Periodontitis

What is periodontitis?

Periodontitis is a serious form of gum disease. It’s a bacterial infection that starts by inflaming the soft tissues around your teeth. Left untreated, it erodes the bone that supports your teeth, leading to mobility and tooth loss.

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 over.

Who does periodontitis affect?

Periodontitis is fairly uncommon in people under age 30. It’s more likely to happen as you age. Still, it can affect anyone with poor oral hygiene — those who don’t brush their teeth and floss regularly. Some people are also more genetically prone to periodontitis than others. If your biological parents or grandparents have a history of gum disease, you’re more likely to develop it as well.

What are the symptoms of periodontitis?

Healthy gums are firm to the touch and fit snugly around your teeth. In comparison, periodontitis symptoms include:

• Reddish or purplish gums.
• Swollen gums.
• Gums that bleed easily.
• Tender gums.
• Bad breath.
• Pus (infection) around your gum line.
• Loose teeth.
• Tooth loss.
• Gum recession (when your gums pull away from your teeth).
• Pain when chewing.
• New gaps or spaces between your teeth.
• Changes in the way your teeth fit together.

What causes periodontitis?

The main cause of periodontitis is poor oral hygiene. Bacteria cling to plaque and tartar on your teeth surfaces. If you don’t clean your teeth as well or as often as you should, bacteria travel down beneath your gum line, where your toothbrush and floss can’t reach. These harmful bacteria erode the tissues that support your teeth, leading to infection, bone loss and tooth loss.

Other factors can increase your risk of developing periodontitis, including:

Other risk factors for periodontitis

• Smoking, the most significant factor, weakens your body’s ability to fight infection.
• People with diabetes have a higher risk of developing infections, including periodontitis.
• Your genetics and family history can put you at higher risk for gum disease.
• Hormonal changes in women and people assigned female at birth, such as pregnancy or using birth control pills, can increase your chances of developing periodontitis.
• Health conditions that cause inflammation in your body — such as arthritis, COVID-19 and cardiovascular disease — are linked to periodontitis.

What happens if periodontal disease goes untreated?

Periodontal disease progresses and becomes more problematic over time. There are four gum disease stages, including:

1. Gingivitis: This is early-stage gum disease and it’s less severe than periodontitis. With gingivitis, your gums become red and swollen, but you haven’t started losing bone around your teeth yet. Gingivitis is reversible if you clean your teeth better and go to your dentist regularly for cleanings.
2. Mild periodontitis: Left untreated, gingivitis turns into mild periodontitis. At this stage, your gums pull away from your teeth and you begin to lose some bone around them. As a result, you’ll develop periodontal pockets. Plaque, tartar and bacteria become trapped in these pockets, where your toothbrush and floss can’t reach.
3. Moderate periodontitis: As periodontitis progresses, you lose even more bone around your teeth. Bacteria continue to erode the ligaments and soft tissues that support your teeth and keep them healthy. At this stage, your gums may become sore and tender.
4. Severe periodontitis: When periodontitis remains untreated, the disease becomes more severe. As bone loss continues, your teeth may become loose and can potentially fall out. In addition to bleeding gums, there’s often pus and infection around your gum line, which can lead to chronic bad breath (halitosis).

In addition to poor oral health, periodontitis can result in poor overall health. Research highlights an important link between oral health and whole-body health. People with periodontitis have a higher risk of developing heart disease, stroke, dementia and other serious health issues.

How is periodontitis diagnosed?

A dentist can diagnose periodontitis during a dental examination. They’ll:

• Ask you about your symptoms and medical history.
• Examine your gums for signs of inflammation.
• Use a periodontal probe, which is like a tiny ruler, to see if you have pockets around your teeth. This test won’t hurt.
• Take dental X-rays to check for bone loss.
• Possibly refer you to a periodontist, a gum disease specialist.

How is periodontitis treated?

Gum disease treatment depends on the extent and severity of your condition. There are nonsurgical and surgical options for treating periodontitis.

