Periodontitis (Gum Disease): Symptoms, Causes & Treatment
Periodontitis is a serious gum infection that damages the soft tissue and gradually destroys the bone supporting your teeth. Without treatment, it can lead to tooth loosening and eventual tooth loss. The good news is that periodontitis is largely preventable through proper oral hygiene and regular dental care.
Key Takeaways
- Periodontitis is caused by bacterial buildup that triggers inflammation and destroys tooth-supporting structures
- Early symptoms include bleeding gums when brushing, but the disease often progresses painlessly
- Smoking significantly increases the risk and makes the disease harder to treat
- While bone loss cannot be fully reversed, treatment can stop progression and preserve remaining teeth
- Regular dental cleanings every 3-4 months are essential for managing periodontitis
What Is Periodontitis?
Quick Answer: Periodontitis is a chronic bacterial infection that affects the gums and bone surrounding teeth, potentially leading to tooth loss if left untreated.
Periodontitis, commonly known as gum disease, is an infection of the tissues that hold your teeth in place. It begins when bacteria in dental plaque accumulate along and below the gum line, triggering an inflammatory response. If not properly managed, this inflammation gradually destroys the periodontal ligament and alveolar bone that anchor teeth to the jaw.
The disease typically develops from gingivitis, a milder form of gum disease characterized by red, swollen gums that bleed easily. Not all gingivitis progresses to periodontitis, but without proper oral hygiene, the risk increases significantly. Understanding the difference between these conditions is crucial for early intervention.
Stages of Periodontal Disease
Periodontitis progresses through distinct stages, each with increasing severity:
| Stage | Pocket Depth | Bone Loss | Characteristics |
|---|---|---|---|
| Stage I (Initial) | 4mm or less | Less than 15% | Slight attachment loss, no tooth mobility |
| Stage II (Moderate) | 5mm | 15-33% | Horizontal bone loss visible on X-ray |
| Stage III (Severe) | 6mm or more | Extends to middle third of root | Tooth loss of 4 teeth or fewer, Class II furcation |
| Stage IV (Advanced) | 6mm or more | Extends to apical third of root | Loss of 5+ teeth, masticatory dysfunction, bite collapse |
Understanding Medical Codes
Periodontitis is classified under ICD-10 code K05.3 (Chronic periodontitis). Related codes include K05.4 (Periodontosis) and K05.5 (Other periodontal diseases). The SNOMED CT code is 41652007 and the MeSH identifier is D010518.
What Are the Symptoms of Periodontitis?
Quick Answer: The most common early symptom is bleeding gums when brushing. However, periodontitis often progresses silently without pain, making regular dental checkups essential for early detection.
Periodontitis typically develops slowly and may not cause noticeable discomfort until significant damage has occurred. This silent progression is one of the most dangerous aspects of the disease, as many people remain unaware of their condition until teeth become loose.
Early Warning Signs
- Gums that bleed when brushing or flossing
- Red, swollen, or tender gums
- Persistent bad breath (halitosis)
- Unpleasant taste in the mouth
- Gums that appear darker red than normal
Progressive Symptoms
- Gum recession (teeth appear longer than before)
- New spaces developing between teeth
- Pus between teeth and gums
- Loose or shifting teeth
- Changes in how teeth fit together when biting
- Pain when chewing
- Tooth sensitivity to temperature
Important Note for Smokers
Smoking constricts blood vessels in the gums, which can mask the bleeding that typically signals gum disease. If you smoke, you may have periodontitis without experiencing bleeding gums. This makes regular dental examinations even more critical.
What Causes Periodontitis?
Quick Answer: Periodontitis is caused by bacteria in dental plaque that trigger chronic inflammation. When plaque isn't regularly removed, it hardens into tartar and creates deeper pockets where more bacteria accumulate.
The primary cause of periodontitis is the accumulation of bacterial plaque on teeth and along the gum line. This sticky film of bacteria forms continuously and must be removed through daily brushing and flossing. When plaque remains on teeth, several harmful processes begin.
