Periodontitis

Written By Sharon Boyd, RDH, BS.       |       Reviewed by Lara T. Coseo, DDS

What is Periodontitis

What is periodontitis? Periodontitis is also known as periodontal disease or an advanced stage of gum disease. The meaning of the name describes the condition: Perio = “around”, dont = “tooth”, itis = “inflammation of.” So periodontitis is the inflammation and infection of the area surrounding the root of the tooth. It is a severe condition that simply begins as gingivitis but ultimately leads to the destruction of gum attachment, bone and results in tooth loss if left untreated.

What Causes Periodontitis

What causes periodontitis? Periodontitis is a natural immune response to germs along and underneath the gumlines around the teeth. When plaque biofilm is not removed effectively, antibodies from the immune system seek the germs out in order to destroy it. When initial symptoms of gingivitis are left untreated, the condition worsens into periodontitis. Simple swelling becomes an area of more advanced infection, causing the destruction of gum and bone attachment around the teeth.

Periodontitis may be due to:

• Inadequate oral hygiene
• Lack of professional preventive care (routine cleanings)
• Susceptibility from conditions such as:
  • A family history of periodontitis
  • Uncontrolled systemic health conditions/li>
  • Badly misaligned teeth.

One drop of human saliva can easily contain 50 to 100 million germs, and a diseased mouth can contain germs into the billions. As germs grow, they accumulate - both dead and alive - and form a sticky, nearly invisible layer called plaque. As plaque grows, it appears as a whitish-gray color. Usually, the formation of this plaque is along the teeth and gum line. If this plaque continues to grow unchecked, it becomes calcified and turns into tartar - also known as calculus. Calculus builds a wedge between the tooth and gum line, and can cause openings called pockets. Pockets are measured by how deep they are from the gum line. Stage 1 periodontitis - called gingivitis - is 2 to 3 millimeters deep, stage 2 periodontitis is 4 to 5 millimeters, and stage 3 periodontitis is 6 millimeters and deeper.

As the gum tissue comes into contact with the spreading plaque and calculus, the infection intensifies. Swelling and redness/irritation begins, the gums become weakened, and bleeding can occur. Once bleeding has started, the germs get an additional source of food and can begin to multiply at an alarming rate.

Early Signs And Symptoms of Periodontitis

Periodontitis is often a silent disease as those who suffer from it rarely experience pain, and may not even be aware there is a problem. The early stages of gum disease are seldom painful, and carry with them very few warning signs. Some of the early warnings to look for are slight bleeding while brushing, softening of the gums, and discoloration of the gums - darker red/irritated in appearance rather than a light, healthy pink. As the disease progresses, more noticeable signs may become more predominant. 

Periodontitis is more than just gingivitis. Here are some warning signs to watch for if you suspect you may be developing the condition:

• Bleeding Gums – Healthy gums should never bleed. Bleeding during brushing or flossing that persists for more than two weeks is a sign of gum infection such as periodontitis or more advanced gingivitis.
• Bad Breath – The germs involved in periodontitis often contribute to halitosis, or breath malodor. Because the problem exists deep under the gums, mouth rinses, gums or mints do not easily cover it up.
• Swollen, Red Gums – Gum lines become inflamed and red along the margins of the teeth when gum disease exists. Mild inflammation, often localized to just one area, is typical of gingivitis. More advanced periodontitis often involves more widespread inflammation and redness.
• Receded Gums – As periodontitis advances, the gums become detached from the teeth and creep down the surface of the roots, leaving exposed root surfaces. This makes teeth appear longer than normal.
• Sore Teeth – Infection around the tooth may make chewing or applying pressure to the tooth uncomfortable.
• Shifting Or Loose Teeth – When gum detachment or bone loss has occurred, it may cause the teeth to be mobile or shift out of their natural position.
• Drainage Of Pus – During very advanced stages of periodontitis, there may be signs of pus that drains along the gumlines when the tooth or gums is depressed. Pus usually appears clear, white or yellow.

If you have any of the above signs, you could be significantly farther down the path of serious periodontitis than you think, and close to the potential loss of your teeth.

Stages And Types Of Periodontitis

While periodontitis is a specific condition, there are various periodontitis classification categories that help identify the type of infection when being described among dental professionals. These classifications usually describe to what degree the infection has advanced, and how much of the mouth has been affected.

Mild Periodontitis/Early Periodontitis
This is the earliest form of periodontitis. Clinical findings show mild gum detachment with mild bleeding. There may be minimal bone loss evident on dental X-rays.

Moderate Periodontitis 
Moderate periodontitis exists when gum pockets measure between four and six millimeters in depth and there is clinical evidence of bone loss evident on the X-rays.

Severe Periodontitis
Severe periodontitis involves advanced bone loss with gum pockets deeper than six millimeters found during a dental examination. Bone has often receded so much that the furcation – division – of the back molar teeth are involved.

Chronic Periodontitis
This is the most common form of periodontitis. It is related to the duration of the disease on the tooth surfaces.

Acute Periodontitis
Acute infections may affect only a localized area, but are often painful and quickly advanced. Acute infections may also involve periapical abscess – around the apex of the root – of the tooth due to the invasive condition.

Localized Periodontitis
When periodontitis is limited to just a few teeth in the mouth without having spread to other teeth it is considered localized. You can still have localized aggressive periodontitis, so being localized doesn’t simply mean it is minor.

Generalized Periodontitis
Generalized periodontitis affects several areas throughout the mouth. It may be a more mild form or can be generalized aggressive periodontitis.

Dangers and Health Risks of Periodontitis

Periodontitis has been linked with many other systemic health conditions. The severity of those diseases is often also directly related to the severity of periodontitis. (1) One example is periodontitis and diabetes. The higher the blood sugar levels are, the more likely you are to suffer from uncontrolled periodontitis.

When you suffer from disease conditions, it places a significant strain on your body’s ability to cope with infection. Progression of periodontitis can occur when you do not adequately manage other conditions. In contrast, periodontitis germs can also enter into your bloodstream and make you more likely to suffer from conditions such as heart attack and stroke.

Common health conditions associated with periodontitis include: (2,3)

• Heart attack
• Stroke
• Cardiovascular diseases
• Respiratory disease
• Pancreatic cancer
• Digestive disorders
• Diabetes
• Erectile dysfunction
• Obesity
• Premature labor
• Low birth weight

The main cause of periodontal disease is germs, but the following factors may also affect the health of your gums: stress, genetics, diabetes, smoking/tobacco use, pregnancy/puberty, hormonal changes in women, clenching or grinding your teeth, and poor nutrition.

How to Prevent Periodontitis

Did you know that preventing periodontitis is the primary concern of your dental hygienist? There is a reason that she is always nagging her patients to brush and floss each day. Periodontitis begins as gingivitis, and if the symptoms aren’t addressed early on they can easily result in damaging consequences. In order to prevent periodontitis you must have exceptional oral hygiene, and reassess what you are already doing to ensure you’re doing it the right way. Here we will review everything your hygienist wants you to know about preventing the invasive dental disease known as periodontitis:

• Brush Effectively
  Use a soft-bristled toothbrush angled 45 degrees toward your gums, focusing on just two teeth at a time. Apply very gentle pressure and make circular motions, removing the debris near the surface of the gum lines. Consider an electric toothbrush, as those are typically more effective in removing plaque biofilm and can greatly improve your chance of preventing gum infections like periodontitis.
• Flossing – Don’t Ignore it
  Flossing, not brushing, removes germs between the teeth and under the gumlines – where periodontitis starts to begin. Neglecting to floss at least once per day can allow germs to settle in and calcify, harboring disease conditions. Once calcified, germs cannot be brushed or flossed off and must be removed by a dental professional. To floss effectively, wrap your floss tightly around the tooth and slide up and down under the gums as far as it will go when gentle pressure is applied. Bleeding is a sign of infection so don’t let that stop you. Healthy gums do not bleed, and it may take flossing daily for up to two weeks before areas of gum infection stop bleeding.
  Consider a water flosser such as a WaterPik. These devices are easy to use and can access areas deeper below the gums where flossing cannot.
• Routine Preventive Care
  Visiting your hygienist on a recurrent schedule allows her to screen for areas of disease as well as remove any germ deposits. Even allowing small areas of tartar (calcified germs) to remain on the teeth when you skip a cleaning can allow an area to harbor ideal conditions for periodontitis.
• Supplementation
  Nutritional and holistic supplements can increase your body’s immune health and reduce the risk of developing more advanced stages of periodontitis. Essential oils and supplementing with things like CoQ10 can greatly decrease your chance of developing advanced periodontitis.
• Choose Your Oral Hygiene Products Wisely
  Conventional wisdom tells us to brush with fluoride toothpaste and rinse with alcohol-containing mouthwash. But research has shown that there are real potential dangers in using these substances – [click here to read more – “The 6 Hidden Dangers in Toothpaste.” For optimal oral health and hygiene it is best to use [100% pure and natural botanical ingredients] whenever possible when brushing and rinsing.

Treatments for Periodontitis

Conventional Treatments
Most periodontitis conditions are addressed through conventional treatment in your dental office. The more aggressive periodontitis treatment needed, the more expensive and invasive it can become. Addressing it early on with prophylactic appointments and great home care is the best way to avoid costly conventional dental treatment.

Prophylaxis/Recall Cleanings
Seeing your dentist and hygienist every six months is the first step you should take in preventing periodontitis. During these routine-cleaning appointments they can remove any calculus deposits that harbor periodontitis-causing germs. They will also alert you to any areas of concern, allowing you to implement at-home steps to prevent the progression of the condition. A typical cleaning is under one hundred dollars, and usually covered 100% by most dental insurance plans.

Prescription Medication
If you are suffering from periodontitis symptoms due to inadequate care or lapse in care, your dentist may prescribe a medication to help alleviate the initial infection and aid in your at-home prevention routine. These medications may be in the form of a gel, rinse or orally-administered drug. Common medications used for periodontitis include:

Fluoride: Prescription fluoride can aid in eliminating initial periodontitis symptoms related to poor oral hygiene. (4) When thinking about using any fluoride product as part of an oral hygiene program or as treatment, be sure to read our free eye-opening report about fluoride, “Why the FDA Requires a Warning Label on Your Toothpaste.”

Chlorhexidine: This antiseptic mouth rinse is usually used for up to two weeks to alleviate inflammation and kill periodontitis disease germs  that it comes into contact with. If used for more than two or three weeks it can cause significant dental stain.

Antibiotics: Most prescription antibiotics are reserved for more severe forms of periodontitis and are only used in conjunction with other conventional treatments. They can reduce germs levels, increasing your body’s response to the therapy. Common antibiotics for periodontitis include Periostat and Tetracycline.

Deep Cleanings/Scaling and Root Planing
Deep cleanings are the most commonly used conventional treatment in your dental office for addressing periodontitis. These treatments address one quadrant of your mouth at a time, and usually involve local anesthesia or desensitizing techniques. Your hygienist will use advanced instrumentation techniques to access disease debris deep below your gums in order to allow the area to heal. Costs are typically $200 to $300 per quadrant, nearing $1,000 for the complete mouth.

Periodontal Maintenance
Periodontal maintenance visits are similar to routine cleaning appointments, but are more frequent and always follow deep cleaning appointments. Typically the fees are the same as prophylactic appointments, but you may be seen every three to four months until the symptoms improve, instead of every six months as with a preventive care cleaning.

Local Antibiotic Delivery
Following in-office therapy, your doctor may decide to place a local antibiotic in areas of more advanced disease. The medication is usually in the form of a capsule and the area should not be flossed for as long as two weeks to allow the delivery of the entire dose. This method is usually only used for a few areas where there is the most concern, and costs about $30-40 per site.

Examples of commonly used local antibiotic medications include:

• Actisite
• PerioChip
• Arestin
• Elizol
• Atridox

Crown Lengthening
Crown lengthening removes the diseased, detached gum tissue and creates a shallower gum “pocket” around your tooth, allowing you to keep it cleaner and free of disease-causing germs. Unfortunately it also exposes the roots of your teeth and isn’t really an aesthetically pleasing treatment, but in some cases it may be necessary if you are otherwise unable to keep the area clean. The cost is usually at least a few hundred dollars per tooth.

