Periodontitis, or gum disease, is a common infection that damages the soft tissue and bone supporting the teeth. Without treatment, the alveolar bone around the teeth will gradually erode.
Periodontitis means inflammation in the supporting structures around the tooth. Bacteria and other microorganisms stick to the surface of the tooth and in the pockets surrounding the tooth. As they multiply, the immune system reacts, leading to inflammation.
Untreated periodontitis will eventually result in tooth loss and may increase the risk of stroke, heart attack, and other health problems.
Periodontitis is a chronic or long-term inflammatory disease. Good oral hygiene practices can help manage or prevent it.
In this article, find out why periodontitis happens, who is at risk, and how to treat and prevent it.
Symptoms
The signs and symptoms of periodontitis include:
- inflamed or swollen gums
- discolored plaque or tartar on the teeth
- bleeding while brushing or flossing
- halitosis, or bad breath
- pain when eating or chewing
- sensitive teeth
- receding gums, which make the teeth look longer
- extra spaces between the teeth
- pus between the teeth and gums
- a metallic taste in the mouth
- loose or lost teeth
- changesTrusted Source in the way the teeth feel when biting
- changes in the fit of partial dentures
Symptoms may not appear until a person is in their 40s or 50s. By this time, periodontitis may be advanced, and the person may have irreversible damage.
Treatment
Treatment aims to clean out bacteria from the pockets around the teeth and prevent further destruction of bone and tissue.
Good oral hygiene
Good oral hygiene can help reduce the risk of periodontitis.
Tips include:
- brushing teeth at least twice a day
- flossing and using interdental brushes or soft picks once a day
- visiting a dentist at least once a year
- avoiding tobacco use
- limiting consumption of alcohol and foods with added sugars
- seeking dental or medical advice for dry mouth, changes in taste or smell, and other mouth problems
Scaling and cleaning
Removing plaque and calculus can help restore periodontal health.
This involves:
- scaling and debridement to clean the surfaces of the teeth above the gum line and in the pockets
- polishing to smooth rough areas on the teeth, which helps prevent the buildup of plaque
- treating the teeth with fluoride
How often a person needs treatment will depend on how much plaque and tartar accumulate.
Medications
A number of medicated mouthwashes and other treatments are available.
They include:
- rinses, gels, and other products containing chlorhexidine, an antimicrobial compound
- antibiotic gels and other products
- a compound made of minocycline hydrochloride microspheres that a dentist can insert into pockets to reduce the buildup of plaque
- oral antibiotics, in some cases
Surgery
If other treatments do not help, a dentist may recommend periodontal surgery.
Surgery can:
- remove plaque bacteria in pockets
- remove bacteria on the roots and where the roots of the teeth divide
- use regenerative treatments to restore lost gum tissue and bone
A dentist may carry out one or all of these procedures under local anesthetic. They will close the gums with stitches after the procedure.
Prevention and home remedies
Home treatment is essential for managing plaque buildup and reducing the risk of gum disease.
Brush the teeth for 2 minutes twice daily with a soft-bristle manual or electric toothbrush.
Use fluoride toothpaste.
Be sure to brush all surfaces.
Replace the toothbrush every 3 to 4 months, or more often if the bristles are matted or frayed.
Choose a brush with the ADA seal of acceptance.
Which toothpaste is best to use?
People should not share brushes, as bacteria can pass between individuals in this way.
A dentist can also advise on:
- dental floss or floss sticks
- interdental brushes
- antiseptic mouthwash
Other prevention tips include:
- avoiding or quitting smoking
- limiting alcohol intake
- following a diet that contains plenty of whole foods and fresh fruits and vegetables
- visiting a dentist at least once a year
- working with a doctor to manage diabetes
- drinking plenty of water
Periodontitis vs. gingivitis
Gingivitis occurs before periodontitis. It usually refers to gum inflammation, while periodontitis refers to gum disease and the destruction of tissue, bone, or both.
Gingivitis
Around 90% of adults have gingivitis, where bacterial plaque accumulates on the surface of the tooth.
With gingivitis:
- The gums are red and inflamed.
