The Progression of Periodontal (Gum) Disease

Periodontal disease, more commonly known as gum disease, is one of the most widespread inflammatory diseases affecting humans worldwide. Despite how common it is, it often develops quietly, without pain, and can go unnoticed for years until significant damage has occurred.

What begins as mild gum inflammation can gradually progress into a destructive condition affecting the gums and the supporting jawbone. Over time, this can lead to gum recession, tooth mobility, and eventually tooth loss, often without obvious warning signs.

Understanding how periodontal disease develops, the stages it progresses through, and the consequences of leaving it untreated is essential. Early intervention can prevent irreversible damage, preserve natural teeth, and protect both oral and overall health.

What is Periodontal Disease?

Periodontal disease is a chronic inflammatory condition affecting the gums and the structures that support the teeth, including the periodontal ligament and the jawbone. It is caused by the build-up of bacterial biofilm and calculus around the teeth, which triggers ongoing inflammation and tissue breakdown.

This process occurs gradually and progresses through 4 distinct stages.

Stage 1: Gingivitis

Gingivitis is the earliest stage of periodontal disease and affects only the gums. It is caused by bacterial plaque building up along the gum line, triggering inflammation.

Common signs include red, swollen gums and bleeding during brushing or flossing. At this stage, there is no bone loss and the damage is limited to the soft tissues. However, if left untreated, gingivitis can progress to more advanced stages of periodontal disease.

Stage 2: Early Periodontitis

This stage marks the point where periodontal disease begins to affect the supporting structures of the teeth. Inflammation extends below the gum line, leading to early breakdown of the periodontal ligament and up to 33% bone loss around the teeth.

As the supporting bone begins to break down, the gums start to recede, following the loss of bone beneath them. This recession happens gradually and is often unnoticed, as the process can take months or years to become visible.

Alongside recession, gums may bleed or feel less firm. Whilst the symptoms may still be mild, the damage is no longer fully reversible. Treatment focuses on stopping further progression through professional periodontal care and improved plaque control.

Stage 3: Advanced Periodontitis

Continued inflammation and plaque build-up leads to further bone loss and the onset of tooth mobility. The gums recede further, often exposing the roots of the teeth, which can increase sensitivity and discomfort.

As bone support is lost, teeth begin to loosen and normal bite stability is affected. This is also the point where the body creates gaps between the teeth, in an attempt to allow saliva to reach areas of active disease.

At this stage, the damage is significant and progressive. Treatment focuses on stabilising the condition, controlling infection, and preserving remaining bone and teeth where possible.

Stage 4: Severe Periodontitis

This is the most advanced form of periodontal disease, characterised by severe bone loss, and pronounced tooth mobility. Teeth may feel loose or unstable, and normal chewing function is often compromised.

At this point, the supporting structures of the teeth have largely broken down. Chewing function is compromised, and tooth loss becomes inevitable if the disease continues unchecked.

As teeth are lost, neighbouring teeth begin to drift out of position, disrupting bite alignment. Continued bone loss also affects facial shape, as the jaw shrinks without the support provided by natural teeth.

The Link Between Periodontal Disease and Overall Health

Periodontal disease does not only affect the mouth. The bacteria associated with gum disease can enter the bloodstream and travel to other parts of the body, including the heart and the brain. This systemic spread of oral bacteria is why periodontal disease is increasingly recognised as a whole-body health issue, not just a dental one.

Research has shown a clear link between periodontal disease and cardiovascular disease, and emerging clinical evidence also suggests an association between gum disease and conditions such as dementia. This highlights the importance of recognising and addressing periodontal disease early, not only to protect teeth and bone, but to support long-term overall health.

The 21D Solution

For individuals whose periodontal disease has progressed beyond the point where natural teeth can be preserved, treatment must focus on removing the source of chronic infection, rather than managing symptoms alone.

At 21D, our approach is designed with this in mind. Through a surgical rest, diseased teeth, infected tissue, and compromised structures are carefully removed to eliminate the bacterial burden responsible for ongoing inflammation. This creates a clean, stable foundation for long-term oral health.

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