Gum Flap Surgery
If periodontitis disease conditions are so extreme that they have extended deeply below the gumlines, it may be necessary for a specialist to perform what is called flap surgery. The gums are retracted in order to access the germs buildup on the root of the tooth. This debris is removed and the gums are sutured back into place. Surgery costs can be up to several thousand dollars depending on how large of an area is affected.

Bone Or Gum Grafting
When bone or gum loss has been significant enough to risk the development of tooth mobility, gum or bone grafting may be needed. These are more invasive surgical procedures but they can aid in the structural stability of teeth that might be at risk for tooth loss. The fee can cost several hundred dollars and is priced per tooth.

Orthodontics
Teeth that are misaligned are more prone to develop gum disease symptoms. Orthodontics can correct the position of the teeth and it has been proven to be part of a comprehensive approach to managing periodontal disease. (5) By moving the teeth into an appropriate position, they are easier to keep clean and reduce the risk of disease. Treatment usually averages a few thousand dollars.

Natural And Home Remedies
There are many ways to treat periodontitis symptoms on your own. Preventive natural and home remedies are actually some of the most significant periodontitis treatment when it comes to improving your oral health. Your dentist and hygienist can provide professional services at limited appointments in their office, but unless you are taking a proactive approach to your own health on a daily basis, you will not benefit as much. To truly improve your periodontitis you must make significant changes in the way you treat the condition at home.

Holistic Dental Options Could Save Your Teeth… and Your Money
Most holistic options for treating periodontitis are fairly inexpensive, which can save you hundreds if not thousands of dollars on professional treatments. However, not making a point to treat periodontitis on your own will ultimately result in the need for advanced professional intervention.

Home Remedy Options
If you’ve been looking for a periodontitis remedy, there are several methods that you can use conjunctively or alone to improve the health of your mouth

Advanced Hygiene Practices

• Making significant changes in the way you brush your teeth does more than you think. Angle the brush 45 degrees toward the gumlines and brush in circular motions focusing on just two teeth at a time. Use only a soft-bristled brush and apply only enough pressure to cause a gentle blanching of the tissues. Brush other areas as well, including the tongue and cheeks to remove excess germs from the mouth.
• Consider an electric toothbrush. Electric toothbrushes can remove a significantly larger amount of germs than manual toothbrushes. (5)
• Floss every single day. Brushing alone does not remove periodontitis germs that rest between the teeth or deep below the gumlines. Wrap the floss in a “c” shape around each tooth and gently slide up and down under the gums several times.
• Consider a water flosser or other irrigation device. Water flossers can remove plaque biofilm in concave areas of the tooth or deep below the gums (in cases of severe periodontitis) when normal flossing cannot. (7)

Symptom Relief

• Antiseptic, over-the-counter mouthrinses can help decrease the amount of bleeding associated with periodontitis. However, avoid mouthrinses that contain alcohol, as it can dry out the mouth, which can lead to more germ growth in the long run. It is best to go with a 100% pure botanical mouthwash that kills the harmful germs that lead to gum problems.
• Warm salt-water rinses are a good way to reduce swelling associated with oral irritation such as periodontitis.
• Ibuprofen may be taken to alleviate any discomfort associated with inflammation, as it is an anti-inflammatory drug.

Supplementation

There are several types of natural supplements that have been shown to be effective in treating periodontitis symptoms. Not only are they easy to use, but also they are usually fairly inexpensive, especially compared to conventional treatment.

Vitamin And Nutritional Supplements

CoQ10
CoQ10 may be one of the most effective supplements available for the treatment of periodontitis. According to the Mayo Clinic, CoQ10 significantly aids in the reduction of gum disease symptoms.

Vitamin A
Vitamin A is found in oils such as olive and sunflower oil. The nutrient promotes a healthy immune system and is shown to improve healing of oral infections when used as a supplement.

Vitamin C
Vitamin C has long been known to promote immune health. Its use has been shown to improve the healing process of periodontitis symptoms.