The Disease Process
- Plaque formation: Bacteria multiply in the sticky film coating teeth
- Tartar development: Unmoved plaque hardens into calculus (tartar) within 24-72 hours
- Gum inflammation: The immune system responds to bacterial toxins, causing gingivitis
- Pocket formation: Inflammation causes gums to pull away from teeth, creating pockets
- Bone destruction: Bacteria colonize deeper pockets, and the inflammatory response destroys supporting bone
- Tooth loss: Without adequate bone support, teeth become loose and may fall out
Risk Factors
While anyone can develop periodontitis, certain factors significantly increase your risk:
Modifiable Risk Factors
- Smoking and tobacco use: The single greatest modifiable risk factor. Smokers are 2-3 times more likely to develop periodontitis
- Poor oral hygiene: Inadequate brushing and flossing allows plaque to accumulate
- Infrequent dental visits: Missing regular cleanings allows tartar buildup
- Stress: Weakens immune function and may lead to neglected oral care
- Poor nutrition: Vitamin C deficiency particularly affects gum health
Non-Modifiable Risk Factors
- Genetics: Some people have genetic predisposition to periodontal disease
- Age: Risk increases with age, though the disease can occur at any age
- Diabetes: Impairs immune function and wound healing
- Hormonal changes: Pregnancy, menopause, and puberty affect gum sensitivity
- Certain medications: Some drugs reduce saliva flow or cause gum overgrowth
- Immunocompromised conditions: HIV/AIDS, cancer treatment, and other conditions affecting immunity
The Diabetes Connection
Research demonstrates a bidirectional relationship between periodontitis and diabetes. People with diabetes are more susceptible to infections including periodontitis, while periodontal inflammation can increase blood sugar levels and make diabetes harder to control. Managing one condition helps improve the other.
When Should You See a Dentist?
Quick Answer: See a dentist if your gums bleed when brushing, if you notice gum recession, or if any teeth feel loose. Early treatment prevents irreversible bone loss.
Because periodontitis often develops without pain, it's important to recognize the warning signs and seek professional evaluation promptly. Early intervention can prevent the irreversible bone loss that characterizes advanced disease.
Schedule a Dental Appointment If You Notice:
- Gums that bleed during brushing or flossing
- Persistent bad breath that doesn't improve with oral hygiene
- Gums that appear red, swollen, or pull away from teeth
- Any tooth that feels loose or has shifted position
- Changes in your bite or how dentures fit
- Pus visible between teeth and gums
Seek Urgent Care For:
Severe tooth pain, significant facial swelling, fever combined with dental symptoms, or difficulty breathing or swallowing. These may indicate a dental abscess or other serious infection requiring immediate treatment.
Recommended Dental Visit Frequency
For people without periodontal disease, dental checkups every 6 months are typically recommended. However, if you have periodontitis, your dentist or periodontist will likely recommend more frequent visits—typically every 3 to 4 months—for professional cleanings and monitoring.
How Is Periodontitis Diagnosed?
Quick Answer: Diagnosis involves measuring the depth of gum pockets around each tooth using a periodontal probe, checking for bleeding, and taking X-rays to assess bone levels.
A thorough periodontal examination allows your dentist or periodontist to determine whether you have periodontitis and assess its severity. This evaluation typically includes several components.
Periodontal Probing
Using a small measuring instrument called a periodontal probe, your dental professional measures the depth of the space (sulcus) between your gum and tooth at multiple points around each tooth. Healthy gums typically have pocket depths of 1-3 millimeters. Depths of 4 millimeters or more may indicate periodontitis.
During probing, the clinician also notes whether the gums bleed, which indicates active inflammation. Bleeding on probing is an important sign that requires attention, even if pocket depths are not severely increased.
Radiographic Assessment
Dental X-rays reveal the amount of bone supporting each tooth. In periodontitis, X-rays show characteristic patterns of bone loss. Comparing X-rays over time helps track disease progression or stability after treatment.
