What Is Periodontitis?

Periodontitis is a gum disease that can damage the soft tissue. And if left untreated, it can destroy the bone that supports your teeth. It’s a common gum disease, but it’s a preventable condition.

The disease begins with bacterial growth in your mouth, causing inflammation (gingivitis), and if not properly treated, it progresses to gum recession and may end in tooth loss due to destruction of the tissue that surrounds your teeth. If patients take their oral health seriously and follow proper treatment protocols, they can easily prevent this disease.

Regular dental checkups and good oral hygiene practices are your first line of defense against periodontitis. If the supporting structures of your teeth are compromised by periodontitis, your entire oral health is in danger.

To protect ourselves, we need to understand this disease, its symptoms, causes, and the treatment options to take control of our oral health.

Periodontitis Symptoms

Usually, periodontitis develops slowly and may not cause noticeable symptoms in its early stages, and it can silently progress for years before causing noticeable discomfort.

That is why most of the patients are unaware of gum disease until it has progressed to an advanced stage. If we recognize the symptoms of periodontitis early, we can provide effective treatment and prevent further damage. So let’s discuss the key symptoms of periodontitis:

1. The earliest and most common sign of periodontitis is bleeding gums, especially during brushing or flossing. Usually, healthy gums shouldn’t bleed easily.
2. If your gums appear red, swollen, or feel tender to the touch, that means they’re inflamed, and it’s a very important symptom of periodontitis.
3. If the disease has progressed, you might notice that your gums are pulling away from your teeth, which is called gum recession. If that happens, your teeth will appear longer, and sensitive as the roots of your teeth will be exposed, also the risk of decay will increase.
4. As periodontitis is a condition caused by bacteria, these bacteria will cause bad breath, and you may have a bad taste in your mouth.
5. In advanced stages of periodontitis, it will affect the bone and the ligaments surrounding your teeth, which leads to movement of your teeth.
6. You may experience pain while chewing your food.
7. In severe cases, infection can combine with periodontitis. So you might notice pus oozing from between your teeth and the gums.
8. Due to bone loss, your teeth might shift, and you will notice changes in how your teeth fit together when you bite.
9. Gaps between your teeth may occur, as the tissues supporting your teeth (bone and gums) are affected by periodontitis.

These symptoms can vary in severity from person to person. Some individuals may have several symptoms, while others might only notice one or two of them. If you are experiencing any of these symptoms, you need to see your dentist immediately, as early intervention can prevent the progression of the disease, also, some damage can be reversed in the initial stages.

What Causes Periodontitis?

There are various factors that can contribute to the development and progression of periodontitis. Identifying the causes of periodontitis can help us prevent and treat this disease.

• The most common cause of periodontitis is bad oral hygiene. Plaque, which is a sticky film of bacteria, should be regularly removed by brushing and flossing. If it isn’t removed, it can harden and turn into tartar. Tartar can only be removed by a dental professional cleaning. If left untreated, it can lead to gum inflammation. 
• Smokers are up to 3.6 times more likely to develop gum disease than non-smokers. As tobacco use is one of the most significant risk factors for periodontitis, smoking also reduces the effectiveness of treatment.
• Some people are more prone to periodontitis due to their genes. If you have a family history of gum disease, you may be at higher risk.
• Hormonal changes, such as during pregnancy or menopause, can make gums more sensitive and susceptible to gum disease.
• There are some medications that may affect oral health, for example, some anti-convulsants, calcium channel blockers, and immunosuppressants. These medications can cause gum overgrowth, which makes maintaining good oral hygiene very difficult.
• Some chronic conditions like diabetes, rheumatoid arthritis, and cardiovascular diseases usually affect the body’s inflammatory response and decrease its ability to heal, which makes patients with these diseases at high risk of periodontitis.
• If the patient is exposed to a high level of stress, that can weaken their immune system and make it harder for their body to fight infections, including gum disease.
• If your diet is poor in important nutrients, especially vitamin C, it can affect the ability of your body to maintain healthy gums.
• Patients with crowding or misaligned teeth face difficulties maintaining good oral hygiene, which allows plaque to accumulate.
• Periodontitis usually occurs at any age, but it’s more common as we get older.

Periodontitis Stages 

To understand how the disease progresses and how early detection and intervention are very important to prevent further progress, we will explore the different stages of periodontitis.

