Periodontal disease is a chronic inflammatory condition that affects the supporting structures of the teeth. This process begins when bacterial plaque, a sticky film of microorganisms, accumulates along the gumline and hardens into calculus or tartar. The body’s immune response to these bacteria triggers inflammation, which, if left unchecked, can progressively destroy the gingiva (gums), periodontal ligament, and the underlying alveolar bone. The stages of this disease range from a fully reversible infection to one that causes permanent tissue damage and tooth loss.
Gingivitis: The Reversible Stage
Gingivitis represents the earliest form of periodontal disease, characterized by inflammation confined to the gum tissue. Clinical signs include gums that appear red, swollen, and tender, often bleeding when brushing or flossing. The damage at this stage is limited to the soft tissues, meaning there is no loss of connective tissue attachment or underlying bone. Gingivitis is completely reversible, typically requiring professional dental cleaning to remove plaque and tartar, combined with rigorous at-home oral hygiene. Resolving the bacterial irritant allows the gums to return to a healthy, non-inflamed state.
Mild Periodontitis: Initial Bone and Tissue Loss
The transition to periodontitis marks the beginning of irreversible damage to the tooth’s support structures. Chronic inflammation causes the gum tissue to detach from the tooth surface, forming shallow spaces known as periodontal pockets, typically measured at 4 millimeters in depth. These pockets allow harmful bacteria to thrive, leading to the initial loss of the alveolar bone that anchors the tooth. X-rays may show early signs of bone resorption, and patients might notice minor gum recession. While the bone loss is permanent, intervention can halt or significantly slow further progression, preserving the remaining support structure.
Moderate to Severe Periodontitis: Advanced Damage and Tooth Loss
As the disease progresses to the moderate stage, the destruction becomes more pronounced, with periodontal pocket depths deepening to 5 to 6 millimeters. At this depth, a significant portion of the bone supporting the tooth has been destroyed, and the pockets are too deep for a toothbrush or floss to clean effectively. Patients often experience noticeable gum recession, increased tooth sensitivity, and a heightened risk of infection.
Severe Periodontitis
The severe stage represents the most advanced form, where pocket depths exceed 6 millimeters, often reaching 7 millimeters or more. Bone loss is extensive, frequently exceeding 60% of the supporting structure, which severely compromises the stability of the teeth. Clinical signs include profuse bleeding, the presence of pus, and significant tooth mobility. Without treatment, the profound tissue and bone destruction in this stage inevitably leads to the loss of the affected teeth.
Non-Dental Factors That Accelerate Progression
While bacterial plaque is the direct cause, the speed and severity of periodontal disease progression are heavily influenced by systemic factors that affect the body’s overall immune response. Smoking and tobacco use are significant modifiable risk factors, as they impair the immune system’s ability to fight infection and hinder the healing process. Tobacco users have a significantly higher risk and often experience a more rapid and severe progression of tissue destruction.
Uncontrolled diabetes also acts as a major accelerating factor, as high blood sugar levels reduce the function of immune cells and impair wound healing. The relationship is bidirectional, as periodontal disease can also make it harder for a diabetic patient to maintain stable blood sugar levels.
Hormonal fluctuations, such as those occurring during pregnancy, can increase the sensitivity of gum tissue to plaque. Genetic predispositions and certain medications, including some antidepressants and heart medicines, can compromise the immune response or reduce saliva flow, making individuals more susceptible to the rapid advancement of the disease.