Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at February 26, 2016

Periodontitis is a form of gum disease, and is common yet preventable. This serious infection of the gums destroys tissue and bone that supports teeth and causes irreversible damage. It is the number one cause of tooth loss in adults.


Definition & Facts

Periodontitis usually begins as gingivitis. This mild form of periodontal disease is also caused by bacteria getting under the gum line; however, while the gums are inflamed, teeth are not lost, and no irreversible damage has been done to the bone or tissue.

The same cannot be said for periodontitis. Neglecting to seek treatment can have devastating results such as tooth loss, an increased risk of stroke or heart attack, and issues with the lungs. This is caused when the bacteria cross the gum tissue and enter the bloodstream. Periodontitis is classified as either chronic or aggressive. Chronic periodontitis is the most common form and affects primarily adults. Aggressive periodontitis usually starts in childhood.

Symptoms & Complaints

The symptoms of periodontitis are apparent to both patient and dentist. The gums of those afflicted may be swollen and will have a bright red or even purplish color. When they are touched, it will cause great discomfort and will bleed easily after tooth brushing or eating hard foods. The gums will recede from teeth making the teeth look longer than previously. This will also cause teeth to loosen in the socket.

Pus will develop in the space between the teeth and gums. This will result in foul smelling breath and a somewhat metallic taste in the mouth. Sores may develop inside the mouth. Teeth will begin to space out as the bone structure deteriorates changing the way teeth match up when the sufferer bites down. Those that wear partial dentures will notice a difference in the way they fit.


The main cause for development of periodontitis is poor oral hygiene. Throughout the day, plaque builds up on teeth. When teeth are not regularly cleaned, plaque located under the gum line can harden into tartar. Simply brushing cannot remove tartar; for that a professional cleaning is required. Tartar buildup acts as a basin for bacteria to pool in. The longer plaque and tartar buildup are left on teeth, the more damage is done to the gum tissue and supporting bone.

At first, the toxins that the bacteria release as well as the immune response they trigger from the body will irritate and inflame the portion of the gum that surrounds the base of teeth. Left untreated, this will cause periodontal pockets to form between the gums and teeth which themselves will fill with plaque, tartar and bacteria. Over time, this accumulation of toxins will get under the gum tissue and start wreaking havoc on the underlying bone. If too much bone is destroyed, tooth loss may occur.

Other causes of periodontitis include hormonal changes such as those that occur with pregnancy and menopause, serious illnesses like cancer and diabetes, certain medications, smoking and drug use, and having a family history of dental disease.

Diagnosis & Tests

Periodontitis is extremely easy to diagnose. The dentist will first take into account the particular symptoms being experienced by the patient. Then an oral exam will occur. The dentist will check over the conditions of the gums, keeping an eye out for plaque and tartar buildup along the base of teeth as well as taking note of how sensitive teeth are to the patient.

Most likely, a periodontal probe will be inserted under the gum line to probe deeper under the tissue. When periodontitis is present, the probe will reach further under the gum line than normal. The dentist may order X-rays to see if there has been any bone loss and to better see any pockets of bacterial infection under the gum tissue. After the examination is complete, the best course of treatment can be determined and put into effect.

Treatment & Therapy

Treatment for periodontitis may be performed by either the dentist or the dental hygienist. In extreme cases, patients may be referred to a specialist called a periodontist. The goal of treatment is to clean out the pockets of buildup and infection around teeth to stop damage to bone. Rough surfaces of teeth may be smoothed out to prevent any more accumulations. Whether treatment is surgical or not will depend on the severity of the periodontitis.

Nonsurgical treatments include scaling and root planing. Scaling is when the dental professional eradicates tartar and bacteria from under the gums and from the surface of teeth. Root planing smoothes out the surface of the tooth root which will hold off further accumulation of toxins. Antibiotics may also be prescribed to help eliminate infection.

Surgical treatments include flap surgery which is where small surgical incisions are made along the gum line so a section can be folded back to expose the root. This allows for more effective results from scaling and root planing. Gingival grafts will be required when the gums have receded too far. During this procedure, tissue is taken from the roof of the mouth or another location and is relocated to the problem area on the gum line.

Bone grafting will be necessary when the bone surrounding a tooth is destroyed. The dental professional may perform guided tissue regeneration. This is where material is wedged between bone and tooth to prevent tissue from entering the area that is healing and thus giving the bone a chance to grow back.

Prevention & Prophylaxis

It takes no time at all to protect gums, bones and teeth from periodontitis. The best thing to do is to brush at least every morning and every evening following at least one of those brushings with flossing. Mouthwash offers added cleaning and helps to wash away particles loosened with brushing and flossing.

Be sure to replace toothbrushes every four months and consider switching to an electronic toothbrush. These can be more effective at cleaning. Most importantly, get dental checkups and cleanings at least twice a year. The prevention of periodontitis is not only easy but a far better alternative to treatment.