Periodontitis Explained

By: Maria Trimarchi

Periodontal disease occurs when gums recede due to a build-up of plaque or tarter. Learn how to treat this condition and practice healthy oral behavior in this video from the American Dental Association.
Periodontal disease occurs when gums recede due to a build-up of plaque or tarter. Learn how to treat this condition and practice healthy oral behavior in this video from the American Dental Association.
American Dental Association

You brush, maybe you floss and you try to get to the dentist for your routine cleanings when you remember. Sound familiar? Only about half of Americans floss every day (and 10 percent admit they never floss) [source: Freeman]. The result of this sometimes lax dental hygiene is that the majority of American adults have periodontal disease.

Periodontal diseases affect an estimated 75 percent of American adults, so the chances are good you're one of them, although you may not know it -- it turns out as many as 40 percent of those with periodontal diseases aren't aware of it [source: University of Maryland Medical Center]. And we all know: Knowing is half the battle. So how would you know if you have a periodontal disease?

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Periodontal diseases are diseases that affect the periodontium, which includes the gingiva (the gums), the roots of the teeth, the periodontal ligament (which holds the tooth in the bone) and the alveolar bone. They may take hold around just one tooth or they may affect a whole mouth. These diseases are most often caused by plaque build-up on the teeth and gums.

Plaque is a sticky residue of bacteria that clings to the surfaces of our teeth and gums. Studies find that a healthy mouth may have more than 350 different species of bacteria in it, and about five percent of that bacteria can be linked to inflammation and infection [source: University of Maryland Medical Center, Lovegrove]. These bacteria feed on the sugars and starches left over from the foods we eat and drink, and in turn they produce acid. When plaque is allowed to linger along the gum line, the acid produced by the bacteria begins to irritate and inflame the gum tissue, leading to tooth decay and eventually, as the bacteria invade the tissues and bone below the gum line, tooth loss.

Other causes of periodontal disease include personal habits such as smoking, poor oral hygiene, certain medications and illnesses as well as hormonal changes in women and your personal family history.

There are two stages of periodontal disease: gingivitis and periodontitis. Let's talk symptoms and severity next.

Periodontitis Symptoms

Gingivitis is the earliest stage of periodontal disease. It causes inflammation of the gum tissue, with symptoms that often include red, swollen gums that may bleed easily. Gingivitis is highly treatable with daily brushing and flossing at home and routine dental cleanings. A mild case may clear as quickly as just one week with proper and diligent oral hygiene practices. Without care, though, gingivitis can become periodontitis. While gingivitis affects more than 50 percent of American adults, fast forward to those who are 70 years old or older and the numbers jump -- 86 percent of American seniors suffer from moderate to advanced periodontitis [source: University of Maryland Medical Center].

Periodontitis is a bacterial infection that affects the tissues, ligaments and bones that keep our teeth in place (and in our mouth). It is a severe form of periodontal disease.

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Periodontitis can be aggressive and it can be chronic. Aggressive periodontitis affects 1 to 15 percent of Americans and is most likely to be diagnosed in adults younger than age 35 [source: Demmer]. Chronic periodontitis, the more common of the types, is primarily an adult disease. Patients with untreated or advanced systemic conditions such as diabetes or HIV are also at a high risk for periodontitis.

As the infection worsens into periodontitis, the red, swollen gums of gingivitis begin to turn bright red or even purple and begin to recede. You may begin to notice the spaces between your teeth are widening as the gums pull away, and there may be pus in those spaces. As the infection deepens, tissues and bone surrounding the affected tooth begin to shrink. In severe, advanced cases, teeth may shift or become loose.

Periodontitis, like gingivitis, is treatable, but the treatments change depending on how advanced the infection becomes. While gingivitis may be treated at home, periodontitis requires professional treatment.

Periodontitis Treatment

To treat periodontitis and keep it at bay in the long-term, regular professional cleanings need to be part of your dental hygiene routine.
To treat periodontitis and keep it at bay in the long-term, regular professional cleanings need to be part of your dental hygiene routine.
©iStockphoto.com/webphotographeer

The goal of treating periodontitis is to clean bacteria from the tooth and gum surface and from below the gums, preventing and reducing inflammation and infection. Depending on how advanced the disease is, treatments may be non-surgical or surgical. The type of treatment depends on the size of your pockets.

