Periodontitis is a long-lasting infection of the gums and the tissues and bone that hold teeth in place. It usually begins when sticky bacterial plaque builds up along the gumline and triggers inflammation. Without dental care, the gums may pull away from teeth and supporting bone can be damaged. Treatment can control the infection and help protect remaining support, but lost bone may not fully return.
How Does Periodontitis Develop?
Periodontitis is an advanced form of gum disease that affects the structures supporting your teeth. These structures include the gums, the fibers connecting teeth to the surrounding tissues, and the jawbone that anchors each tooth. The condition develops when inflammation damages these supporting tissues over time.
According to the National Institute of Dental and Craniofacial Research (NIDCR), gum disease commonly begins when dental plaque accumulates along the gumline. Plaque is a sticky film containing bacteria. When it is not removed regularly, it can harden into tartar, also called calculus, which cannot be removed by ordinary brushing and flossing.
The process often begins with gingivitis, the early stage of gum disease. Gingivitis causes inflammation of the gums, which may become swollen, tender, or prone to bleeding. At this stage, the damage is generally reversible with appropriate oral care and professional cleaning. If the inflammation continues, it can progress to periodontitis, in which the tissues and bone supporting the teeth begin to break down.
As the supporting tissues become damaged, spaces known as periodontal pockets may develop between the teeth and gums. These pockets can collect more bacteria and make effective cleaning difficult. Without appropriate treatment, the pockets may deepen, the supporting bone may be lost, and teeth can eventually become loose or fall out.
What Are the Signs of Periodontitis?
Periodontitis does not always cause obvious discomfort in its early stages. Some people notice changes in their gums before they experience pain, while others may not recognize a problem until the supporting tissues have already been affected. The Mayo Clinic identifies several possible signs, including changes in gum appearance, bleeding, persistent bad breath, and loose teeth.
- Bleeding gums: The gums may bleed during brushing, flossing, or eating.
- Swollen or tender gums: Gum tissue may look puffy or feel sore when touched.
- Persistent bad breath: An unpleasant odor or taste may remain even after brushing.
- Receding gums: The gums may pull away from the teeth, making the teeth appear longer.
- Changes in tooth position: Teeth may begin to shift, or new spaces may appear between them.
- Loose teeth or discomfort when chewing: Loss of supporting tissue and bone can affect how securely teeth are held in place.
- Pus near the gumline: Pus between a tooth and the surrounding gum may indicate an infection that needs prompt dental attention.
These changes can also occur with other dental problems, so they do not establish a diagnosis on their own. Persistent bleeding, swelling, or bad breath should be discussed with a dentist. Loose teeth, pus, or significant gum swelling also warrant prompt evaluation rather than waiting for routine dental care.
What Causes Periodontitis and Who Is More Likely to Develop It?
The main cause is the buildup of bacterial plaque, but not everyone develops periodontitis at the same rate. The body's response to the bacteria, existing health conditions, tobacco exposure, and daily oral hygiene habits can all influence the development and progression of gum disease.
- Inadequate plaque removal: Infrequent brushing or cleaning between teeth allows plaque to remain along the gumline and may contribute to tartar buildup.
- Smoking and tobacco use: Tobacco increases the risk of gum disease and can make treatment less successful.
- Diabetes: Diabetes, particularly when blood sugar is not well controlled, is associated with an increased risk of gum disease and can make gum health more difficult to maintain.
- Increasing age: Periodontitis becomes more common with age, although it can also occur in younger adults.
- Family history: Genetic factors may influence a person's susceptibility to gum disease.
- Medical conditions affecting immunity: Certain illnesses and treatments that affect the immune system may increase the risk.
- Hormonal changes and medications: Some hormonal changes and medicines that affect saliva production or gum tissue may contribute to gum problems.
Having one or more of these risk factors does not mean that periodontitis will develop. However, people who smoke, have diabetes, or have previously received treatment for gum disease may benefit from discussing an appropriate dental examination and follow-up schedule with their dental professional.
How Is Periodontitis Diagnosed?
A dentist diagnoses periodontitis by examining the gums and teeth, reviewing relevant medical and dental history, and assessing the condition of the tissues supporting the teeth. Symptoms alone cannot show whether the underlying bone has been affected or how much support the teeth have lost.
During a periodontal examination, the dentist may use a small measuring instrument called a periodontal probe to assess the spaces between the teeth and gums. The dentist also checks for gum bleeding, recession, changes in tooth stability, and other signs of tissue damage. Deeper pockets may suggest periodontal damage, but the measurements must be interpreted alongside the rest of the examination.
