What causes periodontitis and how to treat it?

What causes periodontitis and how to treat it?


What is a periodontal disease?

Periodontitis is a serious gum infection. It is caused by accumulated bacteria on your gums and teeth. Your teeth and bones can be damaged as a result of a progressed periodontitis. However, the damage of periodontitis can be stopped if you start treating it early, and maintain a proper oral hygiene.

What are the stages of periodontal disease?

In the beginning, periodontitis appears as an inflammation and gets worse over time.

Inflammation (gingivitis)

Periodontitis begins with inflammation of the gums, which is called gingivitis. One of the first signs of gingivitis is bleeding of your gums while brushing your teeth or flossing.

You may also notice your teeth changing color. This discoloration on your teeth is called plaque. Plaque is an accumulation of bacteria and food particles on your teeth. Although bacteria are always present in your mouth, they only become harmful if circumstances allow them to multiply dramatically. This can happen if you do not brush, do not use dental floss, or have regular dental cleanings.

Early periodontitis

In the early stages of periodontal disease, your gums start pulling away or receding from your teeth and small pockets will form between your teeth and gums. The pockets contain harmful bacteria. Your immune system is trying to fight the infection and your gums start receding. Bleeding and possibly bone loss are also likely to occur during brushing and flossing.

Moderate periodontitis

If the progression leads to moderate periodontal disease, bleeding and pain in the area around the teeth and gum recession may occur. Your teeth will gradually lose bone support and become loose. The infection can also lead to an inflammatory reaction throughout your body.

Advanced periodontitis

In advanced disease, the connective tissue that keeps your teeth in place starts deteriorating. The bones, gums and other tissues that support your teeth start getting destroyed. If you have advanced periodontal disease chewing can cause severe pain, your breath will be severely bad, and you will have an unpleasant taste in your mouth. You will probably lose your teeth.

What are the symptoms of periodontal disease?

The symptoms are different depending on the stage of the disease but generally include:

  • Bleeding gums when brushing or flossing
  • Receding gums
  • Bad breath
  • Changes in the position of your teeth or loose teeth
  • Tooth loss
  • Pain when chewing
  • Buildup of plaque or tartar on your teeth
  • Red, swollen or tender gums
  • Inflammatory response throughout your body
  • Unpleasant taste in your mouth

You can’t really notice symptoms in the early stages of periodontitis. Your dentist will probably be the first to recognize them.

What causes periodontal disease?

The mouth of a healthy person usually contains hundreds of different types of bacteria. Most of the bacteria are harmless. If you don’t brush your teeth after every meal, the bacteria will grow and build up on your teeth.

Poor dental hygiene typically causes periodontal disease. If you do not brush your teeth and clean them your mouth thoroughly, the following happens:

  1. The bacteria in your mouth starts multiplying and forming dental plaque.
  2. If you don’t brush your teeth to remove the plaque, the bacteria will deposit minerals in the plaque over time.
  3. This mineral deposit or tartar will promote bacterial growth toward the root of the tooth.
  4. The immune response of your body to this growth of bacteria leads to gum inflammation.
  5. A periodontal pocket or gap may form between the root and gum because the attachment of the gum to the root of a tooth gets disrupted over time.
  6. Harmful anaerobic bacteria colonize the pocket, multiply and release toxins that can damage the teeth, gums and supporting bone structures.

Additionally, you may be under a higher risk of periodontitis due to certain factors such as:

  • Smoking is the biggest risk factors for periodontal disease
  • Obesity
  • Type 2 diabetes
  • Conditions that affect your immune system like leukemia or HIV
  • Genetics
  • Hormonal changes in women like menopause, pregnancy or menstruation, can make the gums more sensitive
  • Medications that reduce the flow of saliva in your mouth
  • Poor diet, and a deficiency of vitamin C

How is periodontitis diagnosed?

Your dentist can detect signs of early-stage periodontitis during a routine checkup. They can monitor your periodontal status regularly so it doesn’t get any worse. For this reason, it is important to get regular dental examinations.

Your dentist may use a small ruler, called a probe, to measure any existing pockets on your gums. This test is painless. If there is tartar, plaque or both on your teeth, your dentist will remove these substances as part of professional cleaning. They can also take dental X-rays or refer you to an expert in diagnosing and treating gum disease called periodontist, for further examination and treatment.

What are the complications of periodontitis?

If you are not being treated for periodontal disease, the structures that support your teeth, along with the bones of your jaw, may be destroyed. Your teeth may loosen to the point where they start falling out or require extraction. Other complications of periodontal disease are:

  • Receding gums and exposure of the roots of your teeth
  • Painful abscesses
  • Migration of your teeth which interferes with eating
  • Increased risk of respiratory disease, diabetes and heart disease
  • Increased risk of complications during pregnancy such as preeclampsia and low birth weight

How to treat periodontitis?

The treatment aims to remove bacterial deposits and plaque accumulated on your gums and teeth.

Oral hygiene practices

Your dental team will instruct you to keep your gums and teeth clean in order to reduce the number of bacteria in your mouth. Your dentist will advise you how to brush your teeth and floss properly and may recommend other products for maintaining a good oral hygiene like mouthwash or a water pick.

Here are a few tips on how to keep your teeth healthy:

  • Consider using an electric toothbrush which may be more effective
  • Brush your teeth after each meal using a fluoride toothpaste
  • Don’t smoke or chew tobacco
  • Floss at least once a day to remove plaque
  • Get dental checkups at least twice a year for professional cleaning

Professional cleaning

During a professional cleaning, your dentist removes tartar and plaque from your teeth and roots, polishes your teeth, and treats them with fluoride. Periodontal pockets have to be thoroughly cleaned in order to start healing. A deep-cleaning method called root planning and scaling helps to scrape off tartar and also remove rough spots on the root of the tooth where bacteria usually accumulates.


Your dentist may prescribe antibiotics if your persistent gum infections haven’t responded to cleanings. The antibiotic may be in the form of an oral tablet, mouthwash or capsule.

Follow up appointments

You may have to visit your dentist after about every three to six months in order to monitor the progress of your situation. If periodontal pockets don’t go away, they may recommend other treatment options such as surgery.


If places that are inaccessible to brushing and flossing are still inflamed, your dentist may recommend a surgical procedure called flap surgery to clean deposits under your gums. Your gums are lifted away under anesthesia and the roots are cleaned. Your gums will then be sewn again.

If you have lost bone, a procedure called bone grafting can be performed simultaneously with a flap operation to regenerate the lost bone.

What is the outlook for periodontal disease?

If noticed and treated early, periodontitis can be stopped. The treatment is usually very successful.

If you suffer from periodontal disease, you must visit a dentist regularly to make sure that the disease doesn’t progress. You need to change your dental hygiene habits and follow your dentist's instructions carefully to get a positive result. The outlook in the long-term depends on your oral hygiene and the ongoing assessment of your dentist.

Additionally, periodontitis progresses much faster in smokers because they often have a poor attitude towards the periodontal disease. In fact, the vast majority of cases in which the treatment is unsuccessful involve smokers.

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Darko Siracevski

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