Periodontal disease is a widespread, chronic inflammatory condition affecting the tissues that support your teeth. This progressive disease begins when bacterial plaque, a sticky film constantly forming on the teeth, is not adequately removed. The host’s immune response to these bacterial colonies causes inflammation, which, if unchecked, can destroy the gingiva, periodontal ligament, and the alveolar bone that anchors the teeth. Understanding its progression through distinct stages is important because early intervention can prevent irreversible damage.
Stage 1: Gingivitis
Gingivitis represents the first, and only reversible, stage of periodontal disease. This stage is confined to the gum tissue, involving inflammation but no permanent loss of attachment fibers or supporting bone structure. Clinically, the gums may appear red, swollen, and tender, and they may bleed easily when brushing or flossing.
The primary cause is the accumulation of bacterial plaque and tartar along the gumline. Professional dental cleaning, known as prophylaxis, removes the hardened plaque deposits, or calculus. Improved and consistent home care alongside professional care is typically enough to resolve the inflammation and restore the gums to a healthy state.
Stages 2 and 3: Early to Moderate Periodontitis
The progression from gingivitis to periodontitis marks an irreversible shift where damage to the underlying bone begins. In these stages, the gum tissue starts to detach from the tooth surface, creating spaces called periodontal pockets. These pockets, which typically measure between four and seven millimeters in depth, trap more aggressive bacteria and plaque below the gumline.
Early periodontitis involves initial signs of bone loss, which can be horizontal, affecting up to 15% to 33% of the root surface. Moderate periodontitis shows a more pronounced loss of supporting bone structure and deeper pocket formation. Treatment for these stages involves a non-surgical procedure called scaling and root planing (SRP), often referred to as a deep cleaning. This procedure removes plaque and tartar from the root surfaces beneath the gumline and smooths the root to encourage reattachment.
Stages 4 and 5: Severe and Advanced Periodontitis
Stages 4 and 5 represent the most advanced phases of the disease, characterized by extensive tissue and bone destruction. The infection leads to significant loss of the supporting alveolar bone, often ranging from 50% to over 85% of the root support. This extensive breakdown of the tooth’s foundation causes noticeable symptoms like severe tooth mobility, teeth shifting out of position, and severe gum recession.
Periodontal pockets are extremely deep, often six millimeters or more, allowing for persistent, difficult-to-reach infection and abscess formation. Management often requires complex surgical interventions to clean the deep infection and repair the damage. Procedures can include flap surgery, where the gum is temporarily lifted for direct cleaning and bone reshaping, or regenerative techniques like bone and soft tissue grafts to stimulate new growth. In some cases, the damage is too extensive, and extraction of the affected teeth may be the only option to eliminate the infection.
Preventing Recurrence and Maintaining Oral Health
After successful treatment of any stage of periodontitis, the focus shifts to preventing recurrence. Periodontal disease is highly susceptible to relapse, making consistent daily care a necessity for long-term stability. This maintenance requires meticulous oral hygiene, including brushing twice daily and flossing or using interdental cleaners once a day to disrupt the bacterial plaque biofilm.
Regular professional maintenance appointments are a structured part of the long-term prognosis, moving beyond a standard cleaning. These appointments, often scheduled every three to four months, involve specialized procedures to monitor pocket depths and remove accumulating bacterial deposits. Adhering to this schedule is important for managing the disease and reducing the risk of further bone loss and eventual tooth loss.