Dental X-rays may be used to look for bone loss around the teeth. The dentist also considers factors such as tobacco use, diabetes, previous dental treatment, and changes in oral health over time. According to the Merck Manual Consumer Version, examination of the gums and, when needed, X-rays help dentists assess the extent of periodontitis.
Depending on the findings, the dentist may manage the condition directly or refer the patient to a periodontist, a dentist specializing in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures.
How Is Periodontitis Treated?
Treatment aims to control the infection, reduce inflammation, remove deposits of plaque and tartar, and help preserve the remaining support around the teeth. The appropriate approach depends on the extent of tissue damage, the location of affected teeth, relevant health conditions, and the response to earlier treatment.
Professional cleaning below the gumline
A common initial treatment is scaling and root planing, sometimes called deep cleaning. During this procedure, a dental professional removes plaque and tartar from the teeth and their root surfaces, including deposits below the gumline. The procedure may be performed with local anesthesia when needed for comfort. It can help reduce the bacterial buildup associated with inflamed periodontal pockets.
The American Dental Association (ADA) identifies scaling and root planing as an initial nonsurgical treatment for chronic periodontitis. Additional care may be considered according to the patient's clinical findings and preferences.
Medication when appropriate
Some patients may need medication as an addition to professional cleaning. Depending on the circumstances, a dentist may recommend a specific antimicrobial rinse or prescribe antibiotics for selected cases. Antibiotics are not necessary for everyone with periodontitis, and using them without appropriate dental guidance is not a substitute for removing plaque and tartar.
Periodontal surgery for selected cases
If deep periodontal pockets remain or the disease has caused substantial tissue damage, a periodontist may recommend surgery. Depending on the findings, procedures may provide access to difficult-to-clean areas, reduce pocket depth, or attempt to regenerate selected areas of damaged supporting tissue. Not every patient needs surgery, and the potential benefits depend on the individual condition.
Ongoing maintenance after treatment
Successful initial treatment does not eliminate the need for continued care. Bacterial plaque begins to accumulate again after cleaning, so daily oral hygiene and scheduled professional maintenance are important for controlling the condition. The dental team may recommend visits more frequently than routine checkups when the risk of recurrence is higher.
Can Periodontitis Be Reversed?
Periodontitis can often be controlled with appropriate treatment and consistent follow-up, but it is not usually reversible in the same way as early gingivitis. Once the disease has destroyed the supporting tissue and bone, that damage may be permanent. Certain regenerative procedures can help restore some supporting structures in selected cases, but they cannot guarantee a complete return to the original condition.
The goal of treatment is to stop or limit further damage, maintain the health of the remaining tissues, and preserve natural teeth when possible. How well this goal can be achieved depends on the extent of the disease, the response to treatment, and the ability to maintain oral hygiene and attend follow-up visits.
How Can You Help Prevent Periodontitis?
Daily plaque removal and regular dental care are central to preventing gum disease or reducing the likelihood that it will return after treatment. Helpful habits include:
- Brush twice daily with fluoride toothpaste, using a soft-bristled toothbrush and careful technique along the gumline.
- Clean between the teeth every day with dental floss or appropriately sized interdental brushes.
- Attend regular dental examinations and professional cleanings as recommended for your oral health needs.
- Avoid smoking and other tobacco products, and seek support if stopping is difficult.
- If you have diabetes, work with your healthcare team to manage your blood sugar and discuss how your condition may affect your gum health.
- Follow your dentist's maintenance plan if you have previously been treated for periodontitis.
Good oral hygiene lowers the buildup of plaque, but it does not remove hardened tartar that is already present. Professional cleaning may therefore be necessary even when you brush and floss regularly. If gum bleeding or swelling continues despite good daily care, arrange a dental appointment to identify the cause and determine whether treatment is needed.
When Should You See a Dentist?
Arrange a dental appointment if your gums bleed repeatedly, remain swollen or tender, or your breath has an ongoing unpleasant odor. Changes in gum position or tooth stability should also be assessed rather than left until pain develops. Seek prompt dental attention if you notice pus, significant swelling, or loose teeth, as these findings can indicate a problem that needs timely care.
Periodontitis is a common but important dental condition because damage to the tissues supporting teeth can progress without causing much pain at first. Recognizing changes in gum health, obtaining a professional examination, and following an individualized treatment and maintenance plan can help protect the teeth and reduce further damage.