Thanks Dean -
As is so often the case, the cause and progression of the periodontitis, especially in the very early stages, can be reversed with specific treatments on a regular basis along with specific home-care maintenance. If the patient is not having regular professional prophylaxis and tissue assessment and is not doing superior home care, inflammation continues and most likely will manifest as periodontal tissue 'pockets' with bone loss over time.
The photo illustrates both tissue and bone loss that's been ongoing for a number of years. It's extremely difficult for patients (themselves) to clean/maintain deep (pathogenic) pockets adequately to avoid progressive tissue and bone loss and that's where the other complications beyond dental start to manifest.
This is not new. For many years, dentistry has emphasized the need for regular dental prophylaxis visits that include periodontal tissue assessment with the focus to avoid 'pocketing' and bone loss by following preventive maintenance.
Unfortunately, as with everything, the cost has escalated and many patients are unable to afford regular treatment.
Jackie