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Gingivitis vs. Periodontitis

Our mouth contains an incredible amount of bacteria.
In healthy gums, they live in harmony without causing any damage. But, when these bacteria accumulate, they will form dental plaque, which can harden into tartar.

Tartar is the main cause of gum disease. We differentiate between gingivitis which is reversible after treatment and irreversible periodontitis.

What is gingivitis?

According to The American Academy Of Periodontology, half of the American adults suffer from gum disease. Another study showed that over 90% of the world's population has chronic gingivitis to some degree.

Gingivitis means inflammation of the gums. It is the early stage of gum disease where the damage is reversible.

In this stage, the inflammation is limited to the gum and has not yet reached the deep tissue that attaches the tooth to the bone.
The gum will appear red, swollen and bleed during brushing or chewing.
Gums that bleed on their own indicate a severe form of gingivitis. Certain hormonal factors are known to trigger this, especially during puberty, menstruation, or pregnancy.

Untreated, gingivitis can turn into periodontitis where the damage is irreversible.

What is periodontitis?

periodontal tissues
Periodontitis is also an inflammation, the difference with gingivitis lies in the affected tissue.

In gingivitis the inflammation is limited to the gum, while in periodontitis, the inflammation has reached the deep tissues that hold the tooth in place including the bone, the ligaments that attach the tooth to the bone, and the cementum that covers the root.

Periodontitis is therefore an advanced stage of untreated gingivitis.
It is known by the periodontal pockets which are spaces between the tooth and the gum charged with bacteria and inflammatory products.
They are inaccessible to brushing, which highlights the need for a professional cleaning at your dentist.

Symptoms of periodontitis include:
  • Red and swollen gums
  • Bleeding gums
  • Tender teeth
  • Sore gums
  • Bad breath
  • Tooth mobility
  • Increased space between teeth (Diastema)
  • Pain during chewing
  • Gums that recede (pull away) from the teeth

How can gingivitis turn into periodontitis?

In normal conditions, our mouths contain friendly bacteria that live in harmony with our immune system.

When the balance is disrupted for various reasons, including poor oral hygiene, pathogenic bacteria will dominate and will form the bacterial plaque. Plaque sticks to our teeth and can turn into tartar if not removed.
Tartar is more difficult to remove and requires professional dental cleaning.

If the plaque or tartar remains in contact with our gums for a long time, the gums will be irritated by the toxins released by the bacteria. Inflammatory reactions will occur causing gingivitis.

The gums become red, swollen and bleed. At this stage, gingivitis is completely reversible once the cause is treated.

Untreated, gingivitis will progress in depth to affect the deep support tissues of the tooth. At this stage, we are no longer in gingivitis but in periodontitis.

In addition to the signs of gum inflammation, there is an irreversible destruction of the tissues (bone, ligaments, cementum).

The gum will recede revealing the root of the tooth. The bone and ligaments destruction will lead to mobility, increased space between teeth or even teeth loss.

The particularity of periodontitis is periodontal pockets which are abnormally deep spaces between the tooth and the gum. They constitute a favorable environment for the development of pathogenic bacteria and the accumulation of plaque and tartar, hence the rapid evolution of periodontitis.

From gingivitis to periodontitis: The risk factors

gingivitis and periodontitis risk factors

Different factors can cause gingivitis to turn into periodontitis. Among these factors:

Bacterial plaque


Plaque is a bacterial deposit that sticks to the teeth and can turn into tartar which is more resistant.
The long contact of the plaque with the gum will aggravate the inflammation and lead to periodontitis.

Stress


Stress is an aggravating factor in gum disease. Patients who have difficulty managing stress are at greater risk for severe periodontal disease.

Studies have shown that stress is linked to an increased risk of gum disease. Indeed, when we are stressed, the molecules released by our body depress our immune system and decrease the blood flow of our gums.

Men who report being stressed every day are 43% more likely to develop gum disease than men who report being rarely stressed.

Smoking


Smokers are:
  • 6 times more likely to develop gum disease
  • More periodontal pockets
  • More gum recession
  • More bone loss.
  • More tooth loss.
  • Less gum bleeding (which can hide the early signs of gum disease).

Infections


Certain viruses such as the human immunodeficiency virus (HIV) can cause periodontal disease by weakening our immune system.

Epidemiological studies have shown that HIV-infected populations, compared to non-HIV-infected populations, have more bone lysis and more gum recession.

Drug-induced Disorders


Some medications significantly decrease salivary flow which is bad for our oral health. These include antihypertensives, narcotic analgesics, some tranquilizers and sedatives and antihistamines.

Some medications may be a contributing factor to gum disease. Nifedipine, Cyclosporine and Phenytoin can cause gum swelling.

Other medications, especially those containing added sugar, alter the acidity of the mouth and the composition of dental plaque, making it more likely to adhere to the surfaces of the teeth and promoting the growth of pathogenic bacteria.

Prevention

Plaque is made up of different types of bacteria that establish connections between them to survive and increase their pathogenic factor.

You can prevent gingivitis and periodontitis by maintaining oral hygiene. When done consistently, an oral hygiene routine can prevent plaque from building up and causing gum disease.

Prevention will also help to reverse gingivitis and prevent it from turning into periodontitis.

Good oral hygiene habits include:
  • Brush your teeth 2 times a day for at least 3 minutes, with a good brushing technique and a soft bristle toothbrush to avoid hurting your gum. Brushing helps remove up to 70% of plaque.
  • Floss your teeth once a day. Flossing helps you to eliminate 30% of the remaining plaque between the teeth. You can also use an interdental brush if your teeth are not tight. Oral irrigator can also be effective. A study has shown that oral irrigator may reduce gum inflammation.
  • Learn about antibacterial treatments. If you're especially vulnerable to gum disease — for example, because of a medical condition — your dentist may recommend special antibacterial mouth rinses or other treatments to help cut down on harmful bacteria in your mouth.
  • Stop smoking. Smoking is a risk factor for gum disease. Quitting smoking will improve your periodontal health.
  • Take care of yourself. Some diseases and conditions harm gum health, especially diabetes, some viral infections and hormonal modifications.