Types of Periodontal Disease
Periodontal disease (also known as periodontitis and gum disease) is a progressive disease which affects the supporting and surrounding tissue of the gums, and also the underlying jawbone. If left untreated, periodontal disease can result in loose, unstable teeth, and even tooth loss. Periodontal disease is in fact the leading cause of tooth loss in adults in the developed world and should not be taken lightly.
Periodontal disease begins when the toxins found in plaque start to attack the soft or gingival tissue surrounding the teeth. This bacterium embeds itself in the gum and rapidly breeds, causing a bacterial infection. As the infection progresses, it starts to burrow deeper into the tissue causing inflammation or irritation between the teeth and gums. The response of the body is to destroy the infected tissue, which is why the gums appear to recede. The resulting pockets between the teeth deepen and, if no treatment is sought, the tissue which makes up the jawbone also recedes causing unstable teeth and tooth loss.
There are many different varieties of periodontal disease, and many ways in which these variations manifest themselves. All require immediate treatment by a periodontist to halt the progression and save the gum tissue and bone. Here are some of the most common types of periodontal disease along with the treatments typically performed to correct them:
Gingivitis
Gingivitis is the mildest and most common form of periodontitis. It is caused by the toxins in plaque and leads to periodontal disease. People at increased risk of developing gingivitis include pregnant women, women taking birth control pills, people with uncontrolled diabetes, steroid users and people who control seizures and blood pressure using medication.
Treatment: Gingivitis is easily reversible using a solid combination of home care and professional cleaning. The dentist may perform root planing and deep scaling procedures to cleanse the pockets of debris. A combination of antibiotics and medicated mouthwashes may be used to kill any remaining bacteria and promote the good healing of the pockets.
Chronic Periodontal Disease
Chronic periodontal disease is the most common form of the disease, and occurs much more frequently in people over 45. Chronic periodontal disease is characterized by inflammation below the gum line and the progressive destruction of the gingival and bone tissue. It may appear that the teeth are gradually growing in length, but in actuality the gums are gradually recessing.
Treatment: Unfortunately unlike gingivitis, chronic periodontal disease cannot be completely cured because the supportive tissue cannot be rebuilt. However, the dentist can halt the progression of the disease using scaling and root planing procedures in combination with antimicrobial treatments. If necessary, the periodontist can perform surgical treatments such as pocket reduction surgery and also tissue grafts to strengthen the bone and improve the aesthetic appearance of the oral cavity.
Aggressive Periodontal Disease
Aggressive periodontal disease is characterized by the rapid loss of gum attachment, the rapid loss of bone tissue and familial aggregation. The disease itself is essentially the same as chronic periodontitis but the progression is much faster. Smokers and those with a family history of this disease are at an increased risk of developing aggressive periodontitis.
Treatment: The treatments for aggressive periodontal disease are the same as those for chronic periodontal disease, but aggressive periodontal disease sufferers are far more likely to require a surgical intervention. This form of the disease is harder to halt and treat, but the dentist will perform scaling, root planing, antimicrobial, and in some cases laser procedures in an attempt to save valuable tissue and bone.
Periodontal Disease Relating to Systemic Conditions
Periodontal disease can be a symptom of a disease or condition affecting the rest of the body. Depending on the underlying condition, the disease can behave like aggressive periodontal disease, working quickly to destroy tissue. Heart disease, diabetes and respiratory disease are the most common cofactors, though there are many others. Even in cases where little plaque coats the teeth, many medical conditions intensify and accelerate the progression of periodontal disease.
Treatment: Initially, the medical condition which caused the onset of periodontal disease must be controlled. At Trillium Dental Centre, the dentist will employ treatments utilized for managing aggressive and chronic periodontal disease to effectively stop the advancement of the condition.
Necrotizing Periodontal Disease
This form of the disease rapidly worsens and is more prevalent among people who suffer from HIV, immunosuppression, malnutrition, chronic stress or choose to smoke. Tissue death (necrosis) frequently affects the periodontal ligament, gingival tissues and alveolar bone.
Treatment: Necrotizing periodontal disease is extremely rare. Because it may be associated with HIV or another serious medical condition, it is likely the dentist will consult with a physician before commencing treatment. Scaling, root planing, antibiotic pills, medicated mouth wash and fungicidal medicines are generally used to treat this form of the disease.
If you have any question or concerns about the different types of periodontal disease and treatments, please ask your dentist.
Recognizing the Different Forms of Gum Disease
Periodontal disease is not one single condition — it covers a range of related conditions with different patterns and severities. Understanding which type you have shapes the treatment plan. The classification has been updated over the years; the most current framework recognizes gingivitis (the earliest, reversible stage), several stages of periodontitis (with progressive bone loss), and a few specific subtypes for unusual presentations.
Gingivitis is the earliest stage, where the gums are inflamed but no bone has been lost. Gums look red, swollen, and tend to bleed when brushed. This stage is fully reversible with thorough professional cleaning and improved daily home care. Most adults experience some degree of gingivitis at some point; consistent attention to it prevents progression.
