Beyond Inflammation – The 4 Stages of Periodontal Disease

A recent study conducted by the CDC, estimates that nearly half of Americans 30-years-of-age or older show some form of periodontal disease— whether this ranges from mild illness, with shallow pocket formation around teeth, to severe illness involving bone loss and systemic inflammation.  For seniors, the numbers are even higher— skyrocketing to an astounding two-thirds of the population sampled.  As with most complex illnesses, early intervention is often key to a better outcome; in this case, intervention may prevent tooth and bone loss, or even later manifestations of cardiovascular disease.

Unsurprisingly, oral bacteria and plaque are the main drivers behind periodontal disease.  As a bacterial biofilm, with a complex, communal structure, plaque is much more resilient than single-celled bacteria and has greater resistance to bodily defenses and antimicrobial agents.  Even in the short term, plaque biofilms have been shown to promote the release of pro-inflammatory cytokines and enzymes from immune cells; these substances, in turn, contribute to the breakdown of the periodontal ligament— the connective tissue that holds teeth in place.

Overall, periodontal disease can be divided into several distinct several stages.

Stage 1: Healthy gums

At this stage, gum colour is normal and the probe depth of the gingival sulcus—the area where the gums meet the tooth— is minimal (approximately 2mm).  Inflammation and bleeding are absent on contact.

Stage 2:  Gingivitis

As plague builds within the gingival sulcus, an inflammatory reaction occurs.  The bacteria within the plaque biofilm emit toxins that prime the immune system, leading to sore, swollen gums that sometimes bleed easily on contact.  At this stage, the gums are commonly bright red or purple. Despite visible inflammation, however, probe depth is still minimal (approximately 3mm).  Bad breath, or a bad taste in the mouth, is common.

Stage 3: Mild Periodontal Disease

As periodontitis progresses, further separation of the gums and teeth occur—leading to deeper gingival pockets.  At this point, a probe depth of up to 6mm is not uncommon—making it difficult for the patient to properly clean the tooth.  Calculus forms in the deeper recesses of the pocket and damage to connective tissue that holds the tooth in place— attachment loss— can occur.  More aggressive cleaning options—such as root planing— are sometimes necessary to halt disease progression.  Antibiotics, such as doxycycline—that help disrupt bacterial deposits and slow support-tissue-destroying enzymes are commonly used to stop tissue loss.

Stage 4: Advanced Periodontal Disease

The final stage of periodontal disease is a sad one, where significant damage to ligaments— i.e. attachment loss—has occurred; varying levels of bone loss may also be present.  Probe depth is often excessive.  Loose, migrating teeth with increasing gaps are not uncommon—not to mention significant infection.  Often, at this point, diseased teeth require extraction and surgical grafts may be required to compensate for bone loss.

Beyond the trauma of tooth loss—which can be devastating in its own right — studies have shown a link to periodontal disease and heart disease.   In fact, a 2004 Finish study estimates the condition may raise the odds of heart and blood vessel disease by up to 20%, with an even greater risk for stroke1.  Elevated levels of c-reactive protein, an important inflammatory marker, are often shown in patients with advanced disease, which can increase the likelihood of blood clots, blood vessel blockages, heart attack, and stroke.  There are also strong associations with diabetes.

While not everyone may go on to develop the most severe form of the illness, periodontal disease is still shockingly common around the world.  Further public education on proper dental hygiene is required.

http://www.ncbi.nlm.nih.gov/pubmed/16938801

http://www.ncbi.nlm.nih.gov/pubmed/6767818

http://jdr.sagepub.com/content/early/2012/08/29/0022034512457373.abstract

http://www.ncbi.nlm.nih.gov/pubmed/15574681

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One Response to “Beyond Inflammation – The 4 Stages of Periodontal Disease”

  1. I am a big fan of your blogs! Love them!

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