Polished Tooth

A focus on
The Different Stages of
Periodontal Disease
By Niki Fontaine, RDH


Hello Readers,
I hope all your holidays were festive and enjoyable with family and friends. With the New Year beginning and we are all back from holidays, I know my focus will be on Health and Wellness, now and in the coming months. This includes diet and exercise, but also oral health. Catherine Fontaine here, known by most as Niki. My career has had a focus in most areas of dental. I have credentials in Dental Administration (DAA), and I am a Registered and Certified Dental Assistant (RDA/CDAII), and a Registered Dental Hygienist (RDH) working on an Oral Facial Myology Specialty (Pre-COM).

Many thanks to all who read my first article and The Seeker for the opportunity to continue sharing my love of prevention and dental knowledge to the readership. I hope you enjoy my second article.

To begin my second article for The Seeker, as it is Health and Wellness month, I felt it would be interesting to talk about health and wellness for the mouth. Head to toe we are connected. Oral health is important to help the rest of the body maintain health. So lets discuss the different stages of periodontal disease (gum disease) to expand on the importance of prevention of disease from my first article.

Periodontal disease (gum disease) is the irreversible and degenerative process of bleeding gums, alveolar bone loss and recession of the gums. The saying “as we get older, we get longer in the tooth” comes to mind.

As the gums, periodontal ligament and bone are the supporting structures of the teeth it is necessary to remediate the gum disease and its factors to reduce the risk of tooth loss both now and as we age.

Stages of periodontal health and disease

Healthy Gingiva (gums)

  • healthy coral pink gums
  • triangular shape gum (papilla) between teeth fits snugly and is attached firmly
  • no bleeding and pain free

Reason: Good Oral Hygiene Habits including brushing twice daily, flossing and rinsing daily, and regular dental hygiene appointments (6 months)


  • Is reversible inflammation (redness/swelling) of the gums *plaque and calculus formation.

Reason: Oral hygiene habits could be improved, more regular hygiene visits (6 months)


  • This is irreversible inflammation (redness/swelling), plus overgrowth of the tissue of the gums, and breakdown of periodontal ligament and alveolar bone, progressing to periodontal disease and tooth loss. Bad breath is also a factor here.

Reason: Oral hygiene habits must be improved, negative factors decreased if possible or controlled, increased frequency of hygiene care visits (every 3 or 4 months).

Negative Factors that affect Gingivitis and Periodontitis

  • Plaque and calculus (tarter) formation and lack of removal
* hormones and genetics: teens,
  • Pregnancy, menopause, thyroid disease, etc.
  • Poor diet and nutrition: heavy carbohydrate (starch/sugar) diet
  • Tobacco or other smoke use (vape/marijuana)
  • Alcohol
  • Drugs: can be prescription or recreational
  • Chronic systemic illnesses such as diabetes, leukemia, HIV, cardiovascular or inflammatory type illnesses etc.

Above picture: Clinical appearance of healthy gums, gingivitis and periodontitis.

  • Healthy gingival tissues (A) are pink, with no evidence of swelling or bleeding.
  • Gingivitis (B) is characterised by inflammation (redness and swelling) of the gingival tissues, particularly at the gingival margin.
  • Periodontitis (C) is characterised by poor oral hygiene, marked gingival inflammation and gingival recession, indicative of underlying breakdown of the periodontal tissues.

As we see from above, the answer is not always clear as to the root cause, there may be multiple factors or reasons for developing periodontal disease.

Pick up the February Seeker to continue reading about some of the Basics of Treatment.

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