1) Gingivitis:

•  It’s like a warning light, telling you that you need to take action before more serious problems develop, so it is considered the earliest stage of gum disease, and it’s the only reversible stage. 
• This stage is characterized by red, swollen gums and bleeding during brushing or flossing.
• There is no bone loss or gum recession that occurs during this stage.
• It can be improved and healed by maintaining good oral hygiene and professional dental cleaning.

2) Early Periodontitis:

• 1–2 mm of the gingiva loses attachment to the teeth.
• In this stage, no tooth loss due to periodontitis has occurred.
• Horizontal bone loss may be detected in this stage.

3) Moderate Periodontitis:

• 3–4 mm of the gingiva is detached from the tooth.
• No tooth loss due to periodontitis.
• Horizontal bone loss can be detected in this stage.

4) Severe Periodontitis:

• More than 5 mm of attachment loss.
• Four or fewer teeth lost due to periodontitis.
• Vertical bone loss or furcation involvement can be detected in this stage.

5) Advanced Periodontitis:

• More than 5 mm of clinical attachment loss.
• Five or more teeth lost due to periodontitis.
• Severe vertical and horizontal bone loss occurs in this stage.

What Are The Complications Of Periodontitis?

There are several serious complications that can arise from untreated periodontitis. These complications can extend far beyond just your mouth.

• The most obvious complication of this disease is tooth loss. With the progression of periodontitis, the supporting structure of your teeth will be destroyed, which eventually leads to tooth loss.
• As a result of periodontitis, the gums may detach from the teeth, and gum recession occurs, exposing the roots of the teeth, which increases the risk of decay and sensitivity.
• If the abscess is combined with infection, pus-filled pockets may occur between your teeth and gums. Usually, these abscesses are painful and require urgent treatment.
• There is a strong relation between periodontitis and various systemic health problems, such as:

• It might cause cardiovascular disease, as the bacteria causing periodontitis can enter the bloodstream and lead to inflammation in the arteries.
• There is a two-way relationship between diabetes and periodontitis, as diabetes increases the risk of periodontitis, and periodontitis can make it harder to control blood sugar levels.
• The bacteria from periodontitis can be aspirated into the lungs, causing respiratory conditions.
• If a pregnant woman has periodontitis, she will be at high risk of early birth.

• The normal progression of periodontitis is tooth loss, which makes it difficult for the patient to eat certain foods, leading eventually to nutritional deficiencies. 
• Bone loss is one of the most common complications of periodontitis, which leads to changes in facial structure, making the patient look older. 
• Periodontitis is a condition caused by bacteria. These bacteria may cause chronic bad breath (halitosis). 

Periodontitis Diagnosis

Regular professional check-ups are very important, as early detection of any disease is key to successful treatment. For an accurate diagnosis and assessment of the severity of periodontitis, your dentist may use a combination of clinical examination, imaging, and sometimes laboratory tests. 

1. During the first step of diagnosis, your dentist will start by discussing your overall health, asking about any medications you are taking, and questioning you about your lifestyle and habits that might affect your periodontal health.
   
   Your dentist may order an X-ray, particularly a bitewing and periapical. In some cases, he might use more advanced imaging, like a cone beam CT. This radiographic examination will allow him to see the bone levels around your teeth.

2. Then your dentist will clinically examine your oral cavity. He will inspect your gums and look for signs of inflammation, recession, or any changes in the color of your gums. He will look for tartar buildup and check how your teeth fit together when you bite.
   
   Using a small instrument called a periodontal probe, he will measure the depths of the pockets between your teeth and gums. Healthy pockets are usually 1-3 mm deep. If you have deeper pockets, that may indicate periodontitis.
   
   Bleeding on probing is a sign of active inflammation. Your dentist will also notice any bleeding during probing.
   If you are experiencing tooth loss or severe tooth mobility, that could be an indication of advanced periodontitis.

3. Laboratory tests may be required in some cases. Your dentist will take a sample of bacteria from your gum pocket. This process can help guide antibiotic therapy if needed. Also, for some patients, your dentist may recommend genetic testing to assess the susceptibility of the patient to developing periodontitis, especially in patients with a family history of gum disease.