Additional Assessments
- Tooth mobility: Checking how much teeth move when pressure is applied
- Gum recession: Measuring how far gums have pulled away from the crown
- Furcation involvement: Assessing bone loss between roots of multi-rooted teeth
- Medical history review: Identifying risk factors like diabetes or smoking
What to Expect During the Examination
The periodontal examination is generally not painful, though you may feel some pressure during probing. If you have active inflammation, you might experience slight discomfort or bleeding. The entire assessment typically takes 15-30 minutes and provides crucial information for planning your treatment.
How Is Periodontitis Treated?
Quick Answer: Treatment involves removing bacterial deposits from tooth surfaces and root surfaces below the gum line. Mild to moderate cases respond well to non-surgical cleaning, while advanced cases may require surgery.
The primary goal of periodontal treatment is to eliminate infection and stop disease progression. While bone that has already been lost usually cannot be regenerated, effective treatment can preserve remaining bone and prevent further tooth loss.
Non-Surgical Treatment
Scaling and Root Planing (Deep Cleaning)
This is the cornerstone of periodontitis treatment. Unlike regular dental cleaning, scaling and root planing reaches below the gum line to remove plaque, tartar, and bacterial toxins from root surfaces. The procedure smooths the root surfaces, making it harder for bacteria to accumulate and easier for gums to reattach.
The treatment is typically performed under local anesthesia and may require multiple appointments to thoroughly clean all affected areas. Most patients experience significant improvement after this initial therapy.
Antibiotic Therapy
In some cases, antibiotics may be prescribed to help control bacterial infection. These can be administered as mouth rinses, gels placed directly into periodontal pockets, or systemic medications. Antibiotics are typically used as an adjunct to mechanical cleaning, not as a standalone treatment.
Surgical Treatment
When non-surgical treatment is insufficient—typically in cases with deep pockets or significant bone loss—surgical intervention may be necessary.
Flap Surgery (Pocket Reduction Surgery)
The periodontist lifts the gum tissue to access root surfaces and underlying bone for thorough cleaning. The gums are then repositioned to fit more closely around the teeth, reducing pocket depth and making home care more effective.
Bone Grafting
When periodontitis has destroyed significant bone, grafting procedures can help regenerate lost tissue. Bone grafts may use your own bone, synthetic material, or donated bone to fill defects and support natural bone regrowth.
Guided Tissue Regeneration
This technique uses a biocompatible membrane placed between bone and tooth to prevent unwanted tissue from growing into the healing area, allowing bone and connective tissue to regenerate.
Soft Tissue Grafts
When gum recession is significant, tissue can be taken from the roof of the mouth or adjacent areas to cover exposed roots, reducing sensitivity and improving appearance.
Maintenance Therapy
After active treatment, ongoing maintenance is essential. This typically involves professional cleanings every 3-4 months for life. During these visits, your dental professional will monitor pocket depths, check for signs of disease recurrence, and remove any new bacterial accumulation.
Treatment Success
With proper treatment and diligent maintenance, most people with periodontitis can keep their teeth for life. Success depends on the severity at diagnosis, how well you maintain oral hygiene, whether you quit smoking, and how consistently you attend maintenance appointments.
How Can You Prevent Periodontitis?
Quick Answer: Prevent periodontitis by brushing twice daily, cleaning between teeth daily with floss or interdental brushes, visiting your dentist regularly, and avoiding tobacco.
Periodontitis is largely preventable through consistent oral hygiene and professional care. Even if you have genetic risk factors, proper preventive measures significantly reduce your chances of developing the disease.