Essential Oils

Essential oils are useful for applying to the area of gum infection or simply adding to a glass of water to be used as mouthwash. They can dramatically affect your healing process when suffering from periodontitis and be a tremendous benefit when added into your normal oral care routine.

Essential oils that have a significant affect on periodontitis symptoms include examples such as:

• Eucalyptol
• Peppermint
• Menthol
• Almond
• Spearmint
• Lemon
• Geranium
• Thyme
• Marigold
• Bloodroot

Essential oils should be used according to directions and sparingly, so as not to accidentally use too much. Typically you can add one or two drops of the oil to your toothbrush and brush in the affected area or apply it with a cotton swab.

Recommended Lifestyle Changes

Having a healthy immune system makes a huge impact on your body’s ability to respond to periodontitis. Neglecting other health conditions such as obesity or diabetes may make it harder for you to address your periodontitis concerns and symptoms because your immune system is already strained. Here are some simple tips to help fight periodontitis in a truly holistic manner:

Work Out To Fight Plaque
Stimulating your cardiovascular system can prevent plaque biofilm from accumulating in large amounts throughout your cardiovascular system. That’s right – the plaque from your mouth can also enter into your arteries and heart!

Kick The Tobacco Habit
Nearly every patient with periodontitis who also smokes will never see an improvement in their condition. No matter how dedicated they are, smoking can counteract everything good that you do for your gums.

Eat A Balanced Diet
Fibrous fruits and vegetables stimulate gum tissue as you chew, while also providing essential nutrients to the rest of your system. They actually cleanse the teeth while you eat them! When your body has healthy nutrients going in, it makes it easier for you to fight infections as they occur.

Limit Sugar And Alcohol Intake
Sugars and refined sugars often found in processed food and alcoholic beverages create an acidic environment inside of the mouth and the rest of the body. Germs thrive in these areas and as they feed on the sugar the result is lots and lots of plaque biofilm (think “germ poop”). The more sugar you eat, whether it be through your coffee, juice, packaged food, alcoholic drink or other source, the more germs that you are going to produce in your mouth. The more germs you have, the easier it is for your periodontitis to advance. 

Your Questions About Periodontitis Answered

Can Periodontitis Be Cured? 

Periodontitis can almost always be cured. Dedicated preventive routines, along with supplementation and necessary lifestyle changes can allow your body to rid itself of the infection. Depending on how advanced the condition is, you may need professional treatment ranging from maintenance visits to surgical therapies. In extremely advanced stages of the disease it may be impossible, requiring extraction of the teeth to rid the body of the chronic infection.

Can Periodontitis Be Reversed? 

In some cases, yes. Unfortunately, the more the advanced the periodontitis is, the less likely you are to reverse it. You can however stop the disease process from progressing further in most cases with professional care and dedicated home routines. It is easier to reverse periodontitis when symptoms are in the beginning stages.

Is Periodontitis Contagious? 

Yes. Periodontitis can be spread between close family members such as husband and wife or parent to child. (8) This is due to the germs passing between people through saliva, making it even more important for you to treat the condition.

I don’t have bleeding or swollen gums. Could I still have periodontitis? 

Symptoms of periodontitis may not be visible for patients that smoke, have undergone radiation therapy or are taking certain medications. In these cases swelling and bleeding may not be evident, but the disease can lie deep below the gums. Other symptoms such as food packing between the teeth or under the gums, or shifting teeth may prove to be identifying factors.

Can I treat periodontitis on my own? 

Mild periodontitis can be efficiently treated through dedicated oral hygiene routines and supplementation. By preventing the condition to continue, you reverse the bone loss process and may also encourage some tissue reattachment. Periodontitis is a serious condition and requires extremely dedicated oral hygiene practices on a daily basis to prevent relapse.

Does brushing and flossing alone remove the germs associated with periodontitis?

Not necessarily. If you have mild periodontitis with only minimum gum detachment or bone loss, it may be just fine. However, due to the loss of attachment with moderate or more severe forms of periodontitis, the concave root surfaces on the sides of the teeth often harbor disease germs that cannot be reached with typical oral hygiene methods. A water flosser may be a more efficient method of home cleansing for these areas. (7)

Could I have a genetic predisposition to periodontitis? 

