Periodontitis

Overview

What is periodontitis?

Periodontitis means “inflammation around the teeth.” As a severe form of periodontal disease (gum disease), it harms the pink tissue holding your teeth in place.

Potential problems go beyond inflamed gums, too. If you don’t get treatment, periodontitis can destroy the bones in your mouth and lead to loss of teeth. Fortunately, you can take steps to prevent this serious disease.

What happens when you have periodontitis?

Periodontitis causes your gums to become very inflamed. They may turn red, swell and bleed. The inflammation is so severe that pockets of air also develop between your gums and teeth.

Bacteria enter and flourish in these pockets, leading to infection below the gum line. Your immune system then starts to fight the infection. It eventually breaks down the tissue and bone holding teeth in place. This response can lead to the loss of teeth.

How common is periodontitis?

Periodontitis affects more than 47% of adults over age 30 in the U.S. That number jumps to around 70% for adults 65 years and older.

Who is at risk for periodontitis?

Periodontitis is fairly uncommon in people under age 30. Still, it can affect anyone with poor oral hygiene — those who don’t brush their teeth and floss regularly.

Periodontitis is more likely to happen as you age, though. That’s because years of poor oral hygiene take their toll. Before you get periodontitis, you’ll develop gingivitis, a less severe form of gum disease. If you don’t get treatment for gingivitis, periodontitis can happen.

Men are also more likely to get periodontitis. One possible reason is that men are less likely to get regular dental care. They also tend to have worse dental health.

Other factors that can increase your periodontitis risk include:

  • Smoking (most significant factor), since it weakens the body’s ability to fight infection.
  • Diabetes, since people with diabetes are at higher risk for developing infections.
  • Medications that lower the production of saliva, which protects your gums. These medicines include antihistamines, antidepressants and drugs for hypertension (high blood pressure).
  • Genetics — you may have genes that put you at higher risk.
  • Hormonal changes in women, such as pregnancy or using birth control pills.
  • Diseases that limit the immune system’s response, such as cancer or AIDS. These conditions can lead to necrotizing periodontitis, the most severe form.

Symptoms and Causes

What causes periodontitis?

A buildup of bacteria in the mouth can eventually cause periodontitis.

All of our mouths have bacteria — that’s healthy and normal. But some types of bacteria mix with mucus (fluid we produce) and other substances. This combination forms a film on our teeth called plaque. When you brush and floss, you get rid of plaque. But if you don’t do so regularly, the plaque hardens and forms tartar. You can’t get rid of tartar through brushing — you need a professional dental cleaning.

The buildup of plaque and tartar leads to gingivitis, an inflammation of the gingivae (gums). Your gums start to swell and bleed. You can treat gingivitis through good dental care, including brushing, flossing and professional cleanings. But untreated gingivitis leads to periodontitis.

What are periodontitis symptoms?

Symptoms of periodontitis include:

Gums that:

  • Bleed.
  • Grow red, swollen and tender.
  • Recede (tissue pulls back, so more of your teeth show).

Teeth that:

  • Become loose.
  • Feel sensitive.
  • Get surrounded by pus.
  • Look like they’re longer (from receding gums).

Other symptoms include:

  • Bad breath.
  • Change in your bite (way your lower and upper teeth come together).
  • Painful chewing.

Diagnosis and Tests

How is periodontitis diagnosed?

You dentist will:

  • Ask you about your symptoms and medical history.
  • Examine your gums for signs of inflammation.
  • Use a special ruler to see if you have pockets around your teeth. This test won't hurt.
  • Take an X-ray to check for bone loss, if necessary.
  • Possibly refer you to a periodontist, a specialist in gum disease.

Management and Treatment

How is periodontitis treated?

Your gum disease treatment plan depends on how severe the condition is. Treatments range from deep cleaning to surgery. No matter what type of treatment you have, it’s important to maintain good dental hygiene after treatment. Doing so will keep your mouth healthy.

How does deep cleaning treat periodontitis?

During a deep cleaning, your provider removes plaque. Providers use methods called scaling and root planing, which they may do with a laser:

  • Scaling scrapes off the tartar from above and below the gum line.
  • Root planing gets rid of the rough spots on the roots of the teeth. It helps remove the bacteria that cause periodontitis.

Will I need medication for periodontitis?

Your provider may prescribe an antimicrobial mouthwash or antibiotic gel. These treatments can reduce bacteria in your mouth.

Will I need periodontitis surgery?

If you have severe periodontitis, your provider may recommend:

  • Flap surgery: Your periodontist lifts back the gums and removes tartar deposits in the pockets around the teeth. The gums then get sutured (stitched) closely around the teeth.
  • Bone and tissue grafting: This procedure uses natural or synthetic (artificial) bone. Your periodontist grafts (connects) it to any areas of lost bone to promote growth. Your provider may also use a procedure to help the gum tissue regenerate (regrow).

Prevention

Can I prevent periodontitis?

Periodontitis is preventable. Take steps to prevent gum disease:

  • Brush teeth twice a day.
  • Floss regularly.
  • Have regular dental checkups and cleanings.
  • Quit smoking.

Outlook / Prognosis

What is the outlook for people with periodontitis?

Periodontitis is a serious condition. It can lead to permanent tooth loss. If you have any symptoms of gum disease, such as gum sensitivity or bleeding gums, see your dentist. The sooner you get treatment, the more likely you can stop periodontitis from getting worse.

Once you’ve had treatment, take good care of your teeth and gums to prevent gum disease from happening again.

Living With

How can I take care of myself?

Care for your gums and teeth to keep them healthy:

  • Brush twice a day, using a toothpaste with fluoride. Fluoride helps fight cavities and strengthens teeth.
  • Floss regularly to remove plaque and food from between your teeth.
  • Get regular dental checkups and cleanings.
  • Quit smoking.

What should I ask my healthcare provider?

If you have periodontitis, ask your provider:

  • What treatment is best for me?
  • How can I keep gum disease from happening again?
  • What type of toothpaste and floss do you recommend?
  • What’s the best way to brush and floss my teeth?
  • How often should I get dental checkups and professional cleanings?

A note from Cleveland Clinic

Periodontitis is a severe form of gum disease. Symptoms include swollen and bleeding gums. If left untreated, periodontitis can lead to loss of teeth. Talk to your healthcare provider if you have pain or tenderness in your mouth. Fortunately, you can prevent periodontitis through good oral hygiene. Brush and floss teeth regularly and see your dentist for checkups and cleanings. You can get rid of plaque before it builds up and causes problems. By doing so, you can keep your gum and teeth healthy for the long-term.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy