What is periodontitis?
Periodontitis is a severe form of periodontal disease. The word ‘periodontal’ refers to the tissues and structures surrounding and supporting the teeth. The common term for periodontal disease is gum disease.
Gum disease starts as gingivitis, which is the mildest form of periodontal disease. Gums become red and swollen and bleed easily, but usually don’t hurt. Because it’s usually due to poor oral hygiene, most cases are reversible with appropriate care. Without treatment, gingivitis can progress to periodontitis. According to the American Dental Association (ADA), nearly half of adults over 30 in the United States have some degree of periodontitis.
Periodontitis occurs when plaque, containing bacteria, and tartar (hardened plaque) grow below the gumline. The bacteria make toxins that irritate the gums and cause inflammation. The inflammatory response begins to destroy the supporting tissues and bones. This allows the gums to pull away from the teeth, forming pockets—or deep spaces. These pockets can become infected, which perpetuates the inflammation and tissue destruction. Without treatment, periodontitis disease progresses to tooth loss. Unfortunately, symptoms can be mild while this destruction takes place, so many people do not realize they have a problem if they don’t go to the dentist.
While plaque and inflammation are the cause, certain factors increase the risk of developing periodontitis. This includes smoking, teeth grinding, aging, and certain diseases, such as diabetes and cancer. Signs you could be headed to problems with periodontitis include teeth that look longer (due to receding gums), painful chewing, chronic bad breath, and changes in the way your teeth fit together.
Periodontitis treatment goals include eliminating the infection and preventing more tissue and bone destruction. Unlike gingivitis, this requires professional treatment. Treatment includes both nonsurgical and surgical options, depending on how advanced the disease is.
If you notice changes or problems with your teeth or gums, see your dentist without delay. The earlier you find gum disease and begin addressing it, the more likely you can reverse or stop the damage.
What are the symptoms of periodontitis?
Despite gum tissue destruction, periodontitis causes only mild symptoms in many cases.
Common symptoms of periodontitis
Common periodontitis symptoms include:
- Bleeding with brushing or flossing, which may result in spitting blood or pink-tinged toothpaste
- Gums that are red or purplish and may bleed easily (gums should be pink)
- Loose teeth, new spaces between teeth, or changes in the way your teeth touch when you bite down
- Persistent bad breath or painful chewing
- Receding gums that make the teeth look longer
- Swollen, puffy gums that may feel tender to touch; pus between the gums and teeth may be visible
Gum disease can develop and progress to periodontitis with few or no warning signs, including pain. This is one reason regular dental care is important for adults. Seeing a dentist on a routine basis can help find gum problems before the damage becomes irreversible. Professional cleanings and good dental care at home with twice daily brushing and flossing can help prevent gum disease.
What causes periodontitis?
Bacteria and inflammation are at the center of periodontitis. It starts with plaque (a sticky substance containing bacteria) and tartar (hardened plaque). Plaque constantly builds on the teeth. If it isn’t cleaned away, plaque and tartar can grow and spread below the gumline. Here, the bacteria release toxins that irritate and inflame the gums. This inflammatory response eventually destroys the tissue and bone supporting the teeth. As the support structure breaks down, the gums pull away from the teeth, forming deep pockets. The bacteria infect these pockets and the destruction progresses. Once enough tissue is gone, the tooth will fall out.
In most cases, periodontitis progresses slowly. But there is an aggressive form that results in rapid destruction and detachment of the tissues.
What are the risk factors for periodontitis?
Oftentimes, the buildup of plaque and tartar that causes periodontitis is due to poor oral hygiene. However, there are a number of factors that can contribute to periodontitis.
Risk factors for developing periodontitis include:
- Aging, with up to 70% of people older than 65 years having periodontitis
- Certain diseases, such as diabetes, heart disease, rheumatoid arthritis, and conditions that weaken the immune system like cancer and HIV infection
- Genetics, meaning the genes you are born with may predispose you to periodontitis
- Medications that cause dry mouth, such as antidepressants and some heart medicines
- Poor nutrition or obesity
- Smoking or other tobacco use and vaping
- Stress and teeth clenching or grinding
Reducing your risk of periodontitis
In most cases, periodontitis is preventable. Prevention relies on practicing good oral hygiene. This includes brushing and flossing twice a day to remove plaque and using a mouthwash to flush away any leftover debris. It also includes regular cleanings and dental exams, usually every 6 to 12 months.
Understanding your risk of gum disease is another key part of reducing your risk. If you have risk factors, you may be able to lower your risk of periodontitis by:
- Controlling chronic medical conditions, such as diabetes and high blood pressure
- Maintaining a healthy body weight through a proper diet and exercise routine
- Practicing stress management techniques
- Stopping smoking
- Talking with your doctor about your medicines if you experience chronic dry mouth
- Using dental appliances to prevent teeth grinding if your dentist recommends it
If you’re at risk of gum disease, your dentist may recommend more frequent cleanings than normal. Your dentist may also suggest seeing a gum specialist called a periodontist. This provider will perform a comprehensive periodontal evaluation to look at your baseline gum health and assess your risk.
How is periodontitis treated?
The goals of treating periodontitis include eliminating the infection, cleaning out the pockets to allow healing, and preventing progressive destruction of the supporting tissues and bone. How dentists accomplish this depends on how serious the gum disease is.
For moderate periodontitis, nonsurgical treatments may be appropriate. This includes:
- Antibiotics, which you take by mouth or use topically in the form of rinses or gels. Oral antibiotics are often necessary to completely eliminate the infection.
- Root planing, which is a dental procedure to smooth the surface of the roots of the teeth. This makes it harder for plaque and bacteria to stick to the roots.
- Scaling, which removes tartar from the surface of the teeth, including surfaces below the gumline
These treatments may be enough to encourage the gum tissue to reattach to the teeth. However, in severe cases, periodontitis surgery may be necessary. Surgical options depend on the extent of tissue and bone damage and include:
- Bone grafting, which uses pieces of your own donor bone or synthetic bone to rebuild the support around a tooth
- Flap surgery or pocket reduction surgery, which involves cutting the gum to scale and plane the roots. If necessary, the surgeon can recontour damaged bone before lifting and suturing the gums back in place.
- Gum grafting, which involves using donor tissue from the roof of your mouth to fill in receding gums
- Tissue regeneration procedures, which places a special membrane or gel with tissue-stimulating proteins between the tooth and existing bone to encourage bone regrowth
Sometimes, it isn’t possible to save a tooth when damage to the supporting tissue and bone is severe. If this is the case, tooth extraction may be necessary.
What are the potential complications of periodontitis?
The main complication of periodontitis is tooth loss. In fact, it is the most common cause of tooth loss in American adults. When periodontitis has progressed to tooth loss, dental implants may be an option to restore your teeth. To be a candidate, you must first make your gums healthy and free of periodontal disease. You also need to have adequate bone left to support the implant.
It’s also possible for the bacteria that cause periodontitis to infect surrounding bone and even enter the bloodstream. This can cause problems in other areas of the body, such as the heart and lungs.