Genetic predisposition may play a factor in your body’s risk to develop periodontitis. (9) Many people with periodontitis identify that one or both of their parents or a sibling has suffered from the same condition. While genetics play a part, it may also be due to the germs spreading back and forth among family members through saliva. Simply being predisposed to the disease does not mean that you cannot effectively treat and prevent the symptoms.

My gums bleed every time I brush them. How else can I improve my periodontitis? 

Many people complain that simple oral care routines at home such as brushing or flossing cause their gums to bleed or be uncomfortable. Bleeding or irritation is simply a symptom of periodontitis. You must begin cleaning the teeth correctly each day for up to two weeks before expecting symptoms such as bleeding or tenderness to go away. If they do not improve you may need professional treatment as well.

What could happen if I delay treatment for my periodontitis? 

Putting off care for periodontitis could result in advancement of the disease condition into a more severe stage. As the stage of disease progresses, treatments become more invasive and costly in an attempt to retain your teeth. Otherwise, the disease continues to destroy gum attachment and bone levels, ultimately resulting in the loss of teeth.

Why is periodontitis a problem?

Periodontitis is a gum infection that causes the tissues around your teeth to detach from the roots. Left untreated, it will lead to tooth mobility and loss. It’s also linked to health problems like heart attack, stroke, ED, and diabetes.

Is periodontitis the same thing as periodontal disease?

Periodontitis is a generic term used to refer to periodontal disease. They’re one and the same. They’re also interchanged with the label of “gum disease.”

How do I get a periodontitis diagnosis?

Since periodontitis is based on gum detachment levels around your teeth, your dentist or dental hygienist will need to use a special tool (probe) during your exam to assess the depth of the pocket. If you have multiple pockets that are five millimeters or deeper, your dentist will diagnose you with periodontitis.

Can I get it from my partner?

The germs that cause gum disease can be transferred through saliva (kissing, sharing food, etc.) but if you have good oral hygiene, it won’t be able to “take over” your dental health. Daily brushing and flossing are a must!

Is it curable?

Although periodontitis infections can be treated so that the germs infection goes away, the gum and bone loss that’s caused by the disease will not improve. From that moment forward, it’s more about a matter of maintaining the bone and gum structures that are left.

Will it go away on its own?

No. Periodontitis exists deep inside of the gum tissues and requires professional dental treatment to remove the infection. There are no DIY treatments available for gum disease. However, if your periodontitis is only a minor form of gingivitis, you will be able to reverse it within two weeks with a dedicated brushing and flossing routine.

Is it permanent?

The gum and bone loss caused by periodontitis is permanent. However, you can get rid of the infection to prevent it from spreading into surrounding tissues.

Is it painful?

Sometimes. Most tooth pain from periodontitis is caused by aggressive gum and bone loss, causing teeth to become mobile. At that point, your teeth may feel sore or hurt when you’re chewing. The gums are also sensitive to touch and bleed easily.

Why is it painful?

The ligaments around each tooth root attach to the gums around it. When those ligaments are strained or stretched due to tooth mobility, it causes your tooth to hurt. Plus, the inflammation that’s caused by the germ infection can make your gums sore.

Is it genetic or hereditary?

Gum disease tends to run in families, but that doesn’t mean you’ll get it if your parents had it. Usually it’s just because self-care habits are passed down by parents, and germs has spread from parent to child. If you keep up a good oral hygiene routine, you will not inherit periodontitis from your parents.

Is it deadly?

In a way. Science shows that aggressive periodontitis and gum disease will significantly raise your risk of a heart attack, stroke, diabetes, and pneumonia. Each of those conditions in and of themselves are deadly.

Will it cause headaches?

Not usually, but if the infection is bad enough that it’s close to your nasal sinuses, there’s a chance you’ll experience referred pain or pseudo-headaches. Headaches can also be caused by clenching your teeth (something some people may do if they have sore teeth.)

Does it cause cancer?