Once bone loss begins, the condition moves from gingivitis to periodontitis. Periodontitis is classified by both severity (how much bone has been lost) and pattern (whether it affects all teeth or specific areas). The current staging system divides periodontitis into four stages — Stage I (mild), Stage II (moderate), Stage III (severe with potential tooth loss), and Stage IV (advanced with tooth loss already occurred or imminent). Each stage involves different treatment approaches.
Common Types and Patterns
Different forms of gum disease show specific patterns:
- Gingivitis — inflammation of the gums without bone loss; reversible with cleaning and home care
- Stage I periodontitis (mild) — 1-2mm of bone loss with pocket depths up to 4mm; usually responds well to non-surgical treatment
- Stage II periodontitis (moderate) — 3-4mm of bone loss with pocket depths up to 5mm; non-surgical treatment plus more frequent maintenance
- Stage III periodontitis (severe) — 5mm or more bone loss with deep pockets and potential tooth loss; often requires surgical treatment
- Stage IV periodontitis (advanced) — significant bone loss with tooth loss already occurring; complex treatment including possible tooth replacement
- Localized periodontitis — affecting only specific teeth or areas
- Generalized periodontitis — affecting most or all teeth uniformly
- Aggressive periodontitis — rapid progression often in younger patients, sometimes with a family pattern
- Necrotizing periodontal disease — a specific aggressive form with tissue death, more common in immunocompromised patients
- Periodontitis as a manifestation of systemic disease — gum changes related to conditions like diabetes, leukemia, or certain genetic disorders
- Peri-implantitis — periodontal-like disease around dental implants rather than natural teeth
Most patients have either gingivitis or one of the four stages of chronic periodontitis. The aggressive and necrotizing forms are uncommon. Knowing which form you have shapes both treatment intensity and long-term monitoring.
Treatment Tailored to the Type
Treatment depends on which type you have. Gingivitis usually responds to one or two thorough cleaning visits combined with improved home care, with reassessment in six to eight weeks. Stage I and II periodontitis is treated with scaling and root planing (deep cleaning under local anaesthetic) plus more frequent maintenance visits, with re-evaluation to confirm response. Stage III often requires surgical treatment in addition — pocket reduction, bone regeneration, or grafting where the bone loss has been most significant. Stage IV may involve some teeth that cannot be saved, with the plan including extraction and replacement options.
Aggressive forms of periodontitis need different consideration. The rapid progression suggests an exaggerated inflammatory response, sometimes with genetic underpinnings. Treatment may include antibiotic adjuncts in addition to mechanical cleaning, and more intensive long-term monitoring. Family members may be at higher risk and benefit from screening.
Long-term management is essential for all forms except gingivitis. Once bone has been lost it does not grow back on its own. Treatment aims to stop progression and stabilize the current state. Maintenance visits every three to four months (rather than every six) become the norm for most patients with treated periodontitis, with periodic re-evaluation to confirm stability.
Cost and Insurance Coverage
Trillium provides comprehensive care for gingivitis through Stage III periodontitis directly, and we refer to a periodontist for complex surgical procedures and Stage IV cases. We follow the current Ontario Dental Association Suggested Fee Guide for periodontal services. Most private dental insurance plans cover periodontal treatment under their normal benefits framework, with major procedures sometimes requiring pre-authorization.
CDCP includes periodontal services within its annual benefits framework. We submit pre-determinations to your insurer before treatment so coverage is clear in advance. Treatment of more advanced forms involves higher costs but is usually staged across visits, with each phase costed separately so you can plan financially.
Frequently Asked Questions
How do I know which type I have?
Your dentist measures pocket depths, takes x-rays to check bone level, and looks at gum tissue appearance. The combination tells them which stage you are at. They explain the findings in plain terms after the exam and discuss what treatment is appropriate.
Can I have multiple types at the same time?
Sometimes. Patients can have gingivitis in some areas and periodontitis in others, or have peri-implantitis around an implant while having healthy gums around natural teeth. Treatment addresses each area according to what it needs.
Does aggressive periodontitis run in families?
Often yes. The rapid progression suggests a genetic component, and family members of patients with aggressive periodontitis are at higher risk. If you have been diagnosed with aggressive periodontitis, it is worth mentioning to first-degree relatives so they can have screening evaluations.
If I have gingivitis, will it definitely become periodontitis?
Not always. Gingivitis treated promptly with cleaning and good home care often resolves completely without progression. Gingivitis that goes untreated for years has a much higher chance of progressing to periodontitis.
Is peri-implantitis treatable?
Yes, though it is more challenging than treating disease around natural teeth because of the implant surface texture. Treatment involves specialized cleaning, sometimes surgical access, and careful long-term monitoring. Some severe cases require implant removal.
What is the most common form?
Chronic Stage I or II periodontitis is by far the most common form in adults — slow-progressing, manageable with appropriate care. Gingivitis is even more common as a temporary state but does not always progress to periodontitis.