Periodontitis

Periodontitis (pronounced “peh-ree-uh-don-TIE-tus”) is a severe form of gum disease. It’s a bacterial infection that causes your gums to bleed and swell. Eventually, it can damage the bone that supports your teeth, leading to wiggly teeth and tooth loss.

Periodontitis is the main cause of tooth loss in adults. It’s usually the result of missing some steps in your oral hygiene routine, like not flossing enough or brushing thoroughly, or not seeing your dentist for routine cleanings. But some people are also more prone to periodontitis because of their genes. If your biological parents or grandparents have a history of gum disease, you’re more likely to develop it, as well.

If you have periodontitis, your dental care provider will plan treatment based on how much inflammation you have in your gums and how much bone you’ve lost around each tooth. There are surgical and nonsurgical treatments that can help treat this oral infection and keep your gums healthy.

Symptoms of periodontitis

Symptoms include:

• Swollen gums (may look puffy or rounder than usual)
• Discolored gums that look reddish, purplish or bright pink, rather than a healthy pale pink
• Gums that bleed easily, especially when you brush or floss
• Gum recession (when your gums pull away from your teeth, exposing the roots)
• Bad breath that doesn’t improve, even after brushing
• Tooth pain or tenderness when you chew food
• Tooth sensitivity to hot or cold foods
• Pus around your gum line
• Loose teeth

What does periodontitis pain feel like?

Often, it doesn’t hurt. Or the area may feel a little tender. In that case, you may not be able to tell that you have periodontitis. This is why it’s important to pay attention to other signs, like bleeding when you brush or floss, or swollen or discolored gums (redness).

Even if you only suspect an issue, it’s important to see a dentist. Getting diagnosed and treated early can keep the infection from doing more damage to your teeth.

Periodontitis causes

This condition happens when bacteria travel beneath your gumline and wear away the tissues that support your teeth. This leads to infection and potentially bone loss and tooth loss.

Here’s how this occurs. Each day, bacteria create a sticky film called dental plaque that clings to your teeth. If you don’t brush and floss it away, it can harden into tartar. The bacteria may travel beneath your gumline, where your toothbrush and floss can’t reach.

Even if you think you’re taking good care of your teeth, you might be missing some steps, like flossing routinely, or brushing for long enough to remove the plaque. Periodontitis results from what healthcare providers may call “poor oral hygiene,” but that doesn’t mean you’re at fault. It just means you might not realize that your teeth and gums need more TLC than they’re getting.

Risk factors

Even if you work hard to take care of your teeth and gums, there may be factors that increase your risk of periodontitis. They include:

• A family history of gum disease
• Hormone changes, like those that happen during pregnancy
• Inflammatory diseases, like diabetes and high blood pressure
• Conditions that cause a weakened immune system, including stress
• Medicines that cause dry mouth
• Smoking and vaping
• Vitamin C deficiency

Complications

Left untreated, periodontitis may lead to tooth loss and a misaligned bite (malocclusion). Long-lasting infection can increase the risk of:

• Heart disease
• Diabetes complications
• Respiratory conditions, like COPD
• Dementia or Alzheimer’s disease
• Low birth weight in babies (if you have periodontitis during pregnancy)

How doctors diagnose this condition

Dentists typically diagnose periodontitis during routine exams. During your visit, they’ll:

• Ask about your symptoms, medical history and smoking history
• Examine your gums for signs of inflammation
• Take dental X-rays to check for bone loss
• Use a periodontal probe, which is like a tiny ruler, to measure areas of bone loss (periodontal pockets) around your teeth

Periodontitis staging and grading

Dental care providers stage and grade periodontitis to see how severe it is. This helps them know which treatments may be best.

• Staging assigns a number from 1 to 4, based on the extent of tissue loss (measured in millimeters) surrounding your teeth. A lower stage means less severe disease.
• Grading assigns a letter, A, B or C, based on how fast the disease is progressing. Grade A is slow progression, Grade C is rapid progression and Grade B is in the middle.

Your provider will explain how serious the infection is, so you understand which treatments you need.

How is periodontitis treated?

Treatment depends on the severity of your condition. Options include nonsurgical and surgical procedures. Your dentist will refer you to a gum specialist (periodontist) unless the disease is mild.

Nonsurgical periodontitis treatments

Healthcare providers may use treatments other than surgery to address mild cases. Options include:

• Antibiotics: Your dentist may prescribe oral antibiotics to fight infection. They may place topical antibiotics under your gums to target the affected area.
• Oral hygiene instructions: Your dentist will review the tools, products and techniques you use to clean your teeth. They’ll tell you if you need to change your routine. They may prescribe new products, like mouthwashes that fight bacteria. A common option is chlorhexidine oral rinse.
• Scaling and root planing: Your dentist or hygienist may numb your mouth with local anesthesia and clean deep beneath your gums.

Surgical periodontitis treatments

Severe periodontitis usually requires surgery. These treatments include:

• Pocket reduction surgery: A periodontist makes a cut (incision) along your gum line and temporarily lifts your gums. This allows them to see your teeth roots and clean them thoroughly. They may offer this surgery with LANAP. This treatment uses a laser to target diseased gum tissue while sparing healthy tissue.
• Dental bone grafts: These materials help rebuild your jawbone in areas where you’ve lost bone density.
• Guided tissue regeneration: A surgeon places a tissue-friendly (biocompatible) membrane between your jawbone and tooth. This membrane keeps unwanted tissue from growing into the area and encourages bone to grow back instead.
• Gum grafts: A surgeon uses your own tissue or biocompatible tissue to fill in spots where you’re missing gum tissue.
• Platelet-rich plasma: This treatment helps rebuild lost bone or gum tissue. Healthcare providers get platelet-rich plasma from a sample of your own blood.

When should I see my healthcare provider?

If you develop sore, swollen or bleeding gums, schedule an appointment with a dentist right away. Early treatment is key to getting your oral health back on track.

The longer you wait, the worse the disease may get. As a result, you might need more extensive (and more costly) treatment. For example, you may be able to treat early-stage periodontitis with a deep dental cleaning. But late-stage periodontitis usually requires surgery, which is more expensive and invasive.

What’s the outlook for this condition?

Your outlook depends on the severity of your condition and how soon you start treatment. When you treat periodontitis early, you reduce your risk of long-term damage to your teeth and gums. Severe or untreated periodontitis can lead to bite changes, tooth loss and many other health problems.

If you have missing teeth due to periodontitis, talk to your dentist about replacement options. Dental implants or bridges can restore your smile and your oral health.

Can periodontitis be cured?

You can’t cure periodontitis. Even if you get treatment, it can come back in the future. Much depends on how you care for your teeth and gums, and how effectively your body fights off new infections.

The good news is that you can manage it with treatment. Talk to your dentist or periodontist about a personalized plan.

Can periodontitis be prevented?

The best way to prevent this condition is to see a dentist regularly and practice good oral hygiene at home. If you’re prone to periodontitis, you may need more frequent dental cleanings than someone without gum disease. Ask your dentist how often you should have cleanings to maintain healthy teeth and gums.

Gingivitis vs. periodontitis

Gingivitis and periodontitis are both types of gum disease. They both happen when the bacteria that cause plaque build up and cause an infection. But periodontitis is more severe.

If you have gingivitis, it means you have inflammation in your gums. At this point, improving your oral hygiene or seeing a dentist can often reverse the disease. But if you don’t make changes, gingivitis often progresses to periodontitis, which isn’t reversible. In addition to damaged gums, periodontitis may involve damage to the ligaments and bones that support your teeth.