Normally there isn't much of a gap between the tooth and the gum tissue that surrounds it -- usually 3 millimeters or less in a healthy mouth. When plaque build-up begins to cause gum inflammation, the gap begins to widen, creating what dentists call a "periodontal pocket" between the tooth and the gum. If a pocket deepens to 3 to 5 millimeters it can usually be managed with non-surgical treatments at a visit to the dentist, followed by good, ongoing at-home oral hygiene. These non-surgical treatments may include:

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  • Scaling to clean plaque, tartar and bacteria below the gum line
  • Root planing to prevent further bacteria growth by smoothing the surface of the tooth below the gum line, and
  • Antibiotics (topical or oral)

All of these treatments aim to reduce the number of bacteria in the pockets and the associated inflammation of moderate periodontitis.

When pockets grow deeper than 5 millimeters, the condition is considered advanced periodontitis, and surgical treatments may be needed to clean out the bacteria and restore damaged soft tissue and bone when possible. Surgical treatments may include:

  • Pocket reduction surgery to deeply clean and tighten the periodontal pockets
  • Soft-tissue grafts to cover exposed roots with tissue (often donated from the roof of the mouth)
  • Bone grafts to restore bone lost to the bacterial infection
  • Guided tissue regeneration to regrow soft tissue, connective tissue and bone lost to the bacterial infection, and
  • Enamel matrix derivative application, where a gel is applied to the root of the tooth to encourage bone and tissue regrowth

Following professional periodontal care it's important to maintain good oral care at home to prevent another infection. If you're recovering from periodontal treatment, both non-surgical and surgical, brushing at least twice a day along with daily flossing will help prevent plaque from re-gaining the upper hand. For best results, ask your dentist if your brushing and flossing technique is correct.

Lots More Information

Related Articles

More Great Links

  • Colgate Oral and Dental Health Resource Center. "Gingivitis." (Nov. 18, 2011) http://www.colgate.com/app/CP/US/EN/OC/Information/Articles/Oral-and-Dental-Health-Basics/Common-Concerns/Gum-Disease/article/Gingivitis.cvsp?cid=ppc_gg_nb_stan_gingivitis_&kw=gingivitis
  • Colgate Oral and Dental Health Resource Center. "Periodontitis." 2006. (Nov. 18, 2011) http://www.colgate.com/app/CP/US/EN/OC/Information/Articles/Oral-and-Dental-Health-Basics/Common-Concerns/Gum-Disease/article/Periodontitis.cvsp
  • Colgate Oral and Dental Health Resource Center. "What are the Stages of Gum Disease?" (Nov. 18, 2011) http://www.colgate.com/app/CP/US/EN/OC/Information/Articles/Oral-and-Dental-Health-Basics/Common-Concerns/Gum-Disease/article/What-are-the-Stages-of-Gum-Disease.cvsp
  • Demmer, RT; PN Papapanou. "Epidemiologic patterns of chronic and aggressive periodontitis." Periodontology 2000. Vol. 53. Pages 28 - 44. 2010. (Nov. 18, 2011) http://www.ncbi.nlm.nih.gov/pubmed/20403103
  • Freeman, David. "Flossing Teeth for Dummies: No More Excuses!" WebMD. 2010. (nov. 18, 20110 http://www.webmd.com/oral-health/healthy-teeth-10/flossing-floss-sticks
  • Lovegrove, JM. "Dental plaque revisited: bacteria associated with periodontal disease." Journal of the New Zealand Society of Periodontology. 2004. (Nov. 18, 2011) http://www.ncbi.nlm.nih.gov/pubmed/15143484
  • Mayo Clinic. "Periodontitis." 2010. (Nov. 18, 2011) http://www.mayoclinic.com/health/periodontitis/DS00369
  • The Merck Manual Home Health Handbook. "Periodontitis." 2008. (Nov. 18, 2011) http://www.merckmanuals.com/home/mouth_and_dental_disorders/periodontal_diseases/periodontitis.html
  • National Institute of Dental and Craniofacial Research (NIDCR). "Study Finds Direct Association Between Cardiovascular Disease and Periodontal Bacteria." 2005. (Nov. 18, 2011) http://www.nih.gov/news/pr/feb2005/nidcr-07.htm
  • Rosen, Paul S. "Treatment of Plaque-induced Gingivitis, Chronic Periodontitis, and Other Clinical Conditions." American Academy of Pediatric Dentistry Endorsements. Reference Manual. Vol. 33, no. 6. Pages 11 - 12. 2004. (Nov. 18, 2011) http://www.aapd.org/media/Policies_Guidelines/E_Plaque.pdf
  • University of Maryland Medical Center. "Periodontal disease - Introduction." 2009. (Nov. 18, 2011) http://www.umm.edu/patiented/articles/what_periodontal_disease_000024_1.htm