- There is bleeding during brushing.
- The teeth are not loose.
- There is no irreversible damage to bone or surrounding tissue.
Untreated gingivitis can progress to periodontitis.
Periodontitis
With periodontitis:
- The gum and bone pull away from the teeth, forming pockets at the base of the tooth.
- The tooth becomes increasingly exposed.
- Debris collects in the spaces between the gums and teeth and can infect the area.
The immune system attacks bacteria as the plaque spreads below the gum line into the pockets. This leads to an immune reaction, which involves the release of toxins and inflammation.
Bone and connective tissues that hold the tooth start to break down. Teeth can become loose and fall out. The changes may be irreversible.
When to see a dentist
A person should see a doctor or dentist if they have:
- bleeding gums when brushing the teeth or eating hard foods
- swollen, red, or sore gums
- bad breath
- loose teeth
- ulcers or red patches in the mouth
- a lump in the mouth or on the lip
These symptoms may indicate a need for urgent treatment or further investigation to rule out other causes, such as mouth cancer or an abscess.
Diagnosis
To diagnose periodontitis, a dentist will likely:
- carry out a physical dental examination
- insert a periodontal probe next to the tooth, under the gum line, to measure any pockets that have developed
- suggest X-rays to assess the teeth and jaw bone
Complications
Complications and consequences of periodontitis include:
- bad breath
- tooth loss
- difficulty eating and speaking
- health conditions that affect other parts of the body, such as the lungs, heart, and kidneys
- during pregnancy, a higher risk of preterm birth, low birth weight, and preeclampsia
One study of people with chronic coronary artery disease, lasting 3.7 years, found that for every five teeth lost, there was a 17% higher risk of cardiovascular death, a 16% higher risk of all-cause death, and a 14% higher risk of stroke.
It is unclear why this happens, but it may be that bacteria from periodontitis infect the coronary arteries, triggering a wider immune response.
One study found that females who develop periodontal disease after menopause may be more likely to develop breast cancer, particularly if they have a history of smoking.
Causes
Bacterial plaque, a sticky, colorless membrane that develops over the surface of teeth, is the most common cause of periodontal disease.
Brushing teeth removes plaque, but it will build up again after a day or so.
Plaque that remains will harden into tartar, also known as calculus. Tartar is harder to remove than plaque. A person cannot remove tartar at home. It needs professional treatment.
Plaque and tartar can progressively damage teeth and surrounding tissue.
At first, gingivitis may develop. This is a reversible inflammation of the gums around the base of the teeth.
If gingivitis persists, pockets can develop between the teeth and gums. These pockets fill up with bacteria.
As the immune system responds to the buildup of tartar, bacterial toxins start destroying the bone and connective tissue that hold teeth in place. Eventually, the teeth start becoming loose, and they may fall out.
Below is an interactive 3-D model of periodontal disease.
Explore the model using your mouse pad or touchscreen to understand more about periodontal disease.
Risk factors
Factors that increase the risk include:
- Inadequate oral hygiene: This includes not brushing and flossing regularly.
- Smoking: This increases the risk of gum problems and undermines the efficacy of treatment. Around 90% of cases that are hard to treat are in smokers.
- Genetic factors: Some people are more likely to develop gum disease, for example, because of the way their immune system reacts.
- Age: Periodontitis can happen at any age but usually starts after the age of 35 years. The risk of consequences, such as tooth loss, increases with age.
- Some health conditions: Type 2 diabetes increases the risk of periodontitis if a person is unable to manage their blood glucose levels.
- Diet: A high intake of processed carbohydrates, including added sugars, increases the risk. In contrast, fruits and vegetables contain antioxidants, which can help protect the gums, according to research.
- Stress: Stress can affect the immune system and increase the chance of inflammation.
- Weakened immune system: Health conditions and medication that affect the immune system can increase the risk of gum disease.
- Medications: Drugs that reduce saliva can increase the chance of gum disease.
- Hormonal changes: A person is more at risk during pregnancy and when using oral birth control.
- Physical irregularities: Examples include crooked teeth, damaged fillings, and dental bridges that no longer fit correctly.
