Periodontal Disease

What is it?
Also known as “gum disease”, is an infection caused by bacteria that affects the supporting structures around
the teeth, which include the gums, periodontal ligament and alveolar bone. This destruction of the supporting
structures can lead to bone loss, recession, pocket formation, as well as tooth mobility. If left untreated and
neglected, it can result in the loss of your teeth.

What can you do to prevent it?

The first and foremost thing everyone should be doing to prevent gum disease is to be brushing and flossing
regularly – and doing it correctly. Brushing with the bristles pointed at a 45 degree angle toward your gums
will help to disrupt and dislodge bacteria under the gums. When flossing, you should be wrapping it around
your middle finger and control the floss with your index finger and thumb. You then should be wrapping the
floss in a “C” shape around each tooth moving it up and down the sides. Other preventative actions you can
take is to routinely visit the dentist, eat a healthy diet and to stay away from tobacco products.

Healthy Gums
Healthy gums will look firm and pink with an “orange peel” texture when dried. Pocket depths should range
from 1-3mm. Gums in this condition will not bleed when you brush or floss.

Gingivitis
“It is characterized by inflammation of the gums which can be seen as increasingly more “puffy” and red gums.
Gums in this stage will bleed upon brushing and/or flossing. Pocket depths will show a few more 4mm
pockets than gingivitis. This is reversible, it has only affected the tissues of the surrounding teeth.
 Periodontal case type I
As gingivitis progresses, it advances to the next stage of periodontal disease. At this point it is termed “early
periodontitis”. The progression of “puffy” - almost spongy - and red gums increases in severity. The
inflammation proceeds deeper into the periodontal structures and alveolar bone resulting in slight bone and
periodontal ligament loss. Pocket depths will be deeper, showing ≤4mm, resulting in CAL levels of 1-2mm.
Most of the bone loss presents as horizontal.

Periodontal case type II

Moderate periodontitis consists of an increased destruction of the periodontal structures. At this stage, the
bone loss has created noticeable support loss and mobility of the teeth may be present. The furcation of multi-
rooted teeth may be visible. Bleeding is moderate upon brushing and/or flossing and probing depths are
≤5mm pockets. CAL levels range from 3-4mm. Similar to above, most of the bone loss presents as horizontal.

Periodontal case type III

Further progression of periodontitis results in this advanced stage. There is major loss of the alveolar bone
support which is accompanied by increased tooth mobility. There is more than 30% bone loss which accounts
for common furcation involvement. The gums are very enlarged, tender as well as producing pus due to the
active and persistent exposure to bacteria. Probing depths are ≥6mm with CAL of ≥5mm. There is also ≤4
teeth lost due to periodontal disease. There is areas of ≥3mm vertical bone loss and often furcation
involvement of class II or III.
 Periodontal case type IV
Periodontal case type IV is similar to class IV, as can be seen with the same visual reference. It presents with
similar characteristics such as more than 50% bone loss, tooth mobility, furcation involvement of class II or
III, probing depths of ≥6mm, vertical bone loss of ≥3mm as well as CAL levels of ≥5mm Periodontal case
type IV is characterized by missing ≥5 teeth due to periodontal disease, as well as the need for complex
rehabilitation due to many aspects including: masticatory dysfunction, severe ridge defects, secondary occlusal
trauma and more. This stage also presents with more tooth mobility.

Proctor & Gamble 1993 “Stages of periodontal disease” table

Darby and Walsh “Periodontal and Risk Assessment.” Dental Hygiene Theory and Practice, 2015, pp. 313–353.
Alicia Froehlich DH1 “Visual Aid Project” 2019