The different types of periodontal disease to know

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Periodontal disease or gum disease is one of the most widespread diseases and the leading cause of adult tooth loss.
According to The American Academy Of Periodontology, half of the American adults suffer from periodontal disease.

Periodontal disease is a multifactorial disease that affects people differently. Some people will never develop periodontitis even if they never brush their teeth, while others are more likely to be affected even with good oral hygiene.

There are two main types of periodontal disease: gingivitis and periodontitis. They occur differently depending on the bacteria involved, oral hygiene habits, and immune system response.

Gingivitis

Gingivitis is the initial stage of periodontal disease where the inflammation is limited to the gum. The most common triggering factor is the accumulation of plaque and the infiltration of harmful bacteria in the gum.

Other factors can also cause the same clinical symptoms of gingivitis and lead to non-plaque-induced gingivitis. These factors include certain drugs, injuries, allergies, tumors, and autoimmune diseases.

Gingivitis is the initial stage of periodontal disease. The good news is that it is reversible after improving your oral hygiene. But, untreated, it can progress to irreversible periodontitis.
The most common types of gingivitis are:

Plaque-induced gingivitis

After a few days without brushing your teeth, bacterial plaque will accumulate on your teeth and gums. Some of them will spread beyond the gum line and activate the immune system.
Blood vessels will swell to carry nutrients and immune cells needed for self-defense, resulting in redness, swelling, and bleeding gums.

Gingivitis and general infections

Some infections can affect our gums and lead to gingivitis. These infections can be of bacterial origins such as syphilis, viral such as the human herpes virus, or fungal such as oral candidiasis.
They are associated with fever and swelling of the lymph nodes. On the gums, they can cause painful gingivitis with sometimes small and painful sores in and around the mouth.

Gingivitis and injury

Sometimes gingivitis can be triggered by an injury or trauma, especially when you brush your teeth aggressively or when food debris, such as a piece of popcorn, gets stuck between the teeth and irritates the gums.

Gingivitis due to autoimmune diseases

In some autoimmune diseases, such as pemphigus vulgaris and mucous membrane pemphigoid, antibodies made by the body attacks the gum cells.
Symptoms include painful ulcerations that develop slowly. The lesions may improve or worsen. But usually, they are persistent and chronic.

Drug-induced gingivitis

Some medications, such as nifedipine, phenytoin, and cyclosporine can cause gingival overgrowth.
This swelling makes the gums more sensitive to inflammation resulting in gingivitis.

Gingivitis due to allergy

Some foods, ingredients, and hygienic products can trigger allergic reactions in some people.
It usually appears as diffuse reddish lesions, ulcerations, and a tingling or burning sensation.
If you think you are allergic to a product, stop using it or replace it with another product.

Periodontitis

If left untreated, gingivitis can develop into periodontitis leading to severe periodontal tissue destruction.

Periodontitis is the result of the interaction of many factors. It depends on specific bacteria that can invade and destroy our tissues.

Other factors, such as smoking, stress, systemic diseases, and certain drugs, can worsen or accelerate the disease by strengthening harmful bacteria and weakening our immune system.
Different types of periodontitis can occur. The most common are:

Aggressive periodontitis

Aggressive periodontitis represents 5% to 15% of periodontal diseases. It most often affects young people, but can also occur in the elderly.
It is characterized by rapid and severe destruction of the tissues surrounding the tooth.

People with aggressive periodontitis have good overall health, and the severity of the disease does not depend on the amount of plaque or tartar. In other words, you can have a mild plaque build-up on your gums and still have severe bone destruction.
On the other hand, genetics is highly related to this type of periodontitis.

Chronic periodontitis

It is the most common type of periodontitis and accounts for 95% of all affected patients.

It begins between the ages of 30 and 40, following untreated gingivitis.
The accumulated plaque will progress towards the tissues surrounding the tooth, causing the enlargement of the space between the tooth and the gum to form what we call the periodontal pockets.

These pockets constitute a reservoir for aggressive bacteria and inflammatory products and are inaccessible to dental brushing. Untreated, these pockets will continue to progress in depth leading to the destruction of the bone which maintains the teeth. At the same time, the gums will recede, and the teeth will become looser and may eventually fall out.

Unlike aggressive periodontitis, chronic periodontitis evolves slowly, and tissue destruction occurs at long intervals.

Periodontitis as a manifestation of systemic diseases

Some systemic diseases can weaken the immune system and negatively influence the progression of periodontal diseases.

Periodontitis related to systemic diseases looks like aggressive periodontitis in terms of progression and severity. Usually associated with severe gum inflammation and pathogenic oral flora.
Among the systemic diseases capable of causing periodontal disease:

  • Blood disorders: Diseases such as Neutropenia, Leukemia, or Agranulocytosis, can disrupt the immune system and lead to severe gingivitis and periodontitis.
  • Genetic disorders: Some hereditary syndromes such as Down, Papillon-Lefevre, and Histiocytosis can lead to severe periodontitis.
  • Metabolic disorder: Some diseases that affect body metabolism, such as diabetes, can harm periodontal health. In type 1 and type 2 diabetes, hyperglycemia will stimulate the production of inflammatory products responsible for periodontal destruction, alter the function of immune cells and disrupt periodontal healing.

Necrotizing periodontal disease

Necrotizing periodontal disease is an acute and painful infection of the tissues surrounding the tooth. It includes necrotizing gingivitis and necrotizing periodontitis, depending on the tissues affected.

