There are two types of gum disease that can be considered stages of the same process of gum degeneration – gingivitis and periodontitis. However, some forms of periodontal disease have been linked to other systemic diseases and health conditions.
Here are the most common types of gum disease:
Gingivitis is regarded as an early or initial stage of gum disease. It is caused by a build-up of bacterial plaque and tartar on teeth surfaces along the gum line. If this build up is not removed with good oral care and hygiene, a bacterial infection can occur as plaque develops below the gum line. Gingivitis is the resulting inflammatory condition of the surrounding gum tissue (gingival tissue) due to irritation by bacterial activity. Visible symptoms include gums that are swollen, bleeding and/or darker red colour in colour.
Gingivitis is easily and effectively treated with a professional dental clean and scale by your dentist. However, if left untreated, gingivitis can progress to periodontitis, a far more serious oral condition that can cause permanent damage to your teeth, gums and jaw bone.
Untreated gingivitis leads to chronic periodontitis (periodontal disease). As bacteria spreads below the gum line, further irritation and chronic inflammation causes little pockets to form between your teeth and gums. These are called periodontal pockets and as they deepen, the bacterial communities within them are given more space to accumulate and continue to destroy connective tissue. Periodontal pockets can become infected with even more serious oral bacterial species that can cause damage to your jaw bone, resulting in bone loss.
Since this gradual degenerative process occurs around your teeth, you may only experience a few mild symptoms, as opposed to a painful toothache caused by an infection within the tooth cavity. As gum tissue separates from your tooth surfaces – to the point that your tooth is no longer anchored and supported in its socket – the tooth may have to be extracted.
Since periodontitis typically occurs in individuals over the ages of 40 and 50, it is considered a chronic oral health condition that takes decades to progress to a more serious stage. In contrast, the onset of aggressive periodontitis can occur at puberty and progress at three to four times the usual rate – with periodontal tissue destroyed at a rate of 0.2 – 0.25 mm per year.
Aggressive periodontitis has been linked to a herpes viral-bacterial co-infection, though there may be other contributory causes.
Necrotising periodontal disease
Necrotising periodontal disease is a relatively rare oral condition that involves death of gum tissue, periodontal support tissue and/or bone. Even though this oral condition is triggered by the same factors as chronic periodontitis, an individual can be predisposed to the disease if they: have an immunodeficiency condition (such as HIV); suffer from malnutrition (e.g. children in third world countries); and are experiencing severe stress (physical and psychological).
To treat necrotising periodontal disease in individuals effectively, both conditions may need to be managed by dentists and doctors who are working in close consultation and cooperation with each other.
Periodontitis linked to systemic diseases
Periodontitis has been linked to a number of underlying systemic diseases such as heart disease, diabetes, kidney disease, cognitive impairment/Alzheimer’s, obesity, respiratory diseases and cancer. These links have been the subject of intense research and further studies are needed to confirm how periodontal disease contributes to systemic diseases.
Periodontitis may affect the body directly (via circulating bacteria) or indirectly (oral inflamation may contribute to systemic inflammation in individuals). On the other hand, systemic diseases may accelerate or intensify the progression of periodontitis. To treat periodontitis in individuals with underlying systemic conditions effectively, both conditions may need to be managed by dentists and doctors who consult and cooperate with each other.