Nonsurgical periodontitis treatments

Nonsurgical options often work well for people with mild to moderate periodontitis. These treatments include:

• Antibiotics: Your dentist may prescribe oral antibiotics to fight infection. Or they may place a topical antibiotic underneath your gums to target the affected area.
• Scaling and root planing: Also known as a deep dental cleaning, scaling and root planing are similar to a routine cleaning. The difference is that you’ll receive local anesthesia to numb your gums. This allows your dentist or hygienist to sweep away bacteria deep beneath your gum line. They’ll also smooth your teeth roots to deter further plaque and bacteria from accumulating. Scaling and root planing is often done in two or more visits at your dentist or periodontist’s office. It’s important that you see your periodontist a month after this cleaning to check your gums and see how well the treatment worked.

Surgical periodontitis treatments

If you have moderate to severe periodontitis, you’ll probably need surgical intervention. Surgical treatments include:

• Flap surgery: During this procedure, a periodontist (gum specialist) makes an incision along your gum line and temporarily lifts your gum tissue away from your teeth. This allows them to see your teeth roots easily and clean them thoroughly. If infection caused bone loss, your periodontist may re-contour your underlying bone ridge. This makes the affected areas much easier to clean once healing takes place.
• Dental bone grafts: If you have a lot of bone loss, your dentist or periodontist may recommend a bone graft. During this procedure, they’ll place bone-grafting material in the areas where you’ve lost bone tissue. (The material may be your own bone, donated bone or a synthetic material.) The graft serves as a scaffolding for new bone growth. The goal is to reduce your risk of future infection and tooth loss.
• Gum grafts: Periodontitis can cause your gum tissue to pull away from your teeth. This is gum recession, and it exposes your teeth roots, making them appear longer. To replace lost tissue around your teeth, your dentist or periodontist may recommend a gum graft. During this surgery, they’ll place a tissue graft around the affected teeth and suture it into place. (They may obtain the tissue from the roof of your mouth or they may purchase it from a licensed bone and tissue bank.) Gum graft surgery covers exposed teeth roots, improves your smile’s appearance and reduces your risk for further recession.
• Guided tissue regeneration: During this procedure, your dentist or periodontist places a special biocompatible membrane between existing bone and your tooth. This membrane keeps unwanted tissue from growing into the area, and encourages bone to grow back instead.
• Platelet-rich plasma (PRP): If you’ve lost bone or gum tissue, PRP can help regenerate it. Your dentist or periodontist obtains platelet-rich plasma from a sample of your own blood. After taking a blood sample, they’ll spin it in a centrifuge to separate your plasma from your red and white blood cells. Next, they’ll place the platelet-rich plasma in deficient areas to encourage new bone growth.

How can I reduce my risk for periodontitis?

The best way to prevent periodontitis is to have regular dental cleanings and practice good oral hygiene at home between visits. People who are prone to periodontitis may require more frequent cleanings than people without gum disease. Ask your dentist how often you should have your teeth cleaned to maintain optimal oral health.

Can periodontitis be cured?

Periodontitis isn’t curable, but it’s manageable with proper care and treatment. Talk to your dentist or periodontist about a personalized treatment and maintenance plan.

When should I see my dentist?

If you develop symptoms of gum disease, such as red, sore or bleeding gums, schedule an appointment with a dentist right away. Early intervention is key to getting your oral health back on track. The longer you wait, the more advanced the disease will become. As a result, you may require more extensive treatment.

What questions should I ask my dentist?

If you have periodontitis, here are a few questions you may want to ask your dentist or periodontist:

• What stage gum disease do I have?
• Do I have bone loss?
• What are my treatment options?
• How long will treatment take?
• How long will my recovery take?
• How often should I have my teeth cleaned to maintain the results of gum disease treatment?

A note from Cleveland Clinic

Periodontitis is a severe form of gum disease. Hallmark symptoms include red, bleeding and tender gums, loose teeth, bad breath and gum recession. You can’t cure periodontitis, but you can manage the condition with proper care and maintenance. This includes good oral hygiene and regular dental cleanings at intervals recommended by your dentist.