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2022 Stages of Periodontal Disease & Immediate Risk on Oral-Systemic Health

2022 Stages of Periodontal Disease & Immediate Risk on ORAL-SYSTEMIC Health

About half of all Americans have some form of Periodontal disease, which continues to increase each year. Periodontal Disease decreases your ability to fight infection and inflammation while increasing your risk of severe systemic health consequences. Few people understand the risk factors for developing periodontal diseases and the consequences it has on systemic health. 

You do not have to be a dentist, hygienist, or medical professional to recognize the warning signs or risk factors of Periodontal disease. While the earlies stages may not be obvious, oral testing and regular dental checks can determine your risk for periodontal disease. 
  1. What is Periodontal Disease?
  2. Warning Signs of Periodontal Disease
  3. Risk Factors of Periodontal Disease
  4. Stages of Periodontal Disease

What is periodontal disease

The word "periodontal" means "around the tooth." Periodontal disease, also known as gum disease, results from infections and information in the mouth. While it starts in the gums, as the stages of periodontal disease progress, infection will spread to the bone and the rest of the body, causing systemic disease and increasing the risk of heart attacks, blood clots, strokes, Alzheimer's disease, and more.

what causes periodontal disease

The mouth holds billions of bacteria; some promote health, and others prompt disease. When the mouth and teeth are not adequately cared for, bacteria infect the tissue, creating inflammation in the mouth. This will begin with mild, sometimes unnoticeable symptoms; bleeding gums, bad breath and end with a full chronic inflammatory disease - Periodontitis. Symptoms throughout the process can go from receding gums to teeth loss and most importantly, other systemic diseases.

warning signs of periodontal disease

Warning signs of periodontal disease include, but are not limited to the following:

  • Bad breath
  • Bone loss
  • Loose teeth
  • Bad taste
  • Bleeding gums
  • Sensitive gums
  • Painful chewing
  • Shifting teeth
  • Gum recession
  • Changes in of fit of dentures
  • Sensitive teeth
  • Tooth loss
  • Inflamed gums

Sometimes, the warning signs of Periodontal disease are not noticeable in a bathroom mirror. The gum might not feel inflamed. This is why regular dental cleanings with a dentist are essential. When caught in the earliest stages, Periodontal disease can be treated and reversed.  

risks factors of periodontal diseaseAAOSH Periodontal Disease Risk Factors

[Download the full infographic here]

What are common risk factors of Periodontal Disease?

 For dental and medical providers, view the "Top 6 High-Risk Inflammatory Markers" here <link> 

  • SMOKING AND TOBACCO USE could be the most significant risk factor for periodontal disease
  • GENETICS cause some patients to be more susceptible to gum disease
  • STRESS is linked to multiple diseases, including gum disease
  • MEDICATIONS can deplete essential vitamins and minerals your body needs to fight disease
  • SYSTEMIC DISEASES decrease the body's ability to fight infections and inflammation

Recent studies show that tobacco use could be THE most significant risk factor for periodontal or gum disease.


Some patients may be genetically more susceptible to gum disease despite their oral regime. Oral systemic tests are available to determine risk for periodontal disease and treatment and prevention options.

Stress is linked to multiple diseases; periodontal disease is no different. High-stress levels make it more difficult for your body to fight infections, increasing the risk of developing inflammatory conditions such as periodontal disease.

Oral contraceptives, anti-depressants, heart medications, and other drugs can affect your oral health. Medications like statins can contribute to the depletion of vitamins and minerals. Oral systemic testing can be used to evaluate and treat deficiencies.

Inflammatory diseases, including but not limited to heart disease, diabetes, and high blood pressure, increase your risk of developing gum disease. Systemic diseases can put you at higher risk for developing periodontal disease and decrease your body's ability to fight off infection and inflammation.

American Academy of Periodontology breaks down several systemic diseases linked to periodontal disease. You can read more here.

Fillings, crowns, and bridges can leak and break. If a patient has had frequent dental work in numerous areas of the mouth, they could be at risk for periodontal disease. These areas can be challenging to clean and a harbor for bacteria to form. Without proper home care and dental visits, these bacteria will multiply and cause periodontal disease - and that's just the start.

Additionally, poor oral hygiene, lack of regular dental cleanings, immunodeficiencies, and more are all considered risk factors for developing any stage of periodontal disease.  


Oral Pathogens and the Critical Role of Salivary Testing

what are the stages of periodontal disease?

Stages of Periodontal disease begin with reversible gingivitis and end with advanced Periodontal disease. Consult a dentist or periodontist if you have signs of any stage of periodontal disease.

  1. Gingivitis 
  2. Early Periodontal Disease
  3. ModeratePeriodontal Disease
  4. Advanced Periodontal Disease


The first visible sign is Gingivitis. When plaque builds up on the teeth and isn't cleaned correctly, inflammation around the gums will begin. This can cause redness or swelling and the mouth may be easily irritated and bleed when brushing or flossing. To stop the development of further stages of Periodontal Disease, proper cleaning and removal of buildup to reduce inflammation in the gums are critical. 

Gingivitis is the only reversible stage of Periodontal Disease. Gingivitis can be easy to ignore as the signs may not be painful, or plaque buildup can't be seen in the mirror. For yourselves and your patients: healthy gums don't bleed! We don't ignore bleeding on other parts of our body - why should our mouths be any different?

Early periodontal disease

This is no longer reversible, but it can be managed with proper periodontal care and cleaning. In the early stage of Periodontal Disease, inflammation has spread to the bone. The inflammation causes gums to pull away from the teeth and form periodontal "pockets." These pockets leave your mouth at risk for inevitable infection. 

Moderate periodontal disease

At the Moderate stage of Periodontal Disease, or Stage 3, inflammation in the gums spreads further into the body, putting the immune system at higher risk. Moderate Periodontal Disease puts you or your patient at risk for bone and tooth loss, increased bleeding, shifting of the teeth, and systemic disease.

There is increasing evidence to support the link between poor oral health and severe health conditions such as diabetes, cardiovascular disease, high-risk pregnancy, and more. It is imperative to consult a periodontist treatment specialist at this stage to manage the disease and stop further progression.   

advanced periodontal disease

Advanced Periodontal Disease is a severe chronic inflammatory disease and needs to be understood as such.

At this last stage of Periodontal Disease, the pockets have deepened and are open for further infection. This stage of requires surgery or laser treatment to clean the infected periodontal pockets. While it cannot be reversed, it can be managed. Tender mouth, loosening or loss of teeth, pain when chewing, or puss build up in the gums are all symptoms of the advanced stage of Periodontal Disease. When left untreated, the inflammation will spread throughout the body and cause continuous systemic diseases - diabetes, heart attacks, and Alzheimer's disease are all connected to Periodontal Disease.

The longer you wait to treat your or your patient's periodontal disease, the harder it will be to correct and the higher the chances of enduring irreversible systemic damage. 


Periodontal Disease Chronic inflammation causes a variety of these systemic disease



Do I have periodontal disease?

How can you be sure if you or your patient has periodontal disease? Oral testing can show risk factors and inflammatory markers for developing periodontal disease. Proper cleaning and regular dental checkups can lower your risk. Make an appointment with a dentist knowledgeable in oral-systemic health from AAOSH or find an AAOSH dentist to collaborate with if your patient is showing signs of Periodontal Disease. Find AAOSH practitioners here.