What are the stages of periodontal disease

 prevalence of periodontal disease

According to The American Academy Of Periodontology, half of American adults suffer from gum disease. Another study showed that over 90% of the world's population have chronic gingivitis to some degree.
Gingivitis is one of the most common diseases in the world, the leading cause of adults tooth loss And, like any other disease, gingivitis evolves if it has not been treated.

What is periodontal disease?

Periodontal disease is an inflammation of the tissues that surround the tooth. It is mainly of bacterial origin: Bacteria of the mouth will colonize the gum triggering an inflammation that will progress towards the bone.
The periodontal disease first affects the gum resulting in gingivitis, you will notice changes in the gum such as redness, swelling and bleeding, then it progresses to the bone to destroy it causing periodontitis, which is more severe. The signs may be the same as gingivitis associated with bone damage.
As long as the lesion is limited to the gum, the disease is reversible by adopting good oral hygiene and a visit to the dentist for better plaque control. However, if the bone is affected, the disease is irreversible because the bone cannot be regenerated.
reversible and no reversible gingivitis

What are the stages of periodontal disease?

The evolution of periodontal disease goes through 4 stages as long as the factors are present (tartar, plaque, certain drugs, stress, tobacco ...) the lesion will continue to progress in this order: Gingivitis, mild periodontitis, moderate periodontitis, and advanced periodontitis.


first stage of periodotal disease: gingivitis This is the earliest stage of gum disease. The bacteria in the dental plaque irritate the gum by releasing toxins. Inflammation occur causing a change of color and may be associated with bleeding during brushing and flossing. At this stage, good dental hygiene is enough to reverse it. But, untreated, gingivitis can turn into periodontitis which is irreversible.

Slight Periodontal Disease

second stage of periodontal disease: Slight Periodontal Disease The inflammation has evolved. Swelling and redness of the gums are more noticeable, the gums tend to bleed on their own and start to pull away from the teeth, forming spaces known as periodontal “pockets.” They constitute a reservoir for debris and bacteria, promoting the spread of inflammation to the bone. The surrounding bone becomes irreversibly damaged both by bacterial toxins and by the immune system’s response to infection.

Moderate Periodontal Disease

third stage of periodontal disease: Moderate Periodontal Disease The symptoms of periodontitis become more severe as inflammation spreads, and some discomfort may occur. Half of the bone supporting the tooth is destroyed causing mobility and loosen teeth. The gum continues to recede as long as the inflammation is persistent.

Advanced Periodontal Disease

fourth stage of periodontal disease: Advanced Periodontal Disease A major cause of tooth loss in adults, the tooth is supported only by a small amount of bone, among the most marked signs: red, swollen gums marked by painful abscesses that are the result of the infection spreading beneath the gums, cold sensitivity, further loosening of teeth, painful chewing, and severe halitosis.

Factors that trigger and worsen periodontal disease

Gingivitis vs periodontitis

Bacterial plaque

Dental plaque is the main factor in periodontal disease. It is a bacterial deposit adhering to the teeth capable of turning into tartar more adherent and more resistant. The persistence of the plaque will cause the proliferation of aggressive bacteria capable of triggering periodontal diseases leading to periodontitis.


With age, the amount of bacterial plaque increases and the immune defense potential decreases. Thus, the prevalence and severity of periodontal disease increase with age, peaking at age 60. Chronic periodontitis is the most encountered in the elderly, it is characterized by slow and continuous bone destruction.


Tobacco is an important risk factor for periodontal diseases because it increases its prevalence, course, and severity. In addition, smokers have an unfavorable response to treatment due to the biological effects of tobacco on the cells responsible for scarring. Smokers present compared to non-smokers:
  • 6 times more risk of developing gum disease.
  • More periodontal pockets (an advanced sign of periodontal diseases).
  • More gum recessions (the exposure in the roots of the teeth caused by a loss of gum tissue).
  • More bone loss
  • More dental loss
  • Less gum bleeding (which can hide early signs of gum disease)
Stopping smoking improves periodontal health.

General diseases and drugs

Certain general diseases and their treatments will be the cause of periodontal diseases. It has been recognized as the sixth complication of diabetes. This is due to the fact that it potentiates the effects of the pathogenic bacterial flora. It also alters the host's immune response, collagen metabolism, and vascularity. Conversely, periodontal disease leads to the release of molecules that disturb glycemic metabolism. In addition to diabetes, there are other diseases such as leukemia, and certain viral infections.
Likewise, certain treatments taken by the patient decrease the salivary flow and increase their vulnerability to periodontal diseases. These are mainly antidepressants, antihistamines, and β-blockers. Other drugs like ciclosporin, phenytoin and nifedipine will induce gingival hyperplasia.


Stress is a factor that aggravates gum disease. Patients with inadequate stress behavior strategies are at greater risk for severe periodontal disease. Stress is associated with poor oral hygiene, increased glucocorticoid secretion that can depress immune function, increased insulin resistance, and potentially increased risk of gum disease. Men who reported being angry on a daily basis had a 43% higher risk of developing gum disease compared with men who reported being angry seldom.


In 40 to 80% of people, there are genetic factors that predispose to the disease; periodontitis is therefore in a way hereditary. Knowledge of hereditary factors is important because it will allow identifying individuals who are at risk of developing periodontitis within the family of the patient and therefore, try to prevent its occurrence by regular control.

How to reverse the initial stage and prevent periodontal disease

Dental plaque is made up of different types of bacteria that establish connections between them in order to survive and increase their virulence factor. It must be eliminated before any treatment because it is considered the main factor of gingivitis and periodontitis.
Good control of plaque makes it possible to reverse gingivitis. It allows the gum to regain its normal appearance and prevent gingivitis from becoming irreversible periodontitis.

If you notice that your gum is abnormal (if your gums bleed when flossing, brushing, or simply when you bite into an apple), it is probably the early stage of gingivitis. The first thing you need to think about is to eliminate the bacterial plaque. I recommend you to:

  • 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 prevents the film that covers the teeth from becoming plaque, which is more difficult to remove.

  • Floss your teeth once a day. Flossing helps you to eliminate 30% of the remaining plaque between the teeth, inaccessible to brushing. You can also use an interdental brush if your teeth are not tight. Oral irrigator will also be effective. A study has shown that oral irrigator reduces inflammation of the gums.

  • Ask your dentist if you should use a mouthwash. The mouthwash is an antiseptic solution that eliminates aggressive bacteria from our mouth responsible for gingivitis. But the mouthwash should not be used continuously, hence the importance of seeking the advice of your dentist.

  • Stop smoking. Tobacco is a risk factor for gum disease. Stopping smoking improves periodontal health. Control your general health. Some diseases aggravate gingivitis especially diabetes, some infections, and hormonal modifications.

  • Balance your diet. Certain vitamins have been shown to play a role in periodontal health. Links have been established between, for example, vitamin B12 deficiency, gingival bleeding, and periodontitis.