Gingivitis and periodontitis are the two main stages of gum disease. Each stage is characterized by what a Dr. Anish Patel sees and feels in your mouth, and by what's happening under your gumline.

Although gingivitis usually precedes periodontitis, it's important to know that not all gingivitis progresses to periodontitis. In the early stage of gingivitis, the gums can become red and swollen and bleed easily, often during tooth brushing.

Bleeding can be a symptom of gingivitis and it is a signal that your mouth is unhealthy and needs attention. The gums may be irritated, but the teeth are still firmly planted in their sockets. No bone or other tissue damage has occurred at this stage.

Although dental disease in America remains a serious public health concern, recent developments indicate that the situation is far from hopeless. When gingivitis is left untreated, it can advance to periodontitis.

At this point, the inner layer of the gum and bone pull away from the teeth (recede) and form pockets. These small spaces between teeth and gums may collect debris and can become infected.

The body's immune system fights the bacteria as the plaque spreads and grows below the gumline. Bacterial toxins and the body's enzymes fighting the infection actually start to break down the bone and connective tissue that hold teeth in place.

As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. At this point, because there is no longer an anchor for the teeth, they become progressively looser, and the ultimate outcome is tooth loss.

Signs and Symptoms

Periodontal disease may progress painlessly, producing few obvious signs, even in the late stages of the disease. Then one day, on a visit to your denstist, you might be told that you have chronic gum disease and that you may be at increased risk of losing your teeth. Although the symptoms of periodontal disease often are subtle, the condition is not entirely without warning signs. Certain symptoms may point to some form of the disease.

They Include:

• gums that bleed during and after tooth brushing
• red, swollen or tender gums
• persistent bad berath or bad taste in the mouth
• receding gums
• formation of deep pockets between teeth and gums loose or shifting teeth
• changes in the way teeth fit togather on biting, or in the fit of partial dentures.

Even if you don't notice any symptoms, you may still have some degree of gum disease. Some people have gum disease only around certain teeth, such as those in the back of the mouth, which they cannot see. Only a dentist or a periodontist--a dentist who specializes in gum disease--can recognize and determine the progression of gum disease.

The American Academy of Periodontology (AAP) says that up to 30 percent of the U.S. population may be genetically susceptible to gum disease. And, despite aggressive oral care habits, people who are genetically predisposed may be up to six times more likely to develop some form of gum disease.

Diagnosis

During a periodontal exam, your gums are checked for bleeding, swelling, and firmness. The teeth are checked for movement and sensitivity. Your bite is assessed.

Full-mouth X-rays can help detect breakdown of bone surrounding your teeth. Periodontal probing determines how severe your disease is. A probe is like a tiny ruler that is gently inserted into pockets around teeth. The deeper the pocket, the more severe the disease.