Periodontitis is defined as an inflammatory disease of supporting tissue of the teeth caused by specific microorganisms or group of microorganisms resulting in progressive destruction of periodontal ligament and alveolar bone with periodontal pocket formation, gum recession or both.  Periodontitis is more severe form of gingivitis.  Periodontitis is usually associated with loss of periodontal attachment, loss of alveolar bone, true periodontal pocket formation, plaque and calculus deposits, bad breath, swollen gums. In severe case of periodontitis, tooth mobility may occur. Pathological migration along with furcation involvement may occur in case of periodontitis. To diagnose severity of periodontitis, dentist will measure the depth of pocket and will take an x-ray to see amount of bone loss. 

Causes of Periodontitis

Poor oral hygiene leads to accumulation of plaque and calculus deposits around the tooth structure. Plaque accumulation can also occur because of malaligned tooth or by tooth malpositioning or because of some faulty tooth restoration present. Periodontitis is caused by microorganisms adhering to the tooth structure along with overly aggressive immune response against these microorganisms.

Classification of Gum Disease

1.    Gingivitis

Mildest form of gum disease is gingivitis. Main cause of gingivitis is plaque and calculus deposits in relation to teeth. Gingivitis can be treated by patient by maintaining good oral hygiene. Patient should brush twice and should floss regularly to avoid any tartar build up. In case of gingivitis, swelling of the gums along with bleeding gums is present. Only gums are affected in gingivitis.

Gingivitis (Inflamed Gums)

2.    Early Periodontitis

Along with gums, connective tissue and jaw bone are also involved in early periodontitis. Gums are inflamed and along with that bleeding occur from gums in early periodontitis.  Recession of gums also occur.

Early periodontitis

3.    Moderate Periodontitis

Severe bone loss occurs in moderate periodontitis and periodontal pocket formation occurs in gums. Periodontal pockets may be filled with pus. Because of bone loss and connective tissue breakdown, teeth may shift. Gums are swollen and bleeding occurs profusely on probing.

4.    Advanced Periodontitis

Advanced periodontitis (advanced gum disease)

Tooth mobility occurs in case of advanced periodontitis. Bone loss can cause mobility of tooth and may even cause tooth loss. Severe bad breath is present in this stage.

Difference between Gingivitis and Periodontitis

  1. Gingivitis refers to inflammation of gums whereas periodontitis is extension of inflammation from the gingiva into the deeper periodontal tissues.  
  2. No clinical attachment loss occurs in gingivitis whereas in periodontitis, there is clinical detachable clinical attachment loss.
  3. Periodontal pocket is accompanied by periodontal pocket formation and changes in the density and height of alveolar bone. In some cases, gum recession, tooth mobility, furcation involvement, bone loss may also occur in case of periodontitis.


Gingivitis                                                Periodontitis

Various Types of Periodontitis are:

  1. Chronic periodontitis
  2. Aggressive periodontitis
  3. Refractory periodontitis
  4. Acute necrotizing periodontitis
  5. Periodontitis as manifestation of systemic diseases
  6. Periodontitis associated with endodontic lesions

Chronic Periodontitis

Chronic Periodonits occurs as a result of extension of inflammation from the gums into the deeper periodontal tissues. Inflammation of supporting tissues of teeth occurs in chronic periodontitis and along with that, progressive bone loss and attachment loss occurs in case of chronic periodontitis. It was formally known as adult periodontitis as it was frequently observed in adults. It can also occur in children and adolescents in response to chronic plaque and calculus accumulation. This led to name change from adult to chronic periodontitis.

Chronic periodontitis is most prevalent form of periodontitis. It occurs because of bacterial plaque, smoking, local plaque retentive factors such as dental calculus and faulty restorations.

Aggressive Periodontitis

Aggressive Periodontitis is characterized by rapid loss of bone loss and attachment loss occurring in otherwise clinically healthy patient with amount of microbial deposits inconsistent with disease severity and familial aggregation of diseased individuals. It was earlier known as early onset periodontitis.

Aggressive periodontitis can be universally distinguished from chronic periodontitis by age of onset (Age of onset for chronic periodontitis is usually 30-35 years and age of onset of aggressive periodontitis is between puberty and 35 years of age) , rate of disease progression (Rate of disease progression is faster in aggressive periodontitis as compared to chronic periodontitis), nature and composition of associated subgingival microflora, alterations in host’s immune response and familial aggregation of diseased individuals. Aggressive periodontitis occurs because of possible impaired immune response along with bacterial plaque, super infection with specific periodontal bacteria, smoking.

Refractory Periodontitis

Refractory Periodontitis has been defined as those cases which don’t respond to any treatment provided, whatever the thoroughness or frequency. It can occur because of abnormal host response or can occur because of resistant strains of bacteria present.  

Necrotizing Ulcerative Periodontitis

Necrotizing Ulcerative Periodontitis can occur as a result of extension of necrotizing ulcerative gingivitis into the periodontal structures leading to attachment loss and bone loss. Two types of necrotizing ulcerative periodontitis can be described on the basis of relationship to acquired immune deficiency syndrome (AIDS), Non-AIDS type necrotizing ulcerative periodontitis and AIDS – associated necrotizing ulcerative periodontitis.

Periodontitis may be associated with disorders of blood or blood forming organs such as neutropenia, leukemia or genetic disorders. Conditions associated with defective neutrophils are:  Papillon -Lefevre syndrome, Chediak-Higashi syndrome, Down’s syndrome, Hypophosphatasia.

Periodontitis may be associated with endodontic lesion. Periodontitis can also be caused by pulpal infections that have entered the supporting tissues of teeth either through apical foramen or through lateral canals.  

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