Periodontitis

The reasons governing why gingivitis progresses to periodontitis or not are poorly known.
Periodontitis is caused by:
. a significant increase in the number of bacteria,
. aggression by external bacteria
specifically aggressive towards the periodontium,
. a decrease in immune defences.

The number and, more importantly, the virulence of the bacteria on the one hand, and the host response (your defence system) on the other hand, are decisive in the triggering and progression of

Periodontitis, a gum ailment...

During periodontitis, your gum detaches from your tooth, thus forming a periodontal pocket. The depth of the pocket is an indication of the severity of the periodontitis.

. Mild: periodontal pocket between 4 and 5 mm
. Moderate: periodontal pocket between 6 and 7 mm
. Severe: periodontal pocket > 7 mm

The size of the pocket can be measured by your dental surgeon using a periodontal probe placed between the tooth and the gum.

... but also an ailment of the alveolar bone

Beyond the detachment of gum from tooth, the periodontal pocket is also linked to bone destruction.
This bone loss renders the teeth mobile. These latter may then move away from each other.
Furthermore, the root may be exposed, this is commonly referred to as periodontolysis. If no treatment is initiated, progression will always be towards an aggravation.
When periodontium destruction is very advanced, the teeth may spontaneously fall out and tooth extraction may also be required.
Bone loss morphology plays an important role in prognosis and choice of treatment: the more bone wall is available, the greater the chance of bone reconstitution during treatment.
 

Periodontitis: chronic or aggressive, what differences?

Periodontitis can be either chronic or aggressive, local (<30% of teeth affected) or generalised (>30% of teeth affected).
 

Chronic periodontitis:

This is the most common form. It develops progressively from gingivitis in subjects aged between 30 and 40 years. The gum presents with variable inflammation, occasionally displaying shrinkage or swelling.

Aggressive periodontitis:

This is a relatively rare form (5 to 10% of periodontitis cases), generally diagnosed in 20 to 30-year-old subjects.
Women appear to be more frequently affected than men. Severity is highly variable from one individual to another.
Aggressive periodontitis progresses rapidly, occasionally presenting alternating acute and stable chronic phases.

Why is it important to rapidly consult in the event of periodontal disease?

It is important to see your dental surgeon rapidly in order to stop the situation deteriorating as damage may be irreversible.
Periodontium reconstitution, after bone loss or gum shrinkage, requires surgery.

References :
Wolf HF, et al. Parodontologie. 3rd Ed. Paris, Masson; 2005. p.21-22; 95-118.
Mouton C. Bactériologie et pathogénie des maladies parodontales. In Bercy P, Tenenbaum H. Parodontologie, du diagnostic à la pratique. 1st Ed. Bruxelles, De Boeck Université; 1996. p.37-47.
Cymes M, Hescot P. Vos dents: Qui, quoi, combien? Tour, Balland/Jacob-Duvernet; 2001. p.19-50.
Lézy JP, Princ G. Pathologie maxillo-faciale et stomatologie. Abrégés. 3rd Ed. Paris, Masson; 2004. p.79-94.