Periodontal (Gum) Disease Stages: When to See a Dentist

Periodontal disease, or gum disease, can be a serious condition with many ramifications for your oral health. However, it could also be harmful to your overall health. 

Gum disease is an integral part of the Mouth-Body Connection^®, which is our term for how what's happening in your oral cavity affects what's happening in other parts of your body, too. The Mouth-Body Connection explains how the inflammation from gum disease can adversely affect the body's response to the management of other systemic conditions, particularly those that are also inflammatory. Gum disease is connected to serious conditions like cardiovascular and respiratory disease, strokes, Alzheimer's, rheumatoid arthritis, diabetes, and cancer, among others. 

Gum disease is an infection. The infection attacks the tissues and bones that support your teeth and is the leading cause of tooth loss. How quickly the periodontal disease progresses depends on several factors, but once it develops, it accelerates progression when left untreated.

Per the American Academy of Periodontology (AAP), the dental specialty that focuses on gum health, there are a few specific risk factors for developing gum disease, which include:[i]

• Age: Older people are more likely to have gum disease than young people, especially those over 65.
• Smoking: Some studies show that tobacco use is one of the most significant risk factors for developing gum disease.
• Genetics: Some people are more prone to gum disease based on their heredity.
• Stress: Stress makes it harder to fight off infections like the one associated with gum disease.
• Medication: Some side effects from prescriptions you take can make your oral environment more susceptible to gum disease.
• Grinding Teeth: Patients who clench or grind their teeth can accelerate the development of gum disease resulting from the additional forces exerted on the teeth and supporting bone. 
• Systemic Illness: Other inflammatory conditions can contribute to the progression of gum disease.
• Obesity: Extra weight is often indicative of a nutrient-poor diet, which inhibits the body's ability to fight off infection, placing you at a higher risk for severe gum disease.

Gum disease has stages. The early stage of periodontal disease is gingivitis. However, if left untreated, gingivitis progresses to a more serious condition, periodontitis. Per the AAP, periodontitis is classified by stage and grade. The stage denotes the progression of the disease, and the grade communicates the rate of the disease progression and how the doctor thinks the infection will respond to treatment. [ii]

Early periodontal disease has many of the same symptoms as late-stage periodontitis, but the symptoms keep getting worse. More serious symptoms occur as the disease progresses through the gum disease stages. If you miss the early signs of gum disease, you could end up with a more severe form of the condition and face the loss of teeth and bone. For example, early-stage periodontitis has early gum recession. However, with moderate and advanced periodontitis, the gum recession worsens and leads to infection attacking the supporting bone, which makes your teeth feel loose.

The specialist for gum health in the dental profession is called a periodontist. 

The periodontist specializes in preventing, diagnosing, and treating gum disease. These dentists have specialized in this area with an additional three years of training past dental school and are experts in gum health and gum disease stages.[iii] 

There are four stages of periodontal disease: early-stage gingivitis, early-stage periodontitis, moderate periodontitis, and advanced periodontitis. Let's take a closer look at the symptoms associated with each stage. 

Gingivitis is the first stage of gum disease. It develops from plaque buildup, a combination of germs and bacteria that combine into a sticky substance, which is sometimes called biofilm. This biofilm hardens over time into calculus and tartar, which gather around your gum tissue. Tartar is challenging to remove from your teeth and is usually handled by your Smile Generation dental hygienist. As the tartar develops and increases, the buildup irritates the gums and creates the early stage of infection. Irritated gum tissue enables tooth decay to set in, also. 

Common symptoms of gingivitis are:[iv]

• Red gums
• Swollen gums
• Bleeding when brushing or flossing
• Gum tissue loss, called gum recession
• Bad breath

With early-stage periodontitis, the tartar buildups grow over the tooth's surface and begin to get below the gum line. Once the infection progresses under the gums, it can cause the tissue to separate from the teeth, forming pockets of infection that cause swelling and bleeding. Without treatment, this condition can damage the bone, leading to tooth loss. Also, the bacteria below the gum line can enter the bloodstream and travel to other parts of the body, contributing to disease progression in conditions like diabetes, rheumatoid arthritis, heart disease, and other chronic inflammatory conditions.[v]

Common symptoms of early-stage periodontitis are:[vi]

• Red, inflamed gum tissue
• Swollen gums
• Gum recession with pockets of infection where the tooth and gum come together
• Bleeding when brushing and flossing
• Bad Breath

Moderate periodontitis doubles down on the previous symptoms. While the infection deepens and grows, more damage to the gum tissue and bones occurs. Also, symptoms may intensify, making it hard to ignore while chewing. You might also notice that your teeth "feel loose," which indicates disease progression and the loss of supporting bone tissue. You might also begin to experience inflammatory responses in other parts of the body.

Symptoms of Moderate Periodontitis:[vii]

• Same as early-stage periodontitis, only more severe, i.e., more bleeding and more gum recession
• Teeth feeling loose
• Beginning of supporting bone loss
• The inflammatory response in the body to the infection 

At this point in the progression of gum disease, the infection is getting severe. Some patients experience pain while chewing and their teeth feel loose in their mouth. Patients also have sores inside their mouths accompanied by bad breath and sensitive teeth. It is also the stage where a discharge of pus from the gums, called Pyorrhea, can occur. If left untreated, patients lose their teeth, and the infection will attack the jawbone. 

Some of the common symptoms of advanced-stage periodontitis: [viii]

• Swollen, tender gums
• Bright red, dusky red, or purplish gums
• More intense bleeding of gums, spitting out blood after brushing and flossing
• Persistent bad breath
• Pus discharge between your teeth and gums
• Loose teeth or tooth loss
• Pain while chewing
• Development of new spaces in teeth
• The appearance that your teeth look longer as gums pull away from teeth 
• Changes to your bite, meaning the way the teeth come together

So, how do you know when to see a periodontist? Your regular dentist can address early-stage gingivitis and sometimes even early-stage periodontitis. However, if your gum disease progresses to moderate or advanced, your regular Smile Generation team might refer you to a periodontist for treatment.  

If you think that you don’t have gum disease, or that the bleeding in your gums is nothing to worry about, you might be right. Then again, you might not. Gum disease is more common than you think. Millions of Americans have it. The CDC suggested back in 2009 and 2010 that 64 million people have gum disease. It affects 47 percent of adults in the US 30 years or older, which breaks down to roughly one in two adults over 30. Over the age of 65, the percentage of adults that have gum disease jumps to 70 percent.[ix]

The good news is that you can stop the progression of periodontal disease. Early-stage gum infections can often be treated with improved and consistent home care. Often, diligent efforts to brush twice daily with fluoride toothpaste for at least two minutes, daily flossing, and using a medicated mouthwash can give your oral health the boost it needs to fight off infection. 

We always want to see you here at your Smile Generation dental practice. However, we especially want to see you as soon as you notice early signs of gum disease. At the first sign of swollen gums or bleeding when you brush and floss, you should call your Smile Generation dental office and make an appointment, especially if you already have another chronic inflammatory disease diagnosis. When it comes to gum disease progression, the Mouth-Body Connection is clear inflammation in the body is not good for your gum disease and vice versa.

Millions of Americans have gum disease, and many don't know it. If you think you might be one of them, why risk the future of your healthy teeth and gums and the health of your body by avoiding the dental chair? Find a Smile Generation dentist here that can help. Treating gum disease today could save your teeth tomorrow.