Periodontitis Treatment

Treating periodontitis is a complex process, ranging from non-surgical interventions to advanced surgical procedures. Based on the severity of the disease and individual patient factors, your dentist will create a treatment plan designed to suit your case.

Non-Surgical Treatment:

1. Scaling and Root Planing is usually the first line of treatment for mild to moderate periodontitis.they are usually performed using ultrasonic devices, although hand instruments may also be used. Scaling is performed to remove plaque and tartar from above and below the gum line. During root planing, your dentist will smooth rough spots on the root surfaces to remove any bacterial toxins. 
2. Antimicrobial Medication can be very effective during the periodontitis treatment plan. Local application of antibiotics directly into the periodontal pockets may be done.
   
   In aggressive cases, systemic antibiotics are prescribed. Amoxicillin and metronidazole are common antibiotics used in periodontitis cases. Amoxicillin is usually effective against some periodontal pathogens, but it works better when combined with metronidazole for a broader spectrum of bacterial coverage.
   
   Your dentist may prescribe an antimicrobial mouthwash as part of the periodontitis treatment plan. Chlorhexidine is the most commonly prescribed mouthwash for periodontitis. It helps reduce plaque and gingivitis, but it is very important to use it for short periods due to potential side effects, such as tooth staining.

Surgical Treatments

1. Flap surgery (Pocket reduction surgery): The dentist will lift back the gums to remove tartar deposits. Additionally, they will smooth irregular bone surfaces and then reposition the gum tissue, which helps to reduce the pocket depth.
2. Bone graft: This surgery is performed to replace the lost bone. Natural or synthetic bone can be used, and sometimes it is combined with growth factors to stimulate tissue regeneration.
3. Soft tissue graft or gum graft: Usually, periodontitis is associated with gum recession. To address this problem, a soft tissue graft procedure is performed to reinforce thin gums or fill in areas where the gums have receded. Your dentist may use tissue from the roof of your mouth or donor tissue.

With proper treatment and maintenance, many patients can successfully manage their periodontitis. The success of the treatment not only depends on professional intervention; it also involves changing the oral environment to prevent future recurrence. This includes improving oral hygiene habits, eliminating risk factors like smoking, and attending regular follow-up appointments, which are very important.

What Can Be Mistaken For Periodontitis?

There are some conditions that share symptoms with periodontitis, which can lead to misdiagnosis. It is very important to get an accurate diagnosis because the treatment approach varies depending on the actual condition. Here are some conditions that can be mistaken for periodontitis:

1) Gingivitis

It is characterized by red, swollen, and bleeding gums. It is considered the earliest stage of gum disease. However, it does not involve bone loss, gum recession, or deep pocket formation. Gingivitis can be reversed with proper oral hygiene and professional dental cleaning.

2) Hormonal Gingival Changes

Changes in hormones during pregnancy, puberty, or menopause can cause gum inflammation, swelling, and sensitivity, which are similar to the symptoms of early periodontitis.

3) Systemic Diseases with Oral Manifestations

conditions like diabetes, leukemia, or HIV. Also, autoimmune conditions like lichen planus or pemphigoid which cause desquamative gingivitis. All of these conditions have oral manifestations affecting the gum tissue, and their symptoms are similar to periodontitis symptoms. These conditions require management of the underlying condition alongside periodontal treatment.

4) Oral Infections

Conditions like candidiasis (fungal infection) or herpetic gingivostomatitis can cause inflamed or red gums, which may resemble periodontitis.

5) Gingival abscess 

It is a condition in which localized infections in the gum tissue occur. This infection causes swelling and pain similar to periodontitis. In this situation, periodontal treatment is not necessary; drainage and possibly antibiotics are the solution.

6) Medication-induced gingival enlargement

Some medications, such as calcium-channel blockers or anticonvulsants, can cause symptoms that mimic the symptoms of periodontitis, such as swollen gums, which make it difficult to maintain good oral hygiene.

7) Dental trauma-induced gingival lesions

Chemical burns or physical injuries can cause gum inflammation. Also, bruxism can cause tooth mobility and tenderness; these symptoms are similar to advanced periodontitis.

At Suave Clinic, we care about your oral health and offer the best treatments to prevent the progression of gum disease, including periodontitis. Don’t hesitate to contact our clinic for a consultation. Our professionals are here to create a treatment plan tailored to your needs.

Periodontitis FAQs