What are the types of periodontal disease

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According to The American Academy Of Periodontology, half of American adults suffer from periodontal disease (gum disease). Another study showed that over 90% of the world's population have chronic gingivitis to some degree.
Periodontal disease is one of the most common diseases in the world and the leading cause of adult tooth loss.
Two main types of periodontal disease can affect people differently: Gingivitis and periodontitis. Each of these two types has a classification according to the causes and symptoms.

The two main types of periodontal disease: Gingivitis and periodontitis

Gingivitis is the initial stage of periodontal disease where inflammation is limited to the gum tissue, it is the only reversible stage with good oral hygiene. Signs of gingivitis include redness, swelling and bleeding when brushing or with a meal, sometimes the bleeding can be spontaneous (the gum bleeds on its own) often indicating a severe form of gingivitis. Left untreated, gingivitis can quickly develop into periodontitis.

We talk about periodontitis when the inflammation is no longer limited to the gum tissue and has progressed deep into the tissues reaching the bone. This is a non-reversible stage because the bone supporting the tooth is destroyed. Periodontitis requires treatment by your dentist in addition to rigorous oral hygiene.

The most common types of gingivitis

Plaque-induced gingivitis

It is the most common form of gingivitis. The inflammation is limited to the gum tissue which is reversible after treatment, that is, causing no tissue damage. The cause is the dental plaque: A white or yellow-colored deposit rich in bacteria that sticks to the teeth.

The bacteria in the plaque will colonize the gum causing inflammation that will progress in depth leading to periodontitis. Gingivitis signs include redness, swelling, bleeding when brushing or spontaneous in the most severe form.

Non-plaque induced gingivitis

  • Gingivitis linked to infection: Certain general infections can affect our gums, they can be bacterial (syphilis) or viral (HIV, herpes...) or fungal (condidosis). The common signs of these infections are limited and painful ulcerations on the gum tissue.
  • Gingivitis due to irritation: Sometimes gingivitis is triggered by us, especially after aggressive brushing, a meal, a reaction from a foreign body or a deep tattoo.
  • Gingivitis due to allergic reactions: Some products can trigger allergic reactions such as toothpaste, mouthwashes, chewing gum or food additives. If you suspect an allergy to a product (you will notice extensive lesions sometimes associated with edema and tingling or burning sensations after using the product.), stop using it and replace it with another.

The most common types of periodontitis

Chronic periodontitis

It is the most common type of periodontitis, affecting mostly adults but can occur at any age. The inflammation has reached the tissues surrounding the tooth causing progressive destruction of the bone and the tooth attachment system, causing mobility or even fall of the tooth and recessions of the gum tissue. Chronic periodontitis responds well to treatment in the absence of general diseases and if the patient is motivated and consults at the first signs.

Aggressive periodontitis

This form of periodontitis mainly affects young people but can also affect adults. It can occur even with good general health and a low amount of bacterial plaque which confirms the role of genetics in aggressive periodontitis. Its progression is rapid and severe resulting in rapid loss of teeth.

Wide variation by ethnicity has been reported:
Region Aggressive Periodontitis
North America 0.4 - 0.8%
South America 0.3 - 1%
Western Europe 0.1 - 0.5%
Africa 0.5 - 5%
Asia 0.4 - 1%
Caucasian 0.1 - 0.2%

Necrotizing periodontitis

This type of periodontitis is an emergency that must be quickly managed due to discomfort and the risk of systemic infection. It has a rapid and abrupt onset, occurs in the presence of a group of virulent bacteria and a weakened immune system which may be due to viral infections, hemopathies, immunosuppression, stress, malnutrition, tobacco ... Necrotizing periodontitis causes necrosis of the tissues surrounding the tooth (cell death) and painful ulcerations on the gum tissue associated with bleeding, halitosis, fever and lymphadenopathy.

Periodontal abscess

Gum abscess is a dental emergency, it is the consequence of a persistent and untreated infection. Its location on the gum is different, but the process is the same: some virulent bacteria will trigger reactions in the tooth or the surrounding tissues. The products of these reactions (dead cells, inflammatory mediators, bacterial products) will form what is called pus. This pus will be collected in an area leading to an abscess. Different types of abscesses can occur including gingival abscess, periodontal abscess, periapical abscess and pericoronary abscess.

Periodontitis as a manifestation of systemic diseases

often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.

Common Causes of periodontal Disease

The main cause of periodontal disease is bacterial plaque. However, other factors predispose and aggravate periodontal disease.
Here are some of the most common causes of periodontal disease:

Habits and behaviors

Some bad habits and behaviors such as smoking, abusing alcohol, snacking between meals and stress are risk factors for periodontal disease.
Tobacco makes the gums more sensitive to bacteria and inhibits the action of the immune cells that protect us.

Smokers present compared to non-smokers:
  • 6 times more risk of presenting periodontitis
  • More pockets
  • More deep pockets
  • More recessions
  • More bone loss
  • More dental losses
  • Less gum bleeding (which can mask early signs of periodontitis)
Stopping smoking improves periodontal health

Stress is also an important factor. Patients with inadequate stress behavior strategies (defensive coping) are at greater risk for severe periodontal disease.

General Infections

Infections with certain viruses such as HIV can cause periodontal diseases by weakening our immune system. Epidemiological studies have shown that HIV-infected populations, compared to non-HIV-infected populations, have greater attachment loss and bone lysis, and more gingival recessions.

Hormonal modification

Hormonal modification can occur after puberty, menopause, pregnancy or after taking a drug. This has the consequence of modifying the tissue metabolism, the imbalance of the immune system as well as the growth of certain bacteria. Periodontal disease is manifested by severe gingivitis.

Drug-Induced Disorders

Some medications significantly decrease salivary flow. These include antihypertensives, narcotic analgesics, some tranquilizers and sedatives, antihistamines, and antimetabolites. Other drugs, particularly those in liquid or chewable form that contain added sugar, alter the pH and composition of plaque, making it more able to adhere to tooth surfaces.


Low dietary intake of calcium and vitamin C has been associated with periodontal disease. People who consume less than the recommended dietary allowance (RDA) for calcium and vitamin C have slightly higher rates of periodontal disease.

Treatment of periodontal disease

Treatment depends on the stage of periodontal disease, its causes and the patient's condition and motivation.

Gingivitis does not require surgical treatment or antibiotics, good oral hygiene is sufficient to treat it. The patient must be motivated enough to apply daily care at home.

Periodontitis treatment is different. The initial stage requires scaling and root planing to clean the tooth surface in addition to an antibiotic to eliminate persistent bacteria in the tissues surrounding the tooth. In an advanced stage, surgical treatment is required to thoroughly cleanse the tissue and rebuild the receding gum tissue.