What Is Periodontitis?
Periodontitis is inflammation of the tissues that surround and support the teeth, including the gums and the bony tooth sockets in the upper and lower jaw. The disease begins as gingivitis (inflammation of the gums, usually due to inadequate dental hygiene) which progresses without treatment.
Gingivitis occurs when dental plaque (a sticky substance made of mucus, food particles, and bacteria) and calculus (the hardened deposit composed of mineralized plaque and saliva) irritate and inflame gum tissue, causing it to gradually erode. Over time, the gums recede and small pockets form between the gums and teeth. As these pockets deepen, they trap increasing amounts of plaque and calculus.
Bacteria in the dental plaque produce an inflammatory reaction that erodes the bone and ligaments that support the teeth, causing the teeth to loosen within their sockets. Pus tends to form as the infection worsens. In some cases an acute infection may cause an abscess to form. Eventually, bone erosion is so extensive that the affected teeth become loose. Indeed, periodontitis—not tooth decay—is the major cause of adult tooth loss in the United States.
What Causes Periodontitis?
- Periodontitis results when gingivitis is left untreated, allowing extension beyond the gums to affect the deeper supportive tissues.
- Failure to brush and floss regularly may lead to periodontitis.
Symptoms of Periodontitis
- Red, shiny, swollen, tender gums that bleed easily
- Bad breath and an unpleasant taste in the mouth
- One or more loose or missing teeth
- Pus appearing at the gumline
- Intense toothache, swelling, and fever (if abscess occurs)
- Bleeding gums when you brush your teeth
Practice careful oral hygiene and see a dentist at least once a year for a routine cleaning and checkup.
- A complete dental examination is necessary. The dentist will measure the depth of gum pockets to assess the extent of the disease.
- Dental x-rays are taken to determine how much underlying bone is present.
How to Treat Periodontitis
- If the disease is discovered early enough, it will be possible to reverse its progress simply by having a dentist remove plaque and calculus from the root surfaces of the teeth. This is called periodontal scaling and root planing and may require local anesthesia. Afterward, a strict self-care program of brushing and flossing is required. Often, periodontal treatments are required every three months to maintain healthy gums.
- More advanced cases may require flap surgery. In this procedure the tissue is cut and pushed away from the teeth so that the roots and supporting bone may be cleaned and recontoured. The flap of gum is then sutured back into place.
- Occasionally, surgical grafting with bone or a bone substitute may be needed to restore damaged underlying bone.
- The recent introduction of polymer granules or beads containing antibiotics, which can be injected into the pocket between the tooth and bone, allows stabilization of the disease and regrowth of some lost bone.
- Loose teeth may be anchored to other teeth by splinting them together; in some cases affected teeth must be extracted due to the extent of bone loss. Dentures or permanent dental implants may then be used to replace missing teeth.
When to Call a Doctor
Make an appointment with a dentist right away if you experience bleeding gums or loose teeth.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media