Periodontal disease refers to a group of problems that arise in the gum sulcus, the crevice between the gum and the tooth. Even in healthy mouths, the sulcus is teeming with bacteria, but they tend to be harmless varieties. Periodontal disease develops usually because of two events in the oral cavity:

• An increase in bacteria quantity.
• Change in the balance of bacterial types from harmless to disease-causing bacteria. In general, the process that causes disease is as follows:
• Harmful bacteria increase in mass and thickness until they form a film known as plaque.
• In healthy mouths, plaque itself actually provides some barrier against outside bacterial invasion. When it accumulates to excessive levels, however, plaque adheres to the surfaces of the teeth and adjacent gingiva and causes cellular injury, with subsequent swelling, redness, and heat.
• When plaque is allowed to remain in the periodontal area, it transforms into calculus (commonly known as tartar).
• This material has a rock-like consistency and adheres tenaciously to the tooth surface. The color and hardness vary depending on the age of the material and extrinsic factors, such as tobacco use. It is much more difficult to remove than plaque, which is a soft amorphous mass.
• Calculus produces injury and inflammation that eventually destroys the support structures and bone and can lead to tooth loss.

Periodontal diseases are generally divided into two groups:

• Gingivitis, which causes lesions (wounds) that affect the gums.
• Periodontitis, which damages the bone and connective tissue that supports the teeth.

Gingivitis

Gingivitis is an inflammation of the gingiva, or gums. Is nearly always chronic, but an acute form infrequently occurs.

Chronic Gingivitis - Chronic gingivitis affects over 90% of the population. It characterized by tender, red, swollen gums that bleed easily and may be responsible for bad breath (halitosis) in some cases. Treatment is very effective if initiated early in the course of gingivitis. Without good management, however, the problem can progress.

Periodontitis

Periodontitis is characterized by the following:

• Gum inflammation, with redness and bleeding.
• Deep pockets (greater than 3 millimeters in depth) form between the gum and the tooth.
• Loose teeth, caused by loss of connective tissue structures and bone.

Gingivitis precedes periodontitis, although it doesn't always lead to this more severe condition. In fact, some experts believe it is an entirely different disease. There are different categories of periodontal disease, including the following:

Chronic Periodontitis. Chronic periodontitis (also referred to as adult periodontitis) may begin in adolescence as a slowly progressing disease that becomes clinically significant in the mid-30's and continues throughout life. Some experts question whether it is a chronic unrelenting condition and suggest instead that it waxes and wanes depending on the response of the immune system in fighting the bacteria causing this disease.

Aggressive Periodontitis. Aggressive periodontitis (also referred to as early onset periodontitis) often occurs in young people. It is subdivided according to whether it begins before or after puberty. Immune deficiencies and a genetic link have been shown to be possible factors for all types of aggressive periodontitis. If the condition is localized and treated, the outlook is positive. People with severe and widespread aggressive periodontitis are at high risk for tooth loss. It is notable that according to a study in 2001, impaired infection-fighting white blood cells, together with bacterial presence, can lead to aggressive periodontitis. Stress, poor diet, smoking, and viral infections are predisposing factors for this illness.