Gingivitis

         In this, the earliest stage of periodontal disease, inflammation is limited to the gingiva (gums) surrounding the teeth. This condition is very easily treated and controlled. Most people, at some time in their lives, will have gingivitis even though it can be prevented with good oral hygiene.

What happens: As dental plaque accumulates at the gumline, bacteria in the plaque release toxins. This causes irritation and inflammation of the gums.

Symptoms: Your gums become red around the teeth, puffy and may bleed easily when brushed or probed. These symptoms can easily be missed because there is usually no pain associated with them. If you see blood in the foam when you spit out your toothpaste or if you get minor bleeding if you use a toothpick or floss, chances are you have gingivitis and should see your dentist. If you ignore these early signs, the condition may worsen.

Variations: Although the cause of gingivitis is bacteria in dental plaque, numerous factors can affect the disease process. For example, severe gingivitis can occur in adolescents as they go through puberty. In part, this is because certain types of harmful plaque bacteria grow very well in the presence of the extra hormones that surge through a young person's body at that time.

      Another, more serious form of gingivitis, is seen most often between the ages of 16 and 30. Necrotizing ulcerative gingivitis (NUG) is associated with high levels of stress and poor oral hygiene. Smoking increases the risk of NUG, commonly called trench mouth. NUG appears suddenly; symptoms include painful gums, bleeding gums, a metallic taste, bad breath and poor appetite. Unlike ordinary gingivitis, NUG causes rapid destruction of the triangles of gum tissue between the teeth (interdental papillae).

     Adolescents need to be particularly careful about their dental care. Other preventative measures include eating a healthy diet and making sure to get enough Vitamin C.

What can be done: The best remedy for gingivitis is meticulous attention to oral hygiene. Your dentist might want to do a careful and complete cleaning of the teeth, but the rest is up to you — brush regularly and floss daily. Your dentist may give you special instructions about the proper way to brush and floss. This may feel like going back to dental kindergarten, but brushing and flossing the right way is a bit trickier than it seems. Just swiping back and forth with your toothbrush won't do the trick and could harm your gums. Twice-yearly dental visits will help ensure that the disease is caught at its earliest appearance, when it is most easily treated.

Early (Mild) Periodontitis

     Initially, this may go unnoticed by the patient. The symptoms of gingivitis typically worsen. The gums may be slightly more tender and can have a greater tendency to bleed. Periodontal pockets will measure in the range of 3 to 5 millimeters.

    What can be done: Once periodontitis has set in, good oral hygiene should remain top priority, but specific periodontal treatments will be needed. For mild periodontitis, a conservative, non-surgical approach can still be used to get the disease under control. The first step is scaling and root planing, a deep cleaning technique. If this is not successful, periodontal surgery may be necessary.

      Important: Unlike in gingivitis, the effects of periodontitis are not always reversible. Even if the disease is brought under control, it is a chronic condition that can always resurface if oral hygiene becomes lax. Patients must diligently follow up on their periodontists' recommendations.

Moderate Periodontitis

     Although periodontitis usually progresses slowly, it can worsen in bursts. Therefore, if mild periodontitis goes untreated, more bone and connecting fibers can be destroyed.

    What happens: The inflammatory response to the bacteria in your plaque continues to wreak havoc on the connective tissue and bone around the teeth. The pockets around teeth deepen as more tissue is destroyed.

   Symptoms: Gums may become even more red and puffy and bleed easily. Because there is a greater amount of tissue destruction, teeth may begin to loosen. Teeth may start to hurt when you chew or become more sensitive to hot or cold. Pockets measure 5 to 7 millimeters.

   What can be done: More extensive periodontal treatment is needed, including antibiotic treatments or surgery. Loose teeth may be splinted to stabilize them.

Advanced Periodontitis

   What happens: Bone and connective tissues continue to be destroyed.

   Symptoms: The symptoms are similar to those of moderate periodontitis, but worse. Teeth can become very loose and it may hurt to bite or chew. Because the teeth are so loosely connected to the underlying bone, they may reposition themselves in the mouth. Pressing on the gums may produce pus, a sure sign of a severe infection. Pockets measure more than 7 millimeters.

   What can be done: This stage of the disease will require surgical treatment. Loose teeth may be splinted to stabilize them.Extremely loose and/or painful teeth may need to be extracted.