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.
Types of Periodontal Disease
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 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
Treatment: Initially, the medical condition which caused the onset of periodontal disease must be
controlled. The dentist will halt the progression of the disease using the same treatments used for
controlling aggressive and chronic periodontal disease.
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.
Types of Periodontal Diseases
There are many types of periodontal diseases and they can affect individuals of all ages from
children to seniors.
ingivitisis is the mildest form of periodontal disease and causes the gums to become red,
swollen, and bleed easily. There is little to no discomfort at this stage and it is reversible with
professional treatment and good home oral care.
hronic periodontitis results in inflammation within the supporting tissues of the teeth and
progressive loss of tissue attachment and bone. Progression of attachment loss usually occurs
slowly, but periods of rapid progression can occur. It is prevalent in adults, but can occur at any
age and is the most frequently occurring form of periodontitis.
is a highly destructive form of periodontal disease that occurs in patients who are otherwise
clinically healthy. This disease may occur in localized or generalized patterns and can include
rapid loss of tissue attachment and destruction of bone.
eriodontitis as a manifestation of systemic diseases. This form of periodontitis is associated
with one of several systemic diseases, such as diabetes. Patients who have rare but specified
blood diseases or genetic disorders frequently show signs of periodontal diseases.
ecrotizing Periodontal Diseases are infections characterized by necrosis (death) of gingival
tissues, periodontal ligament and alveolar bone. These lesions are most commonly associated
with pain, bleeding, and a foul odor. Contributing factors can include emotional stress, tobacco
use, and HIV infection.
The most important components in the management of HIV-associated gingival and
periodontal disease should be the removal of local irritants from the root surfaces,
débridement of necrotic tissues, and appropriate use of antibiotics.
Two types of gingival/periodontal disease associated with HIV infection have been widely
reported in the literature. In the past, these have been called HIV-associated gingivitis (HIV-G)
and HIV-associated periodontitis (HIV-P). There is now evidence that these diseases also occur
in HIV-negative immunocompromised individuals and are not specific to HIV infection, thus
making the original terms inappropriate. Therefore, HIV-associated gingivitis has been renamed
linear gingival erythema (LGE) and HIV-associated periodontitis has been renamed necrotizing
ulcerative periodontitis (NUP).
The prevalence of these two diseases remains unclear,1-3
with estimates of occurrence among
HIV-infected individuals ranging from 5% to 50%. It is not yet clear where in the spectrum of
HIV disease these conditions occur or which patients are at greatest risk for developing them.
There is some evidence that NUP is associated with a low CD4 count (<200 cells/mm3
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II. LINEAR GINGIVAL ERYTHEMA (LGE)
LGE is limited to the soft tissue of the periodontium and characteristically appears as an
erythematous linear band that extends approximately 2 mm to 3 mm from the free gingival
margin. There also may be punctate erythema, which extends onto the alveolar mucosa. At times,
these areas coalesce, creating broadly diffuse erythematous zones from the gingival margin into
the vestibule. Unlike conventional gingivitis, LGE is not significantly associated with plaque. In
most cases of LGE, bleeding is seen after gentle probing (see Appendix 3-A for photographic
The diagnosis of LGE is made on the basis of distinctive clinical characteristics (see Section
II. A. Presentation).
There is no known treatment for LGE.
III. NECROTIZING ULCERATIVE PERIODONTITIS
NUP affects the osseous structures of the periodontium. Clinical features include pain,
interproximal gingival necrosis, and cratered soft tissues (see Appendix 3-A for photographic
example). Patients frequently complain of spontaneous bleeding and deep-seated pain in the
jaws. Destruction of the periodontal attachment and bone can be extremely rapid and extensive
and may result in as much as 90% bone loss around isolated teeth in as few as 12 weeks. If left
untreated, NUP may extend into the contiguous tissues and expose the alveolar or palatal bone.
When this occurs, the condition has been called necrotizing stomatitis.
The diagnosis of NUP is made on the basis of distinct clinical characteristics (see Section III.
Systemic antibiotics, such as metronidazole, tetracycline, clindamycin, amoxicillin, and
amoxicillin-clavulanate potassium, should be combined with débridement of necrotic
As systemic antibiotics increase the patient’s risk of developing candidiasis, concurrent,
empiric administration of an antifungal agent should be considered.
Frequent appointments are appropriate and recommended in the acute and healing stages
of NUP to perform the necessary periodontal therapies, to assess tissue response, and to
monitor the patient’s oral hygiene performance.
A thorough periodontal examination should be performed at each recall session for any
patient with a history of NUP. Because the periodontal maintenance program for patients
with HIV should be individualized, oral health care providers should consider plaque
control, past severity of disease, and evidence of case stabilization when determining the
frequency of recall visits.
Published reports, supported by clinical experience, suggest that an antibiotic regimen of 250 mg
metronidazole 3 times per day for 5 to 7 days, often combined with 250 mg amoxicillin-
clavulanate potassium 3 times a day for 5 to 7 days, is effective for management of this disease.
Chlorhexidine oral rinse 15 cc twice daily has been reported to be very useful in the management
and control of NUP, and intrasulcular lavage with povidone-iodine has been shown to have a
palliative effect for patients with NUP.
Oral health care providers report their most favorable treatment responses when HIV-associated
periodontal disease is addressed in the earliest stages. Patients who have been treated for NUP
may develop repeated episodes, especially when oral hygiene levels are unsatisfactory. NUP can
be insidious, localized, and not necessarily related to plaque. Once clinical stabilization has
occurred, recall visits are generally scheduled every 3 months to detect and prevent disease
recurrence at an incipient stage.
IV. NECROTIZING ULCERATIVE GINGIVITIS (NUG)
Necrotizing ulcerative gingivitis should be treated similarly to NUP.
Necrotizing ulcerative gingivitis (NUG) has been associated with HIV infection. NUG and NUP
may represent different stages of the same pathologic process, with NUP being a later stage of