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Periodontitis: Symptoms, Causes, Treatment & Management

Updated: Nov 11

Periodontitis is an inflammatory oral condition that affects the periodontium around the teeth, which includes the gums and jaw bone.


severe gum bleeding from periodontitis
severe gum bleeding from periodontitis

It is more commonly known as the advanced stage of gum disease and is the progression after gingivitis. A hall mark trait of this condition is as loss around the teeth and when left untreated it can eventually lead to tooth loss.


Yes, it is possible to lose teeth from it which is why you shouldn't take this condition lightly nor should you ignore it. It's not just cavities and infections that you can lose teeth from.


Table of Contents:


Symptoms

Periodontitis is advanced staged gum disease but it will also affect the teeth and the bone around it. Essentially, it affects the entire periodontium.


effect of periodontitis on periodontium
Credit: Shahrzad Torabi; Abhinandan Soni


Affected Area

Signs & Symptoms

​Gums (gingiva)

​Gums may be non-pink (red/purple), swollen (puffy), & tender.

Bleeds easily when brushing or spitting.

Loose gums that pull away from the teeth.

Receding gums that make teeth that look longer.

Teeth

Loose gums that pull away from the teeth.

Receding gums that make teeth that look longer.TeethLoose, sensitive, painful when chewing.

Black triangles forming between teeth.

Change in bite and how teeth come together.

Others

Halitosis (bad breath)


Epidemiology

Together with tooth decay, periodontal disease are the two biggest threats to dental health. In other words, it is a very common oral disease and by no means rare.


Below are prevalence statistics from the CDC:

Age Group

Prevalence

30+

47.2%

65+

70.1%

In summary, gum disease is very common because it affects nearly half of the US population and its prevalence only increases with age.


Risk Factors

Factors which may increase your risk for periodontal disease:

  • Pre-existing gingivitis.

  • Poor oral health hygiene.

  • Smoking or chewing tobacco.

  • Recreational drugs - marijuana or vaping.

  • Hormonal changes (pregnancy or menopause).

  • Obesity.

  • Poor nutrition, including a low vitamin C level.

  • Genetics.

  • Medications that cause dry mouth or gum changes.

  • Immuno-compromised - leukemia, HIV/AIDS and cancer treatment.

  • Diseases such as diabetes, rheumatoid arthritis and Crohn's disease.


Causes

Periodontitis not caused by a single factor but from a combination of factors (inadequate oral hygiene, lack of routine dental care, and complacency in leaving gingivitis untreated). All of these contribute to the progression of gum disease from gingivitis to periodontitis.


Factors contributing to development of periodontitis:

  • Inadequate oral hygiene. The standard of care for oral hygiene involves brushing for 2 minutes twice daily and flossing before bedtime. If you are doing less than that, it is considered sub-optimal and it increases your risk for gum problems.

  • Lack of routine dental care. Best practices involves routine dental check ups and cleanings twice a year or every 6 months. Once tartar forms on teeth, you won't be able to remove it without a dentist.

  • Complacency in untreated gingivitis. If you're already experiencing signs and symptoms of gingivitis but you leave it untreated. You are at high risk for progressing to the next stage of gum disease.


Gum disease progression

Periodontitis is not a standalone gum condition, it is an advanced progression of gum disease and it all begins with the formation of plaque.


gum disease progression stages

Stages and development of gum disease:

  1. Plaque formation. A soft thin biofilm of bacteria forms on the surfaces of teeth called plaque. This can be easily removed with gentle brushing and flossing.

  2. Tartar formation. Unremoved plaque will calcify and turn hard into a substance known as calculus (tartar). Once this forms, you will not be able to remove it without a professional teeth cleaning.

  3. Gum inflammation. Unremoved tartar that is constantly next to the gums will result in gingival inflammation. This causes the gums to swell up and bleed easily. You've officially reached the first stage of gum disease known as gingivitis.

  4. Jaw bone inflammation. When gingivitis is left untreated for an extended period of time, the inflammation from gums spreads to the jaw bone. Eventually the inflammation results in bone loss around the teeth. You've officially reached the advanced stage of gum disease known as periodontitis.

  5. Tooth loss. Untreated periodontitis will lead to progressive bone loss until the teeth become loose enough to fall out on their own. The end result of untreated gum disease is edentulism which is when you no longer have any teeth.


The end result of periodontitis is complete tooth loss. In layman's terms, you will end up with full upper and lower dentures if you leave your condition untreated.


Diagnosis

The two criteria used by dentists to diagnose periodontitis are evidence of bone loss and active inflammation. All other criteria are used to determine the severity of your condition.


Bone loss

A tell-tale sign of periodontitis is bone loss around the teeth, which can be diagnosed with a visual clinical exam or via dental x-rays.


severe bone loss around teeth on x-ray
severe bone loss around teeth on x-ray

Signs & symptoms of bone loss:

  • Longer looking teeth.

  • Black triangles forming between teeth.

  • Receding gums.

  • Loose teeth.

  • Teeth floating on x-rays.


gum recession resulting in longer looking teeth
gum recession resulting in longer looking teeth

The beginning stages or milder forms of it may not be as easily detectable. However, once it progresses and becomes more severe, even the patient can tell that something is wrong.


Active inflammation

An important criteria in diagnosing gum disease is whether your condition is active or was it previously treated and now stable?


