Periodontitis
(Gum Disease)
Symptoms, Causes, and Treatment
Symptoms
Healthy gums are firm and fit snugly around teeth. The color of healthy gums can vary. They may range from light pink in some people to dark pink and brown in others.
Symptoms of periodontitis can include:
Swollen or puffy gums.
Bright red, dark red or dark purple gums.
Gums that feel tender when touched.
Gums that bleed easily.
A toothbrush that looks pink after brushing your teeth.
Spitting out blood when brushing or flossing your teeth.
Bad breath that won't go away.
Pus between your teeth and gums.
Loose teeth or loss of teeth.
Painful chewing.
New spaces that develop between your teeth that look like black triangles.
Gums that pull away from your teeth, making your teeth look longer than usual, called receding gums.
A change in the way your teeth fit together when you bite.
Causes
In most cases, the development of periodontitis starts with plaque. Plaque is a sticky film mainly made up of bacteria. If not treated, here's how plaque can advance over time to periodontitis:
Plaque forms on your teeth when starches and sugars in food interact with bacteria commonly found in your mouth. Brushing your teeth twice a day and flossing once a day removes plaque, but plaque quickly comes back.
Plaque can harden under your gumline into tartar if it stays on your teeth. Tartar is more difficult to remove. You can't get rid of it by brushing and flossing — you need a professional dental cleaning to remove it. Because plaque and tartar are filled with bacteria, the longer they stay on your teeth, the more damage they can do.
Plaque can cause gingivitis, the mildest form of gum disease. Gingivitis is irritation and swelling of the gum tissue around the base of your teeth. Gingiva is another word for gum tissue. Gingivitis can be reversed with professional treatment and good home oral care, but only if treated early before you have bone loss.
Ongoing gum irritation and swelling, called inflammation, can cause periodontitis. Eventually this causes deep pockets to form between your gums and teeth. These pockets fill with plaque, tartar and bacteria and become deeper over time. If not treated, these deep infections cause a loss of tissue and bone. Eventually you may lose one or more teeth. Also, ongoing inflammation can put a strain on your immune system, causing other health problems.
Treatment
Treatment may be done by a dentist or a periodontist. A periodontist is a dentist who specializes in gum disease. A dental hygienist may work with your dentist or periodontist as part of your treatment plan. The goal of treatment is to thoroughly clean the pockets around teeth and prevent damage to surrounding gum tissue and bone. You have the best chance for successful treatment when you also have a daily routine of good oral care, manage health conditions that may impact dental health and stop tobacco use.
Nonsurgical Treatments
If periodontitis isn't advanced, treatment may involve less invasive procedures, including:
Scaling. Scaling removes tartar and bacteria from your tooth surfaces and below your gumline. It may be done using instruments, a laser or an ultrasonic device.
Root planing. Root planing smooths the root surfaces. This helps prevent further buildup of tartar and bacteria. It also helps your gums attach to your teeth again.
Antibiotics. Topical or oral antibiotics can help control bacterial infection. Topical antibiotics can include antibiotic mouth rinses or putting gel containing an antibiotic into gum pockets. Sometimes oral antibiotics are needed to get of bacteria that cause infections.
Surgical Treatments
If you have advanced periodontitis, you may need dental surgery, such as:
Flap surgery, also called pocket reduction surgery. Your periodontist makes cuts in your gums to carefully fold back the tissue. This exposes the tooth roots for more effective scaling and root planing. Because periodontitis often causes bone loss, the underlying bone may be reshaped before the gum tissue is stitched back in place. After you heal, it's easier to clean the areas around your teeth and maintain healthy gum tissue.
Soft tissue grafts. When you lose gum tissue, your gumline gets lower, exposing some of your tooth roots. You may need to have some of the damaged tissue reinforced. This is usually done by removing a small amount of tissue from the roof of your mouth or using tissue from another donor source and attaching it to the affected site. This can help reduce further gum loss, cover exposed roots and give your teeth a better appearance.
Bone grafting. This procedure is performed when periodontitis destroys the bone around your tooth root. The graft may be made from small bits of your own bone, or the bone may be made of artificial material or donated. The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone.
Guided tissue regeneration. This allows the regrowth of bone that was destroyed by bacteria. In one approach, your dentist places a special type of fabric between existing bone and your tooth. The material prevents unwanted tissue from growing into the healing area, allowing bone to grow back instead.
Tissue-stimulating proteins. Another approach involves applying a special gel to a diseased tooth root. This gel contains the same proteins found in developing tooth enamel and stimulates the growth of healthy bone and tissue.
Complications
Periodontitis can cause tooth loss. The bacteria that cause periodontitis can enter your bloodstream through gum tissue, possibly affecting other parts of your body. For example, periodontitis is linked with respiratory disease, rheumatoid arthritis, coronary artery disease, preterm birth and low birth weight, and problems controlling blood sugar in diabetes.
Prevention
The best way to prevent periodontitis is to get into the habit of taking good care of your mouth and teeth. Start this routine at a young age and keep it throughout life.
Good oral care. This means brushing your teeth for two minutes at least twice a day — in the morning and before going to bed — and flossing at least once a day. Flossing before you brush allows you to clean away the loosened food bits and bacteria. Good oral care keeps your teeth and gums clean and removes the bacteria that cause periodontal disease.
Regular dental visits. See your dentist regularly for cleanings, usually every 6 to 12 months. If you have risk factors that increase your chance of developing periodontitis — such as having dry mouth, taking certain medicines or smoking — you may need professional cleaning more often.