out of 4 adults over age 35 have some evidence of this condition.

Some groups of people are at increased risk:

  • People with poorly controlled diabetes
  • Pregnant women
  • Teenagers
  • Women taking birth control pills
  • People taking steroids
  • People taking certain other drugs, such as cyclosporine (Neoral, Sandimmune, SangCya), medicine for seizures and blood pressure pills called calcium channel blockers

When you have gingivitis, your gums are red and swollen. They bleed easily with brushing. Gingivitis doesn't usually hurt. However, gingivitis can get worse. It can lead to a more serious form of periodontal disease, called periodontitis.

Gingivitis can be reversed with a combination of professional and home care. You will need a thorough cleaning in your dentist's office, including removal of plaque below the gum line. Then you must practice good oral care at home.

Periodontitis

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Periodontitis is a more advanced disease than gingivitis. Periodontitis involves all of the tissues that support the teeth. This includes both the gums and the bone. Periodontitis can be subdivided into Chronic, Aggressive and Necrotizing.

Chronic periodontitis is the most common form of periodontitis. Almost 50% of U.S. adults have some form of it. The older you are, the more likely you are to show signs of periodontitis.

If you have periodontitis, your gums become detached from your teeth. Spaces called pockets form between the teeth and gums. Dental plaque builds up in the pockets. Bacteria in the plaque penetrate deeper into tissues and triggers an immune response. Eventually, this destroys the ligament and bone that support the teeth. In more severe cases, teeth can become loose and even fall out.

Periodontitis usually is not painful. Some people notice that their gums are bleeding. The gums may recede (move back away from the teeth). People also may have bad breath or a bad taste in the mouth. However, periodontitis may not cause any symptoms that you would notice. Your dentist can diagnose it during an examination. It is considered a chronic disease and the condition usually gets worse quite slowly and can progress over several years.

Unlike gingivitis, periodontitis can't be completely reversed. That is because the lost supporting tissues usually can't be rebuilt. However, treatment and proper brushing and flossing can improve your oral health. This can stop periodontitis from getting worse. Stopping the disease in this way can help prevent tooth loss and other serious problems.

Treatment for periodontitis typically includes a thorough cleaning called scaling and root planing. In certain cases, you may need other steps, such as antimicrobial therapy, periodontal surgery or both.

Aggressive periodontitis gets worse faster than chronic periodontitis. Aggressive periodontitis tends to run in families. Recent research suggests that people can inherit an increased risk of this disease. It also is more common in smokers.

Aggressive periodontitis used to be considered a young person's disease, but it is no longer classified this way. However, it is more common in younger people than in older people. Bacteria found in dental plaque also cause this form of periodontitis.

The treatment generally is the same as treatment for chronic periodontitis. However, antibiotics and periodontal surgery are needed more often. In certain situations, aggressive periodontitis can be difficult to treat. These patients do not get better with treatment.

Necrotizing periodontal diseases are forms of disease that get worse rapidly. They cause distinct symptoms, such as:

  • Loss of the little triangles of tissue between the teeth
  • Bleeding gums
  • Significant pain
  • Bad breath
  • A whitish film on the surface of the gums

People with these forms of periodontal disease also may develop a fever and swollen glands.

Necrotizing periodontal diseases are classified as

  • Necrotizing Gingivitis
  • Necrotizing Periodontitis
  • Necrotizing Stomatitis

These conditions occur most often in people whose immune systems have been suppressed. They are much more likely in people who smoke or have poor nutrition, psychological stress or HIV infection.

The treatment typically involves:

  • Scaling and root planing
  • Antibiotic pills
  • Use of a mouth rinse containing chlorhexidine
  • Education to improve brushing and flossing habits

Periodontitis as a manifestation of systemic diseases

Periodontitis can be a symptom of diseases that involve the whole body. These include certain types of leukemias, neutropenias and genetic disorders. This type of periodontitis can vary, depending on the medical condition. However, it sometimes looks and acts like aggressive periodontitis. These patients often are young and do not have large amounts of dental plaque.

Treatment involves controlling the medical problem first. This is followed by treatment similar to that for chronic or aggressive periodontitis.

Other medical conditions can make all forms of periodontitis worse. Examples include diabetes and HIV infection. People with these conditions usually have a fair amount of dental plaque and/or calculus (tartar) on their teeth. They are more prone to developing severe periodontitis.

 

Updated- January 22, 2021

 

References:

  • Caton JG, Armitage G, Berglundh T, Chapple ILC, Jepsen S, Kornman KS, Mealey BL, Papapanou PN, Sanz M, Tonetti MS. A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification. J Periodontol. 2018 Jun;89 Suppl 1:S1-S8. doi: 10.1002/JPER.18-0157. PMID: 29926946.
  • Gasner NS, Schure RS. Periodontal Disease. 2020 May 18. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 32119477.
  • https://www.perio.org/consumer/gum-disease-and-other-diseases (Accessed January 22, 2021)