Progression of Gingivitis and Periodontitis

Initial Lesion

Early Lesion

Advanced Lesion

Established Lesion

Greater vascular permeability, vasodilation, and gingival crevicular fluid

Junctional epithelial cells activate cytokines, PGE2, MMPs , and TNFa, triggering the release of PWNs to combat the infection.

2-4 Days

Apical migration of the junctional epithelium and irreversible damage to the periodontium begins

Periodontal pocket formation, bleeding on probing, periodontal ligament destruction, alveolar bone loss, furcations, and tooth mobility

Cells that are present in previous stages are present here

Time frame depends on host's reponse

60%-70% collagen loss (noted at sulcular epithelium and connective tissue), epithelial ridges are formed from inflammation and junctional epithelial cells start to proliferate

Edema and redness on the gingival margin

Cytokines recruits 2A cells, macrophages are sent to the connect tissue and release PGE2 and MMPs.

4-10 days

Epithelial ridges extends deeper, collagen loss and junctional epithelium begins to lose attachment

Progression of gingivitis

Further cytokine secretion that recruit more PMNs, macrophages, and lymphocytes

14-21 days

Clinically, the gingiva looks healthy