Periodontitis is a serious gum infection that affects the tissues supporting your teeth and is the primary cause of tooth loss in adults. The condition begins when bacteria in plaque cause inflammation of the gums, a reversible stage called gingivitis. If the inflammation spreads below the gumline, it progresses to periodontitis, which damages the soft tissue and the underlying bone that anchors the teeth. Unlike gingivitis, periodontitis causes irreversible damage to the tooth’s supporting structures. The condition is not a temporary infection, but a permanent state of disease that requires lifelong management.
Why Periodontitis Is a Chronic Condition
Periodontitis does not resolve on its own; it is classified as a chronic, destructive, and irreversible inflammatory condition. The persistence of the disease stems from the infection taking hold beneath the gumline, where routine brushing and flossing cannot clean. Bacteria colonize deep spaces, known as periodontal pockets, which form as the gum tissue detaches from the tooth root.
These harmful bacteria constantly trigger a sustained inflammatory response from the body’s immune system. This defense mechanism, while trying to eliminate the infection, inadvertently causes the destruction of the periodontal ligament and the alveolar bone. Because the bacterial source is continuously present in these deep, inaccessible pockets, the destructive process will continue indefinitely unless professional intervention removes the contamination. Therefore, the condition is controlled and managed over the patient’s lifetime to prevent further damage.
Understanding Disease Progression
If periodontitis is left untreated, the disease progression follows a timeline of increasing destruction, directly influencing how long the teeth will remain stable.
Initial Periodontitis
The initial stage is marked by pocket depths around 4 millimeters and slight bone loss, which can continue to deteriorate over several years. At this point, the damage is present but the teeth usually remain firm.
Moderate Periodontitis
The condition advances to moderate periodontitis when pocket depths reach 5 to 6 millimeters and noticeable bone loss becomes visible on X-rays. The loss of supporting bone structure accelerates, and the infection continues to break down the connective fibers that hold the tooth in its socket. Without treatment, affected teeth may begin to loosen and could potentially be lost within three to five years.
Advanced Periodontitis
The final phase is advanced or severe periodontitis, characterized by deep pockets of 6 to 8 millimeters or more and significant bone loss. Teeth become visibly loose, chewing can become painful, and teeth may shift out of position. In this severe state, the tooth’s foundation is so compromised that tooth loss is often inevitable, requiring extraction within one to three years. The timeline is variable and depends heavily on factors like a person’s immune response, genetics, and lifestyle habits like smoking.
Stopping Active Periodontitis
Stopping the active, destructive phase of periodontitis requires professional treatment aimed at removing the bacterial infection from the root surfaces. The first line of defense is scaling and root planing (SRP), a deep cleaning performed under local anesthesia.
Scaling and Root Planing
Scaling involves meticulously removing all plaque, tartar, and bacterial toxins from the tooth surface, both above and below the gumline, reaching into the periodontal pockets. Root planing is performed to smooth the rough surfaces of the tooth roots. This smoothing action encourages the gum tissue to reattach to the tooth, reducing the depth of the periodontal pocket.
Surgical Intervention
In cases of severe periodontitis, non-surgical treatment may not be sufficient, necessitating surgical intervention. Surgical options, such as flap surgery, involve temporarily lifting the gum tissue to gain direct access for cleaning and smoothing the roots and bone. Bone grafting or soft tissue grafts may also be used to repair some of the damage. Successful treatment halts the active progression, shifting the patient into a lifelong maintenance phase.
Managing Long-Term Effects
Even after the active disease process is successfully stopped, periodontitis leaves behind permanent effects that require ongoing management. The damage to the gum tissue and bone is largely irreversible, meaning the lost bone structure and gum recession cannot simply grow back. Gum recession causes the teeth to look longer than normal and exposes sensitive root surfaces, which can lead to increased risk of root decay.
Bone defects and remaining deep pockets may persist, requiring vigilant, continuous care to prevent recurrence. Patients treated for periodontitis must commit to a strict schedule of supportive periodontal maintenance appointments. This typically means visiting the dental professional every three to six months, rather than the standard twice-yearly cleaning, to ensure the bacterial infection does not flare up again.