There are two main categories of gum diseases (also known as periodontal disease): gingivitis and periodontitis. Each category has its own stages of progression – early or mild, moderate, and advanced or severe.
Gingivitis is by far the most common category and is most commonly caused by the build-up of dental plaque and its inadequate removal. Dental plaque is a biofilm of bacteria and the byproducts produced by the bacteria. The gums become inflamed – red and swollen – and may bleed easily, especially during toothbrushing or flossing. When the dental plaque is removed by thorough oral hygiene, the cause of the inflammation subsides and the gums will return to a healthier state.
Gingivitis is reversible and may recur. However, plaque left on the teeth for a long time will become hardened by the minerals in saliva and will not be easily removed by normal oral hygiene methods. This hardened material is calculus (also known as tartar) and can only be removed by a dentist or dental hygienist through a prophy (dental prophylaxis) or scaling procedure.
The stages of early, moderate, or advanced gingivitis refer to the strength of the inflammatory reaction of the body. Gingivitis may occur on only one or two teeth, in several areas of the mouth, or around all teeth and gums. Its prevention is based upon good oral hygiene practices, using a correctly designed toothbrush, interdental cleaning aids, and an anti-plaque mouth rinse.
Periodontitis is also quite common, but not as common as gingivitis. It affects almost half of the adult population of the United States, with 38.5% having moderate or severe disease. It has some similar features to gingivitis.
Periodontitis occurs when the challenge from the dental plaque to the body’s defenses is stronger, and the reaction of both the bacteria and the body’s defenses results in the irreversible destruction of the tissues that surround the tooth and hold it into the jawbone. In this process, the destruction includes the attachment of the gum to the tooth. The loss of this attachment or seal allows the bacteria and their byproducts to get under the gums and help to destroy the surrounding bone and the ligament that connects the bone to the tooth. The gums may also start to recede, making the teeth look longer and yellower.
Without dental treatment, the disease process usually progresses intermittently and, over time, may result in the total destruction of the attachment of the tooth to the jaw, as well as the surrounding bone. This may result in the loss of the tooth by an extraction procedure.
Gingivitis and periodontitis are separate diseases, but it is not unusual for a patient with periodontitis to have some gingivitis as well.
Like gingivitis, periodontitis may occur just on one tooth, several teeth, or all teeth and gums. Periodontitis is one of the two most common causes of tooth loss. The other cause is tooth decay or cavities.