Periodontal disease can best be described as a three-stage process starting with gingivitis, progressing to periodontitis, and finally to advanced periodontal disease. These stages are associated with bacterial accumulations, or plaque, at and below the gum line. As with other types of infections, these dental infections may worsen the diabetic state, resulting in hyperglycemia, fatty acid mobilization, and acidosis. Exacerbation of dental infection may undermine good diabetic control, and initial control may be difficult or impossible in a person newly diagnosed with diabetes who has active dental infection. Severe periodontal disease may also hamper systemic management by making chewing painful or difficult, leading the person to select foods that are easier to chew but which may not be nutritionally appropriate.