These diseases are due to virulent bacteria and a compromised immune response. They have a rapid and abrupt onset, resulting in severe pain, necrosis and ulceration of the gingiva, and often halitosis.

They can be limited to a few teeth or generalized over the whole mouth. The general condition can also be affected, causing fever and swollen lymph nodes.
Among the factors that predispose to necrotizing periodontal disease:

  • Stress: A high level of stress will lead to a dysfunction of the immune system resulting in a higher susceptibility to necrotizing periodontal disease.
  • Smoking: Smoking is among the most significant risk factors for periodontal diseases. It alters immune cell function, decreases blood flow to the gums, and has a toxic effect on the cells that regulate our periodontal tissues.
  • Immune deficiency: Studies have shown a strong correlation between temporary or long-lasting immune deficiency and the frequency of necrotizing periodontal disease. Patients with AIDS, blood disorders, and those on immunosuppressive therapy are more susceptible.
  • Local factors: Factors that lead to bacterial buildups such as poor oral hygiene or poorly fitting dental crowns can promote the onset of necrotizing periodontal disease.

Factors that increase the risk of periodontal disease

Many factors including habits, environment, and genetics will interact with local bacterial factors to result in one type of periodontal disease.

Some people will have gingivitis and never develop periodontitis, while others who are genetically susceptible will develop more severe forms of periodontal disease like aggressive periodontitis.
Among the factors that promote and aggravate periodontal disease:

  • Poor oral hygiene: Poor oral hygiene will lead to the accumulation of plaque and tartar on the teeth and gums, considered the primary cause of periodontal disease. -Systemic disease: Untreated systemic diseases such as diabetes, blood disorders, or hormonal imbalance can aggravate and accelerate the periodontal disease.
  • Stress: Stress increases the inflammatory products in the bloodstream responsible for periodontal destruction and weakens our immune cells. As a result, people under stress have more severe forms of periodontal disease.
  • Smoking: Tobacco contains about 4000 toxic elements for the body. It alters immune cell function and decreases blood flow to the periodontium, which can worsen periodontal disease.
  • Nutrition: Nutrition can impact dental plaque formation and composition. An extreme diet can weaken our immune system and worsen bone loss.
  • Medication: Some medications can cause gingival overgrowth and aggravate gingivitis.
  • Saliva: Saliva plays an important protective role. It covers all surfaces of the mouth to lubricate and protect them from injury and contains antimicrobial agents that prevent bacteria from invading our tissues. Certain factors such as oral breathing and medications can decrease salivary secretion and thus increase the risk of periodontal disease.
  • Teeth grinding: Teeth grinding causes excessive stress on the teeth. This will apply tension in the periodontal tissues causing tooth mobility and aggravating bone loss in periodontal disease.
  • Teeth crowding: Teeth crowding will promote plaque accumulation by making some areas inaccessible to brushing. This will increase inflammation and thus aggravate the periodontal disease.

The most common symptoms of periodontal disease

Depending on the type of periodontal disease, different symptoms may occur, among them:

  • Receding gums: receding gums are a sign of periodontal destruction. It exposes the teeth roots causing sensitivity to cold.
  • Inflamed gums: Inflamed gums are red, swollen, and bleeding. These signs exist in both gingivitis and periodontitis. Only, in the latter, they are more pronounced.
  • Abscessed gums: The formation of an abscess and the drainage of pus through the tooth indicates a severe form of periodontal disease. It usually means rapid and severe bone loss.
  • Teeth shifting: After losing bone, teeth will be looser and will tend to shift gradually. You may feel that your bite is not like it used to be.
  • Tooth mobility: Tooth mobility means that more than one-third of the bone has been lost.
  • Tooth loss: This is the final stage of periodontal disease. The tooth is held in place by a small amount of bone and will fall out.

Treatment of periodontal diseases

The treatment of gingivitis and periodontitis consists first of eliminating the cause.

The first treatment goal is to improve your oral hygiene. Your dentist or hygienist will recommend additional tools such as interdental brushes or oral irrigators.

He or she will perform supragingival scaling to remove plaque and tartar above the gum line, considered the main factors of periodontal disease.

This step aims to inform and motivate you about the importance of your oral hygiene. It will help reduce the bacterial load in your mouth and get you as close as possible to the treatment plan so that you are an integral part of it.

In gingivitis, the initial stage of gum disease, this step is usually enough to reverse it. However, regular appointments for check-ups will be necessary.

In periodontitis, where the deep tissues are affected, including bone, ligament, and cementum, a deep dental cleaning is necessary. It aims to clean the areas inaccessible to dental brushing.

Once the causes are removed, the disease will stop, and the tissues will begin to regenerate.

In more severe cases of periodontitis, deep periodontal pockets and bleeding gums persist even after deep cleaning. A surgical cleaning is therefore indispensable. It consists of opening the gums and removing the diseased tissue. After a thorough cleaning, the gum will be closed with sutures to ensure healing.

This approach allows reaching areas under the gums that regular deep cleaning cannot.

In case of significant bone loss and receding gums, surgical techniques can help regenerate and restore the damaged tissue.

Prevention

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

You can prevent gingivitis and periodontitis by maintaining good oral hygiene. Done regularly, it prevents plaque from building up and causing gum disease.

Prevention also helps reverse gingivitis and prevent it from turning into periodontitis.
Good oral hygiene habits include:

  • Brush your teeth two times a day for at least three 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 removes 30% of the remaining plaque between your teeth. You can also use an interdental brush if your teeth are not tight. Oral irrigators can also be effective. A study has shown that oral irrigators 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, viral infections such as HIV, and hormonal disorders.