Periodontitis is an inflammatory disease of the periodontium, i.e., the supportive tissues that hold a tooth in its socket. It can cause detachment of the gums from the tooth structure. It begins with redness and swelling of gums, a condition known as gingivitis, and eventually progresses towards gum recession and bone loss. In severe periodontitis, you can lose one or more valuable teeth as a result.
The primary cause of periodontitis is the ill maintenance of oral hygiene. If you don’t brush your teeth regularly as per advised guidelines, plaque formation occurs, and the bacteria in your oral cavity accumulate within the gum pockets surrounding the tooth structure. In the early stages, they cause inflammation of gums (gingivitis). If not addressed at this stage, this progresses to further inflammation, loss of supporting tissues, and eventually tooth loss.
Another major cause of periodontitis is smoking. Research shows that periodontitis occurs more frequently in smokers than non-smokers. It irritates the gum tissues, leading to an inflammatory response and detachment of supporting tissues.
Other periodontitis causes include underlying medical conditions such as diabetes, obesity, HIV, leukemia, vitamin C deficiency, genetic diseases, dry mouth, and increased stress levels. During menstruation and pregnancy, women's hormonal changes can also be risk factors for periodontitis.
Stages of Periodontitis:
Periodontitis can be divided into three stages based on the severity of progression. The primary factor in identifying this disease’s severity is the loss of supportive tissues surrounding tooth structure, also known as clinical attachment loss.
Early-stage periodontitis displays 1-2 mm of clinical attachment loss, moderate stage periodontitis displays 3-4 mm of clinical attachment loss, and severe stage periodontitis displays five or greater than 5 mm of clinical attachment loss. With growing severity, the gums recede or detach over time, the bone surrounding your tooth structure reduces, and the tooth may become loose in its socket.
There are internal and environmental risk factors that may lead to periodontitis. Internal factors include lack of proper oral hygiene, poor living conditions, incomplete nutrition, diabetes, diseases compromising the immune system, genetic factors, and fluctuation of hormonal levels. Among external risk factors, smoking is one of the most significant factors that increase the risk of this disease.
Periodontitis occurs widely across the globe and is the second most prevalent tooth-related disease after dental caries. In the US, almost 30-50% of the population is at risk of periodontitis, although fewer severity cases have been reported since it is diagnosed and treated early.
The signs and symptoms of periodontitis may include redness or swelling of gums, bleeding from gums (spontaneous or overzealous brushing), bad breath, foul or metallic taste in the mouth, the recession of gums over time, and loss of supporting tooth structure. Early-stage signs are similar to gingivitis, but gum tissue detachment occurs in late stages, which forms deep pockets around the tooth structure. Mobility of tooth and eventual tooth loss might occur as well.
Early-stage periodontitis is usually diagnosed during routine dental checkups. Your dentist might ask for a detailed history of underlying risk factors and smoking to rule out possible causes. A simple diagnostic test performed at dental clinics is to insert a periodontal probe in gingival pockets. This is potentially a painless procedure and gives an approximate measurement of clinical attachment loss to determine the severity of the disease.
Radiological tests consisting of Postero-Anterior X-rays or panoramic X-rays might be performed as well by your dentist to gauge the progression of the disease. In a few cases, microbiological tests might be necessary to determine the particular species of bacteria within pockets of your gums.
Deep-seated bacteria of non-gingival origin might mimic the signs and symptoms of periodontitis. Specific endodontic lesions can lead to irritation of your gums as well. In these scenarios, your dentist must identify the cause of the existing disease and treat it accordingly.
The primary treatment option for early-stage periodontitis is the maintenance of oral hygiene by brushing twice a day and using dental floss to clean in between teeth. If there are interdental gaps present, an interdental brush is suggested. In excessive plaque and calculus deposition around teeth, it is necessary to seek professional dental help. Your dentist would perform scaling as early treatment to remove plaque/ calculus buildup. This usually leads to healthy gums within one or two weeks if oral hygiene is maintained. In the case of deep periodontal pockets, deep curettage is performed under local anesthesia to clean any deposits off the tooth surface thoroughly.
If the condition is severe, non-surgical means are insufficient, and you might require periodontal surgery. In such cases, a surgical flap is raised, and thorough debridement is performed. This is followed by frequent checkups and regular maintenance of oral hygiene.
Adjunctive medication might be recommended in a few cases of periodontitis which includes the usage of oral antibiotics such as amoxicillin, metronidazole, and anti-inflammatory drugs such as ibuprofen, naproxen. Although in most cases, non-surgical maintenance alone is sufficient to reduce the severity of this disease.
Periodontitis is a chronic disease, and the prognosis depends on the stage of diagnosis, severity, and long-term treatment and maintenance. If you have been diagnosed early with no or less attachment loss, the prognosis is usually good with non-surgical treatment methods. If the attachment loss is beyond 7 mm, you might risk tooth loss over the years. The forecast also depends on underlying conditions and external risk factors.
Brushing twice a day and using dental floss can highly reduce the risk of periodontitis. Use of antiseptic mouthwash as prescribed by your dentist is helpful as well. If you have diabetes or any other medical condition that might make you susceptible, it is suggested to have regular dental checkups to avoid developing this disease. Quitting or reducing the frequency of smoking also decreases the risk of periodontitis.
Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 26, 2023.
Periodontal Disease | Oral Health Conditions | Division of Oral Health | CDC
Recent epidemiologic trends in periodontitis in the USA - Eke - 2020 - Periodontology 2000 - Wiley Online Library