Daily Oral Hygiene
Brushing
- Brush at least twice daily for two minutes each time
- Use a soft-bristled brush and fluoride toothpaste
- Angle the brush toward the gum line at 45 degrees
- Use gentle, circular motions rather than harsh scrubbing
- Replace your toothbrush every 3-4 months or when bristles fray
Interdental Cleaning
Cleaning between teeth is crucial because brushing alone only reaches about 60% of tooth surfaces. Options include:
- Interdental brushes: Small brushes that fit between teeth. Often more effective than floss, especially with larger gaps
- Dental floss: Effective for tight contacts between teeth
- Water flossers: Useful for people with braces, implants, or difficulty using traditional floss
- Wooden or plastic interdental picks: Convenient for on-the-go cleaning
Professional Care
- Visit your dentist for checkups at least twice yearly
- Get professional cleanings to remove tartar that home care cannot
- Follow individualized recommendations based on your risk factors
- Don't skip appointments even when your teeth feel fine
Lifestyle Factors
Quit Smoking
If you smoke, quitting is one of the most important steps you can take for your periodontal health. Smoking weakens the immune system, impairs blood flow to the gums, and significantly slows healing after periodontal treatment.
Manage Systemic Health
- Keep diabetes well-controlled through diet, exercise, and medication
- Manage stress through healthy coping strategies
- Eat a balanced diet rich in vitamins C and D
- Stay hydrated to maintain healthy saliva production
Your Dentist Is Your Partner
Your dental team can provide personalized advice on the best cleaning techniques and tools for your specific needs. Don't hesitate to ask for a demonstration of proper brushing and flossing during your appointments.
What Happens If Periodontitis Is Left Untreated?
Quick Answer: Untreated periodontitis leads to progressive bone loss, tooth loss, difficulty chewing, and changes in facial appearance. It may also increase risk for systemic health problems.
Without treatment, periodontitis continues to destroy the structures supporting your teeth. The process typically takes 10-20 years from initial inflammation to tooth loss, though it can progress faster in some individuals.
Oral Consequences
- Tooth loss: As bone support diminishes, teeth become loose and eventually fall out or require extraction
- Difficulty chewing: Missing or loose teeth impair your ability to eat properly
- Speech changes: Tooth loss can affect pronunciation
- Aesthetic changes: Missing teeth and bone loss alter facial appearance
- Need for tooth replacement: Bridges, implants, or dentures may be required
Potential Systemic Effects
Research increasingly suggests connections between periodontal disease and systemic health conditions, though the nature of these relationships is still being studied:
- Cardiovascular disease: Periodontal inflammation may contribute to arterial inflammation
- Diabetes complications: Periodontitis can make blood sugar control more difficult
- Respiratory infections: Oral bacteria can be aspirated into the lungs
- Pregnancy complications: Some studies link severe periodontitis to preterm birth and low birth weight
- Rheumatoid arthritis: Shared inflammatory pathways may connect these conditions
The Importance of Treatment
While damage already done to bone cannot typically be reversed, treatment at any stage can stop progression. Even if you have advanced periodontitis, working with a periodontist can help you keep your remaining teeth and prevent further loss.
Frequently Asked Questions
Medical References
- Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. J Periodontol. 2018;89 Suppl 1:S159-S172. doi:10.1002/JPER.18-0006
- Sanz M, Herrera D, Kebschull M, et al. Treatment of stage I-III periodontitis—The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020;47 Suppl 22:4-60. doi:10.1111/jcpe.13290
- Loe H, Anerud A, Boysen H, Morrison E. Natural history of periodontal disease in man. Rapid, moderate and no loss of attachment in Sri Lankan laborers 14 to 46 years of age. J Clin Periodontol. 1986;13(5):431-445. doi:10.1111/j.1600-051x.1986.tb01487.x
- Genco RJ, Borgnakke WS. Diabetes as a potential risk for periodontitis: association studies. Periodontol 2000. 2020;83(1):40-45. doi:10.1111/prd.12270
- Bergström J. Tobacco smoking and chronic destructive periodontal disease. Odontology. 2004;92(1):1-8. doi:10.1007/s10266-004-0043-4
- World Health Organization. Global oral health status report: towards universal health coverage for oral health by 2030. Geneva: WHO; 2022.
- American Academy of Periodontology. Guidelines for the Management of Patients with Periodontal Diseases. J Periodontol. 2006;77(9):1607-1611.