Signs of active periodontal inflammation:

  • Red poofy swollen gums.

  • Bleeds easily upon touching, brushing, and flossing.

  • Deep pocketing upon probing.


red poofy inflamed gums
red poofy inflamed gums

The effects or consequence of having had periodontitis is bone loss and once that occurs the damage is permanent. You cannot regrow bone meaning you can't reverse its effects.


However, the good news is that the condition can be stabilized and managed. That means signs of inflammation will go away but the bone loss will remain.


Periodontal probing

The instrument your dentist uses to measure and assess gum inflammation is with a periodontal probe. The tip of the instrument has markings at every millimeter and it is used to measure the pocket depth of your gums.


perio probe used to measure probing depths
perio probe used to measure probing depths

Probing Depth

Severity

1-3 mm

Normal

4 mm

Mild

5 mm

Moderate

6+ mm

Severe

Essentially, the deeper the gum pocket the more severe your periodontal condition is.


Other criteria

Bone loss and active inflammation are the two primary criteria that dentist use to determine if you have periodontitis or not. However, there are a lot of other clinical criteria which assist in determining the severity of your periodontal disease.


Criteria used to assess severity of gum disease:

  • Probing depth.

  • Gingival bleeding.

  • Bleeding on probing.

  • Gingival margin or gum recession.

  • Clinical attachment loss.

  • Furcation involvement.

  • Tooth mobility.

  • Mucogingival junction.


Treatment

Mild-moderate periodontitis can usually be treated/managed by your general dentist but if it becomes moderate-severe, you should see a periodontist instead. The latter are the gum specialists and they can offer surgical periodontal therapy in addition to non-surgical treatment.


Non-surgical treatment

Mild to moderate forms of periodontitis can be successfully treated with non-surgical treatment options, including:

  • Scaling and Root planing. More commonly known as a deep teeth cleaning, this procedure will clean above AND below the gum line. That means tartar build up on the root surfaces will also be removed. Local anesthesia is usually used.

  • Antibiotics. Chlorhexidine, an antibiotic oral rinse may be prescribed after the deep cleaning. Sometimes Minocycline, a localized antibiotics may be placed directly into the gum pockets to assist with bacterial elimination.


before deep cleaning
before deep cleaning

A regular dental cleaning is usually insufficient treatment for advanced stage gum disease. The procedure only cleans above the gum line thus leaving all of the calculus below the gums untreated/unremoved.


after deep cleaning
after deep cleaning

Surgical treatment

Moderate to severe forms of periodontitis will require surgical periodontal therapy with a periodontist, which includes:

  • Osseous surgery. Also known as pocket depth reduction surgery, which involves making a surgical flap by peeling back the gums and exposing the bone. All bacterial build up can be effectively cleaned out. Afterwards the alveolar bone will be re-contoured to recreate positive architecture.

  • Guided tissue regeneration. This involves soft tissue grafts (gum grafting) and also bone grafting to address bone/gum defects. Remember that periodontitis causes permanent damage to the periodontium, meaning the bone loss and gum loss won't repair itself without surgical intervention.



Both of these treatments are major surgical procedures in the mouth and consequently you should expect to be numb and also leave with stitches.


Management

Periodontitis cannot be permanently cured, it must be continuously managed throughout your life because it can always return. In other words, the disease becomes inactive after successful treatment but it can reactivate if you don't manage it properly.


How to prevent periodontitis from returning:

  • Brush for 2 minutes at least twice a day. After every meal is even better.

  • Floss before going to bed or after every meal.

  • Use a mouthwash regularly.

  • Dental cleaning every 6 months. However, for periodontitis you may need one every 3-4 months but it depends on your dentist. These cleanings are called perio maintenance.

  • Reduce snacking especially sweet and sugary foods.

  • Stop or reduce smoking if possible.


Most of the tips above is basic oral hygiene and the more diligent you are with it, the less likely you are to have the disease return.


Living with periodontitis

This is a very common oral condition that affects close to half the US population. There may not be a cure but at least you can manage it and prevent it from recurring.


Those who've turned a new leaf and stay on top of their oral hygiene usually do not end up losing all of their teeth. However, those who do not change their lifestyle habits will often slowly lose their teeth and end up in dentures.


So, what are you going to do?


We highly recommend scheduling a consultation with your dentist and get it treated if you have this condition.

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About the author: Dr David Chen, DDS

Hello, I'm Dr Chen and I'm an actively practicing dentist in Long Island City, NY. I graduated from Columbia University College of Dental Medicine in 2016 but prior to going to dental school I was already working in the dental field. It's been more than a decade since I first got to know dentistry and let me tell you, time flies by quickly. Since then I've developed a fondness for writing, which is how this all got started!

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Medical Disclaimer:

This blog is purely meant for information purposes and should not be used as medical advice. Each situation in your mouth is unique and complex. It is not possible to give advice nor diagnose any oral conditions based on text nor virtual consultations. The best thing to do is to go in person to see your dentist for an examination and consultation so that you can receive the best care possible.

The purpose of all of this oral health information is to encourage you to see your dentist and to inform you of what you may expect during your visit. Due to the unfortunate nature of dentistry, there isn't really any true home remedies that will get rid of dental problems. Roughly 99.99% of them require in-person intervention by a healthcare professional.

Hint: That is the reason why you can't eliminate seeing dentists in your life!

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