Periodontitis is a serious infection of the tissues surrounding the teeth, representing an advanced form of gum disease. This condition actively attacks the supporting structures that anchor teeth firmly in the jaw. Affecting nearly half of all adults over the age of 30 in the United States, periodontitis is a major public health concern. If this chronic infection is not addressed promptly, the destruction of tissue and bone can ultimately lead to tooth loss.
Defining Periodontitis and Its Stages
Periodontitis refers to the inflammatory process that impacts the periodontium, which includes the gum tissue, the periodontal ligament, and the alveolar bone. The disease progresses through distinct phases, beginning with a milder, reversible precursor known as gingivitis. Gingivitis involves inflammation, redness, and swelling of the gums, often resulting in bleeding upon brushing or flossing, but without any loss of supporting bone.
If gingivitis is left untreated, the inflammation becomes chronic and destructive, marking the transition to periodontitis. The initial stage is characterized by the inflammation spreading below the gum line, causing the gum tissue to detach from the tooth surface. This detachment forms deepened spaces called periodontal pockets, which become reservoirs for bacteria and hardened plaque, known as calculus or tartar.
As the disease moves into moderate stages, the infection destroys the periodontal ligament fibers that connect the root to the bone. This destruction leads to irreversible loss of the surrounding alveolar bone, which is visible on dental X-rays. In advanced stages, bone loss becomes extensive, reducing the stability of the tooth and causing mobility, significantly raising the risk of tooth extraction.
Primary Causes and Risk Factors
The fundamental cause of periodontitis is the persistent accumulation of bacterial plaque, a sticky film that forms on the teeth and gum surfaces. If plaque is not consistently removed through daily cleaning, the bacteria release toxins that irritate the gingiva, initiating the inflammatory response. Over time, minerals in saliva cause the plaque to calcify, forming hard deposits of tartar both above and below the gum line. Tartar cannot be removed with a toothbrush and provides a rough surface that encourages further bacterial growth, accelerating the disease.
Beyond oral hygiene, several systemic and lifestyle factors increase susceptibility to the infection. Smoking is a major risk factor, as tobacco use impairs blood flow to the gums, masking inflammation signs and hindering the tissue’s ability to heal. Uncontrolled diabetes also exacerbates periodontitis because high blood sugar levels reduce the body’s ability to fight infection and manage inflammation effectively.
Genetic predisposition can play a role, as some individuals have a heightened immune response that overreacts to bacteria, leading to aggressive tissue destruction. Other contributing factors include hormonal fluctuations, such as those during pregnancy or menopause, which increase gum sensitivity to plaque. Chronic stress and certain medications that cause dry mouth also compromise the mouth’s natural defenses.
Recognizing the Signs
The physical manifestations of periodontitis can be subtle at first, often progressing without significant pain until the later stages. Common early indicators include gingival bleeding when brushing, flossing, or eating harder foods. The gums may also appear swollen, puffy, or a darker shade of red or purple compared to healthy, pale pink tissue.
Persistent bad breath, medically termed halitosis, is a frequent symptom caused by anaerobic bacteria trapped within the deep periodontal pockets. As supporting bone is lost, the gums may begin to pull away from the tooth surface, a process known as recession. This recession makes the teeth appear unusually long and exposes the softer root surfaces, increasing sensitivity.
In advanced cases, the loss of bone support can cause teeth to become loose or shift positions, leading to changes in the way the upper and lower teeth fit together when biting. The presence of pus oozing from the gum line is a definitive sign of active infection and advanced periodontal disease.
Professional Treatment Options
Treatment for periodontitis focuses on controlling the bacterial infection and halting the destructive process to preserve the remaining bone and tissue. For less advanced cases, the initial treatment involves non-surgical procedures, primarily Scaling and Root Planing (SRP). Scaling involves removing the tartar and bacteria from the tooth surfaces both above and below the gum line, often using specialized instruments.
Root planing follows scaling, smoothing the root surfaces to eliminate rough areas where bacteria easily accumulate. This smoothing encourages the gum tissue to reattach to the clean tooth surface, which helps shrink the periodontal pocket depth. Adjunctive therapies may include the local placement of antibiotic gels or chips directly into the deep pockets, or the prescription of oral antibiotics to manage widespread infection.
If non-surgical methods are insufficient, particularly when pockets remain deep, surgical interventions become necessary. Flap surgery, also known as pocket reduction surgery, involves temporarily lifting the gum tissue to gain direct access to the deeper infection and bone defects. The periodontist then cleans the root surfaces and reshapes any damaged bone before stitching the gum tissue back tightly around the tooth.
Bone and Tissue Regeneration
To address bone loss, procedures like bone grafting may be performed, using the patient’s own bone, donated bone, or synthetic material to regenerate lost structure. Guided tissue regeneration is often used alongside grafts, where a biocompatible membrane is placed between the gum and the bone. This prevents the faster-growing gum tissue from interfering with the slower regeneration of new bone. Soft tissue grafts may also be used to cover exposed tooth roots, reducing sensitivity and preventing further gum recession.
Preventing Progression and Recurrence
Periodontitis requires long-term management following professional treatment because it is a chronic condition with a high potential for recurrence. Patient commitment to an effective home care regimen is essential for maintaining the stability achieved through deep cleaning or surgery. This regimen includes brushing twice daily with a soft-bristled brush, paying attention to the gum line, and using a proper technique to ensure thorough plaque removal.
Flossing or using interdental brushes once a day is necessary to clean the surfaces between the teeth and below the gum line where a toothbrush cannot reach. A water flosser can also be an effective device for disrupting bacterial colonies and irrigating the periodontal pockets. These daily habits prevent the formation of new plaque and the subsequent calcification into tartar, which would otherwise trigger a relapse of the infection.
Equally important is adherence to a Supportive Periodontal Therapy (SPT) schedule, involving regular professional maintenance visits. These appointments are typically more frequent than standard six-month checkups, often scheduled every three or four months, depending on the initial disease severity and the patient’s risk factors. During SPT, the dental professional removes any new tartar deposits and monitors the gum pockets for signs of disease reactivation. Addressing modifiable risk factors, such as controlling blood sugar or quitting tobacco use, improves the long-term prognosis and reduces the likelihood of disease progression.