What is periodontitis?

Periodontitis, also known as gum disease, is an infection of the gums. Periodontitis occurs when plaque builds up on your teeth. Regular brushing and flossing prevent plaque from building up, but if the plaque solidifies, it becomes tartar, which irritates your gums and lets bacteria in. The bacteria that naturally reside in your mouth can then begin to infect and destroy your teeth, bone, and tissue.

Periodontitis is more common in men than women (56.4% to 38.4%) and affects 70.1% of adults over the age of 65 and 47.2% of adults over the age of 30. 

Proper oral hygiene is essential for preventing  plaque, tartar, and bacteria from building up and causing periodontitis. It's important to know what causes gum disease so that you can work to avoid it, and so you know when to see a dentist if you develop symptoms.

Symptoms of periodontitis

Periodontitis begins with a buildup of plaque on and between your teeth. Plaque can cause gingivitis, an early stage of gum disease which, if not dealt with, will develop into periodontitis. Periodontitis is identified by:

  • Bad breath
  • Gums that hurt and bleed after brushing and flossing
  • Teeth that appear to be moving apart
  • Gums that recede, showing more teeth
  • Gums that are red or swollen
  • Teeth that are loose or sensitive
  • Painful chewing

Causes of periodontitis

Our mouths are full of bacteria. When you don't brush and floss your teeth regularly, the bacteria form into a thin film on your teeth called plaque. If plaque is allowed to build up on teeth, it can turn into tartar, also known as dental calculus. Plaque begins to turn into tartar between 1 and 12 days of forming. The tartar adheres to teeth and cannot be removed except by a dentist.

People who smoke are more prone to periodontitis, as are people with diabetes and AIDS. Other risk factors include hormonal changes in women and girls, and certain medications. Some people are more susceptible to gum disease based on their genetics.

When to see the dentist for periodontitis

Your dentist should be able to identify any risk you have of developing gum disease through regular checkups. Even so, regardless of whether you see a dentist regularly or not, if you develop any of the symptoms listed above or experience any pain in your gums or teeth, you should see a dentist as soon as possible. If you wait until periodontitis develops, you risk losing teeth, gum tissue, or bone.

Diagnosing periodontitis

Your dentist will examine your gums and teeth for plaque and tartar buildup. If they see any inflamed tissue, they will use a probe to measure the pockets between your gums and teeth. If these pockets are more than 3 millimeters deep, your dentist will want to investigate further.

Your dentist might want to perform x-rays to check for bone and tooth damage in areas with deep pockets. If the gum disease has developed past an early stage, your dentist will refer you to a periodontist that specializes in treating people with periodontitis. 

There are four stages of periodontitis. It's important to note that bone loss in teeth occurs either horizontally — when the bone surrounding the teeth gets shorter in relation to the teeth — or vertically — with sections missing near or beside the teeth — and is key to diagnosing which stage the periodontitis has reached:

  • Stage I is mild periodontitis. Gum pockets measure 2 millimeters or less, with some horizontal bone loss that requires non-surgical treatment.
  • Stage II is moderate periodontitis. Gum pockets measure 5 millimeters or less, with some horizontal bone loss that requires non-surgical treatment. 
  • Stage III is severe periodontitis. Gum pockets measure deeper than 6 millimeters, with possible vertical bone loss and tooth loss requiring surgical treatment.
  • Stage IV is very severe periodontitis. Gum pockets measure deeper than 6 millimeters, with vertical bone loss. There may be less than 20 teeth left in the mouth with a chance of losing more. Surgery with implants is required, and there might be a need for regenerative bone and tissue therapy.

Treatments for periodontitis

If you have gum disease, your dentist will refer you to a periodontist for treatment. The periodontist might give you antibiotics for the infection or conduct non-surgical procedures such as scaling or root planing. Scaling removes tartar and bacteria from beneath your teeth and in your gums. Root planing smooths out the surfaces of the roots of your teeth, which keeps more plaque and tartar from building up.

If your periodontitis is too advanced for non-surgical treatment, the periodontist may need to conduct one or more of the following procedures:

  • Flap surgery
  • Bone grafting
  • Guided tissue regeneration
  • Soft tissue grafting
  • Application of a tissue-stimulating protein 

Flap surgery, also known as pocket reduction surgery, is a procedure in which the periodontist makes small incisions in your gums that allow them to lift a section of gum tissue to more easily scale and plane the roots of your teeth. The periodontist may also reshape the bone underneath your gums so the area is easier to clean after healing.

If any bone has been destroyed, the periodontist can use bone grafting or guided tissue regeneration to help the bone grow back. Bone grafting replaces any damaged bone, letting new bone grow and preventing tooth loss. For guided tissue regeneration, the periodontist puts a special fabric in place that prevents tissue from growing in the area and helps the bone regrow. Similar to bone grafting, soft tissue grafting replaces lost tissue on your gums to build your gumline back up. Tissue may be taken from healthier parts of your mouth to graft onto damaged areas.

Tissue-stimulating proteins are applied with a special gel containing the same proteins found in tooth enamel. These proteins help soft tissue regenerate. 

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Medically Reviewed on 3/12/2021
References
American Dental Association: "Frequently Asked Questions on the 2018 Classification of Periodontal and Peri-Implant Diseases and Conditions."

Centers for Disease Control and Prevention: "Periodontal Disease."

Informed Health: “Gingivitis and periodontitis: Overview.”

Journal of Indian Society of Periodontology: "An unusual presentation of dental calculus." MayoClinic: "Periodontitis."

Mouth Healthy: “Scaling and Root Planing.”

National Institute of Dental and Craniofacial Research: "Periodontal (Gum) Disease."

Periodontology 2000: “Advanced reconstructive technologies for periodontal tissue repair.”