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