Advanced periodontal disease, typically classified as Stage III or Stage IV periodontitis, is a severe, chronic infection that progressively destroys the tissues supporting the teeth. This condition moves beyond simple gum inflammation to cause irreversible damage to the bone and ligaments holding the teeth in place. The visible signs of this advanced stage result from the body’s ongoing inflammatory response attempting to fight the deep-seated bacterial infection.
Visual Markers of Gum Tissue Destruction
The soft tissue surrounding the teeth undergoes noticeable changes in advanced disease. While healthy gums are typically firm and pale pink, severe inflammation causes a marked shift in appearance. Infected gums often appear bright red, dark red, or purplish, indicating a significant increase in blood flow due to chronic inflammation.
This inflammation makes the gum tissue look puffy, swollen, and sometimes shiny, contrasting sharply with the stippled texture of healthy tissue. The gums are often tender to the touch and will bleed readily with light contact, such as during brushing or flossing, or even spontaneously. This bleeding results from the fragile, ulcerated lining of the inflamed gum pockets.
A highly visible sign of this disease stage is significant gum recession, where the tissue pulls away from the tooth surface. This recession makes the teeth appear visibly longer than normal by exposing the root surfaces that should be covered. As the gums recede, the underlying infection causes the formation of deep spaces, known as periodontal pockets, between the teeth and the gums.
The depth of these pockets measures disease severity, often reaching 6 millimeters or more in advanced cases. This detachment of the gum tissue from the tooth root creates an environment where bacteria thrive, accelerating the destruction of the supporting bone.
Indicators of Tooth and Bone Instability
The progressive destruction of the underlying jawbone is the defining characteristic of advanced periodontitis, and this bone loss leads to unmistakable physical signs in the teeth. The most prominent indicator is increased tooth mobility, which presents as a noticeable wiggling or looseness when a tooth is touched or used for chewing. This instability occurs because the bone that anchors the tooth root has been resorbed, reducing structural support.
Another significant visual manifestation is pathologic tooth migration (PTM), where teeth visibly shift, rotate, or tilt out of their normal alignment. This shifting is common in the front teeth, often resulting in new or widening gaps, known as diastemas. This movement is a direct consequence of the weakened periodontal support, allowing subtle forces to push the teeth into new positions.
The shifting of teeth can also change how the upper and lower teeth meet, altering the patient’s bite or occlusion. In some instances of PTM, teeth may even appear to extrude, migrating slightly out of the socket and appearing longer than adjacent teeth. Severe bone loss is visually confirmed when a significant portion of the tooth root, which should be entirely embedded in bone, becomes exposed.
In Stage IV of the disease, the complexity of these issues is compounded, often involving a severe ridge defect or bite collapse due to extensive loss of multiple teeth. The widespread lack of bone and ligament support compromises the entire dental structure, severely limiting the ability to chew and function.
Functional and Olfactory Symptoms of Severe Disease
Advanced periodontal disease produces noticeable sensory and functional symptoms beyond the visual appearance of the gums and teeth. A hallmark of this severe infection is chronic halitosis, or persistent bad breath, which cannot be resolved by standard brushing. The odor results from bacteria thriving in deep periodontal pockets, releasing volatile sulfur compounds (VSCs) as waste products.
This persistent odor is often described as foul, putrid, or metallic, reflecting the presence of bacterial decay and tissue breakdown. Patients may also experience a persistent bad taste in the mouth, technically known as dysgeusia, which is linked to the ongoing infection and inflammatory factors. The presence of pus, or suppuration, is a clear visual sign of an active, deep-seated infection.
Pus often appears as a yellowish or whitish fluid that can be seen oozing from the gumline, especially when pressure is applied to the adjacent gum tissue. This discharge indicates the formation of periodontal abscesses—localized collections of infectious material within the deep pockets. The ultimate functional consequence is the eventual loss of teeth (edentulism), as supporting structures fail and teeth become so loose they must be removed or fall out. Stage IV periodontitis is specifically characterized by the loss of five or more teeth due to the disease.