No. But if you have an autoimmune disease, you’ll be more likely to develop periodontitis. Your body’s immune system can only do so much! Battling two co-existing conditions makes it harder for your body to recover from either of them.

Does it cause heart disease?

There is research that shows having periodontitis increases your chance of having heart disease (including suffering a heart attack or stroke.) Experts believe the germs inside of your mouth can travel via bleeding gums into your cardiovascular system, lodging within blood vessels and your heart.

Does it have a smell?

Yes, periodontitis causes chronic halitosis that smells different than other types of bad breath. It’s not possible to cover it up with mouthwashes, mints, or breathe strips. The only way to eliminate the odor is to have the germs cleaned out from under your gums.

Can it make you sick?

Periodontitis makes it difficult for your body’s immune system to fight off other types of illnesses. So even though it may not “make you sick,” it can lead to you being sicker for longer amounts of time.

Can it spread?

Yes. If you have periodontitis around one tooth but don’t treat it, it will spread to the tooth next to it. This “chain reaction” can eventually lead to complete tooth loss throughout your entire mouth. It’s best to treat it as soon as the infection is diagnosed, which is usually only around one to two teeth.

What are the symptoms?

Symptoms of periodontitis/periodontal disease/gum disease include:

• Gums that are swollen
• Receding gumlines
• Gums that bleed easily
• Red, purple, or blue gum tissues
• Bad breath/halitosis
• Tooth mobility
• Sore teeth and gums
• Spaces between teeth

If I have it what can I do?

Start brushing at least twice a day, paying particular attention to the gumlines. Floss daily, making sure to clean just under the gums on both sides of your teeth. Schedule a deep cleaning with your dentist’s office to remove calcified tartar under your gums, so that your body can start to heal.

What can it lead to?

Untreated periodontitis leads to gum recession (exposed roots), loose teeth, and tooth loss. But it also jeopardizes your health if you have diabetes or heart disease. Research shows that couples where one partner has gum disease have a more difficult time trying to conceive. 

Does it cause bad breath?

Yes. The germs under the gum tissues and necrotic (dying) tissue layers next to the teeth lead to chronic, severe halitosis.

How is it different from gingivitis?

Gingivitis is only inflammation of the edges of your gingiva (gums). But with periodontitis, the tissues around your tooth roots – including gums and bone – are diseased.

Can you get it because you are pregnant?

Hormonal changes during pregnancy or menses can cause symptoms of gingivitis, such as swollen, tender, or bleeding gums. In some cases, small swollen areas called “pregnancy tumors” may also develop. Fortunately, most of these symptoms are only temporary.

However: If you have true periodontitis while pregnant, it can raise your risk of preeclampsia, pre-term labor, and low birth weights in infants.

Are you pregnant if you have it?

No. Periodontitis is not a symptom of pregnancy. It is only caused by germ infections inside of your mouth. If you or your partner have gum disease, it can actually take longer to get pregnant to begin with.

How does it affect pregnancy?

If you have periodontitis while you’re pregnant, the germs from your mouth can travel through your blood supply into the placenta and umbilical cord to your baby. There are serious pregnancy risks for women who have gum disease.

When does it start?

Periodontitis is the next phase of gum disease after gingivitis. If you have gingivitis symptoms but do not treat them, it is only a matter of time before it evolves into a more aggressive periodontal infection.

Where did it come from?

It’s an inflammatory response caused by germs. If plaque biofilm isn’t removed via daily brushing and flossing, it will trigger an immune response which leads to swelling and bleeding in that area. Basically, periodontitis is caused by poor oral hygiene.

What is juvenile periodontitis?

A rare form of periodontitis is a strain that affects young children and pre-adolescents. It mimics gum disease, where the tissues detach from the tooth. Usually it only involves a specific area in the mouth as opposed to all of the teeth.

When should I go to the ER with periodontitis?

Hospital emergency rooms do not treat dental diseases such as periodontitis. The only time you should go to the ER for a dental problem is if there is uncontrollable bleeding, facial swelling, or a suspected broken jaw.

If I have periodontitis what should I eat?

