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There are many different types of periodontitis, the most common being aggressive periodontitis, chronic periodontitis, necrotizing periodontitis, and periodontitis caused by systemic disease. No matter the type, gum disease typically occurs in four stages, namely gingivitis, early periodontitis, moderate periodontitis, and advanced periodontitis. Symptoms are usually only noticeable to dentists in the early stages, but as the disease progresses, sufferers may experience bad breath, swollen gums, a foul taste in the mouth, painful chewing, and bloody gums.

Chronic periodontitis is the most common type of periodontal disease and is characterized by gingival recession, loss of gum attachment, and periods of rapid progression. Aggressive periodontitis, on the other hand, occurs in generally healthy adults and is characterized by rapid loss of attachment, familial aggregation, and bone destruction. Necrotizing periodontitis usually affects sufferers of systemic diseases, such as malnutrition or immunosuppression, and is characterized by tissue death in the alveolar bone, gingival tissues, and periodontal ligament. Lastly, periodontitis caused by systemic disease tends to start earlier in life and is commonly seen in sufferers of diabetes, heart disease, and respiratory disease.

Gingivitis is the first stage of gum disease, a mild condition that can be treated with good oral hygiene and professional dental cleaning. Gingivitis, in short, refers to inflammation of the gums which is usually caused by a bacterial infection. Healthy people have hundreds of harmless bacteria in their mouths, but when they don’t brush and floss regularly, these bacteria interact with leftover starches and sugars from food to form plaque. In other words, substandard oral care and irregular dental cleanings will often lead to gingivitis, but the damage is fully reversible when caught early. Signs of stage one gum disease typically include gums that bleed when flossing or brushing, bad breath or a metallic taste in the mouth, as well as yellow teeth or other tooth discoloration.

Early periodontitis is the second stage of gum disease and is characterized by receding gums. When the gums become inflamed and begin to pull away from the teeth, it creates space for bacteria to multiply between the gums and the teeth. This space is called periodontal pockets, and the excess bacteria in these pockets can lead to infection. As a result, the bacterial toxins and the body’s immune response to infection can eventually damage the surrounding bone. Early periodontitis occurs when gingivitis is left untreated, and can often be reversed by eating a balanced diet and engaging in good oral hygiene habits. Signs of stage two gum disease include bleeding while brushing or flossing, and potentially some bone loss.

Moderate periodontitis is the third stage of gum disease and is often accompanied by discomfort and inflammation. Symptoms include bleeding and pain around the teeth, receding gums, and loose teeth due to the loss of bone support. As the infection spreads and the bacteria attack both the bones and the bloodstream, an inflammatory response may occur throughout the entire body. Advanced periodontitis is the fourth stage of gum disease, a serious condition that often leads to tooth loss. During this stage, the connective tissue that supports the teeth begins to deteriorate, and when the infection spreads beneath the gums, painful abscesses may form as well.