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Gum disease is one of the common dental problems around the world. Its two main presentations are gingivitis and periodontitis. In this article, we outline the differences between the two in terms of symptoms, treatment, and prevention.

Gingivitis and periodontitis both come under the category of gum disease and one can be said to be an extension of the other.

Gingivitis refers to inflammation of the gums [1] while periodontitis refers to inflammation of the supporting structures of the teeth which includes the gums, the periodontal ligament, and the bone which keeps the teeth firm [2].

What is the difference between these two conditions? Can both be stopped with bleeding gums treatment? How to recognize, as a patient, if you have gingivitis or periodontitis?

Gingivitis

The gums in our mouth cover the bone in which our teeth are embedded. They are, in many respects, the first line of defense of the teeth. The gums have hundreds of thousands of small blood vessels which bring bacteria fighting molecules to protect against gum disease.

When plaque starts to accumulate around the teeth, due to poor oral hygiene or food lodgment or any other reason, these blood vessels start to engorge and the various signs of inflammation begin to appear [3].

These symptoms include a reddish appearance of the gums, bleeding from the gum during brushing/eating/spontaneously, swelling of the gums, and even a slight amount of pain [4].

It only takes about 48-72 hours of plaque accumulation after which these signs of gingivitis start to become apparent. As long as the inflammation is limited to the gums, the condition is called gingivitis.

  • The treatment of gingivitis 

Bleeding from the gums is the most apparent symptom among those described and is the reason why patients end up seeking treatment from their dentist. Gingivitis is also very easily reversed. All it requires is a scaling or professional cleaning to remove the plaque from the surface of the teeth to reverse the symptoms [5].

The gums are very good at healing during this stage. All the signs and symptoms will disappear within a few days after the completion of scaling. Gingivitis can be prevented by maintaining good oral hygiene, getting a scaling done periodically (every six months is ideal), and treating any factors that make the removal of plaque difficult.

Gingivitis is left unchecked will lead to the development of periodontitis as the inflammation spreads into the supporting structures of the teeth.

Periodontitis

Once the inflammation has started to spread to the ligament and bone, it starts to cause some serious damage. In most cases, this damage is slow to progress and takes years before it starts to become serious enough to cause visible changes.

There is a small subset of patients that suffer from fast progressing periodontitis due to the presence of a systemic disease or a genetic mutation [6].

The signs and symptoms that are associated with periodontitis include the development of pockets around the teeth, the appearance of spaces in between teeth, teeth may start to become shaky, the gums may start to recede, bad breath, and eventually teeth will start to fall out [7].

Unfortunately, pain is not one of the causes of periodontitis and so patients often don’t seek treatment out until the disease has progressed quite a lot. Periodontitis has also been associated as having a contributory link to certain diseases like: 

  • diabetes,
  • preterm low birth weight childbirth,
  • build up of plaques in the arteries and more [8].
  • The treatment of periodontitis

The treatment of periodontitis requires a lot more work than gingivitis. It involves, depending upon the state of the destruction causes, scaling, root planning, gum surgeries, the use of bone grafts and soft tissue grafts to help regenerate some of the lost structures, and even the removal of a few teeth with poor prognosis [9].

Most importantly, though, periodontitis requires an excellent recall regimen from the patients to prevent a relapse. If the patient does not keep good oral hygiene after the treatment has been completed or does not get a regular scaling done, then the chances of further destruction of the structures around the teeth is very high.

Smoking is another habit that increases the severity of periodontitis and the rapidity of its spread significantly. Patients who are diabetic and smokers are at the highest risk for the development and progression of periodontitis [10].

It was believed for a long time that periodontitis was an age-related disease but that has now been proven to be false. If the teeth are taken care of then they will last a lifetime.

Conclusion

Both gingivitis and periodontitis affect teeth as well as implants that may have been placed in the mouth. It is very much in the interest of the patient to prevent gingivitis from spreading to periodontitis otherwise the length, cost, invasiveness, and success of the treatment starts to really become a factor.

Gingivitis and periodontitis are often looked at as separate conditions but periodontitis is, in fact, an extension of gingivitis in the overwhelmingly large number of cases. The slow progressing nature of gum disease also gives the patient adequate time to get the necessary intervention needed.

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