When you think of gum disease, you might think of one condition, with one set of symptoms. However, gum disease is actually a term that covers a whole range of illness in the tissue surrounding your teeth.
If you are worried you might have gum disease, you’re probably looking for answers. You may want to know how to recognise which stage you may be at, what you can do to stop its progress, and what kind of professional help you should seek.
The stages of gum disease are quite different from each other, and treatment and management options vary. The outlook for each stage also depends significantly on how far it is allowed to progress.
This series of articles by specialist periodontists at EO Perio will give you all the information you need to understand gum disease at every stage.
There are basically two different ‘types’ of gum disease.
Gingivitis is the mildest, most common form of gum disease and can be cured or ‘reversed’. Gingivitis, left unchecked, can turn into the more destructive and incurable Peridontitis. Periodontitis is broken down into four stages:
This article outlines the causes, symptoms, prevention and management methods and outlook for each one.
There’s no delicate way to put it: our mouths are full of bacteria. Bacteria and other particles form a sticky substance called plaque, which coats the teeth like grime if you don’t brush and floss regularly with good technique.
When plaque isn’t cleaned away, the body’s immune system reacts to it, and the gums become inflamed. Inflamed gums often look redder and puffier than normal, and tend to bleed when you brush or floss your teeth. This can become visible in as little as two weeks.
The word gingivitis can be broken down to ‘gingiva’ and ‘itis’. The gingiva are the gums and ‘itis’ is a Latin-derived term for inflammation. So the term gingivitis literally means inflammation of the gums.
Because you can’t see into your own mouth - especially when it’s full of toothpaste - to spot plaque, cleaning your own teeth properly is not as easy as you might think. Most people need a little coaching to do it well. Most people have a little gingivitis somewhere in their mouth.
Plaque that isn’t cleaned away begins to harden, and turns into a substance known as calculus (or tartar). Calculus is a hardened build-up on your teeth, there are two types.
People with healthy saliva get ‘supragingival’ calculus on their bottom front teeth, where you can often see it. It is a creamy yellow colour and forms from minerals in your saliva. This type of calculus is easy for your dentist, hygienist or periodontist to clean off.
The more serious type, called ‘subgingival calculus’, forms under the gum and is black in colour. You can’t see it and it can be hard to detect, even for a dentist. So it is very difficult to remove completely. It’s black in colour due to the presence of blood when your gums are inflamed. Black subgingival calculus usually means you have one of the more serious types of gum disease. Read more about this in the next section.
Gingivitis symptoms can be easy to ignore as the condition is usually painless. Too often, people put it down to brushing too hard. But bleeding gums are a warning sign that should never be ignored.
The simple fact is: healthy gums don’t bleed.
Gingivitis is the only stage of gum disease that can be reversed. Good oral hygiene at home and regular check-up and cleans will help prevent it, and your dentist or periodontist can help you treat it and get your gums completely healthy again.
If gingivitis is left untreated, it can advance to Stage 1 Periodontitis. This is when the inflammation in the gums becomes destructive. The fact is that chronic (long term) inflammation anywhere in the body can be destructive. Arthritic joints such as knees, hips and fingers can be damaged due to chronic inflammation. With periodontitis, the inflammation causes damage to the fibres that join the roots of the teeth to the socket. These fibres are called the ‘periodontal ligament’ and when they are damaged, it is permanent. The signs and symptoms are almost identical to gingivitis and can make this stage hard to discern from it.
You still won’t notice any pain or other symptoms at this stage. However, your gums will still be bleeding when you brush, and they’ll begin to become more inflamed.
Once gum disease has reached this stage, it cannot be reversed - but it can be managed by a specialist periodontist and dental health team.
Treatment of initial periodontal disease begins with coaching to improve your teeth cleaning technique and a deep clean, known as debridement. Debridement is an intensive procedure that removes the bacteria and calculus from your gums and the roots of your teeth.
Without treatment for initial periodontitis, your condition will progress to Stage 2 - Moderate Periodontitis.
The main difference between initial and moderate periodontitis is the amount of damage to the ligaments or joints between the root of the tooth and its socket. Initial periodontitis is when the damage is only slight, almost undetectable. Moderate periodontitis should be more obvious to your dental team because there is more damage, which unfortunately is permanent.
Now we enter into the severe stage of periodontitis, which is the stage where you have the very real potential of losing teeth.
If your gum disease has reached this stage, you are still unlikely to experience pain. However, you might notice bad breath, a bad taste, and you might notice your teeth look longer because your gums will have receded. You also may notice your teeth moving or becoming loose. The way they fit together when you bite may change. Biting on the teeth can become sore and sometimes people get localised swellings or abscesses with pus, which are often painful.
At this stage, all options for treatment are on the table - including periodontal surgery - to manage your condition. It may already be at the point where some teeth cannot be saved and will need to be replaced by dentures or dental implants. But a periodontist can help you find the most suitable treatment option for you, and will give you the best chance of saving the most teeth. Periodontists are gum disease specialists, and can sometimes see possibilities that general dentists cannot.
By the time Stage 4 is reached, people are often already missing several teeth, and the ones that remain are often loose. Because the teeth don’t have enough gum or bone supporting them, they may not be strong enough to support the force of your bite when you try to chew.
There will be significant drifting and splaying of the front teeth with gaps forming between the teeth. It’s absolutely crucial to get treatment at this stage. Advanced periodontal disease can lead to other, extremely serious health problems such as diabetes or even a heart attack.
It cannot be reversed, but it can be managed. With help from your periodontist, and often other dental specialists as well such as prosthodontists and orthodontists, it is possible to stabilise gum disease even at this late stage.
People often will consider removal of all the teeth when Stage 4 is reached to replace them with dental implants. The problem is that dental implants also can also get gum disease. Implants with gum disease are much more difficult to treat and more expensive. We have seen numerous cases of people who have had all their teeth replaced with implants (often overseas) only to have the same problem. We strongly recommend consulting a specialist periodontist before taking this step. Once teeth are removed, they can’t be replaced.
Periodontitis is not only divided into stages, it’s also categorised into three rates of progression. Periodontists identify exactly what type of treatment to prescribe to patients depending on whether the disease is:
Grade A - Slow progressing
Grade B - Moderately progressing
Grade C - Rapidly progressing
Obviously, the more rapid the progression, the sooner you should seek treatment.
And the younger you are, the more damage can occur. People in their early 20s can suffer from Grade C, Rapidly Progressing Periodontitis.
Caught early, gum disease can be fully reversed. But, for those who have Periodontitis, it must be managed for the rest of your life. The signs and symptoms are hard to spot in the early days of gum disease, so it’s crucial to visit your dentist regularly for check-ups and cleans. And if you notice any signs - like bleeding gums - that aren’t getting better, book in to see a specialist periodontist immediately.