Maintain your normal diet. When possible, eat as many fresh fruits and vegetables as possible to get the vitamins and minerals your body needs to stay healthy. Fish, which contains omega-3 fatty acids, is also a good food when you’re battling gum disease.

Do drugs cause periodontitis?

No, but periodontitis is common in people who use recreational drugs, vape, or smoke. Inhaled drugs irritate the gum tissues. And recreational or illegal drug use are linked to poor oral hygiene with an increased cariogenic (cavity-causing) diet.

What germs causes it?

There are multiple strains of germs inside of dental plaque. Some thrive above the gums where there’s oxygen, while others do better under the gums where there’s a lack of oxygen. Failure to clean them away regularly allows them to multiply and invade the tissues around your teeth.

Does smoking cause periodontitis?

It’s a catch-22. Smoking usually covers up the symptoms of periodontitis, so that it’s harder to diagnose. But smoking also makes it harder for your mouth to heal, which in turn can make gum infections worse.

Does amoxicillin help?

Antibiotics like amoxicillin aren’t typically used for treating periodontitis. The best treatment is to have your teeth cleaned to remove the germs that are causing the infection. The only time antibiotics are used is when they’re placed in a small capsule form down into deep, aggressive pockets of gum disease.

If I have periodontitis will I lose my teeth?

Possibly. Mild periodontitis usually only causes gum recession and minor bone loss. But as that infection evolves into moderate and then severe periodontitis, tooth loss is inevitable.

Will my gums ever return to normal?

If you have gum recession or bone loss, those issues won’t recover back to a normal, healthy status. But if it’s only minor inflammation or bleeding that you have, good oral hygiene can reverse those symptoms within a couple of weeks.

Who does it affect?

Minor forms of gingivitis affect as much as 80 to 90 percent of adults. Since periodontitis develops when there’s inadequate oral care, all of those individuals have the chance of getting more aggressive gum disease. The CDC estimates anywhere from 47 to 70 percent of adults have periodontitis (with the likelihood increasing with age).

Is there a periodontitis quiz to know if I have it?

No, because sometimes periodontitis is asymptomatic (without symptoms.) But if you do notice sore gums, gums that bleed, receding gum tissues, gaps between teeth, or you smoke, there’s a chance that you have some type of gum infection.

Who treats it?

Your dental hygienist – under the supervision of your dentist – will perform most periodontitis treatments. The typical process usually includes a series of deep cleanings and possible local antibiotic placement. If the disease is severe, your dentist may need to perform gum grafting or refer you to a periodontist.

Why did this happen?

Periodontitis usually happens gradually, over an extended period of time. If you’ve had gingivitis symptoms for several months or years, you’re at a high chance of getting gum disease. If you don’t floss regularly or schedule regular cleanings with your dentist, you’re at an even higher risk.

Can you reverse it naturally?

Only if you’re still in the earliest stage of gingivitis. Good oral hygiene is key! But once it evolves into gum and bone deterioration, only a dentist can help.

Can my dog get periodontitis – if so, what do I do?

Yes. If you see tartar buildup on your dog’s teeth, notice they have bleeding gums, or there are visibly loose teeth, they probably have canine periodontitis. Take your pet to the vet to have their teeth cleaned!

Same for cats?

Yes. Any time oral germs collect along gum tissues, it causes periodontitis. Cats are no exception to the rule! Have your vet screen your pet for feline gum disease at least once per year.

How does it affect the body?

When oral biofilm (germs) spread through bleeding gums into your cardiovascular system, it triggers an inflammatory response in your body. Since your immune system can only fight off so many infections, having active periodontitis can make it more difficult to manage coexisting health conditions (like diabetes, ED, heart disease, etc.)

Does it cause diabetes?

There’s a hand-in-hand relationship with periodontitis and diabetes. Since diabetes causes irregular blood sugar levels, germs can thrive in those environments. Studies show that if you’re only addressing the diabetes but ignoring the gum disease, you won’t see much of an improvement in your glucose levels. But if you treat periodontitis at the same time, it’s easier to stabilize your blood sugar.

Does periodontitis cause bleeding gums?

Yes. It’s common for gums to bleed when you brush or floss. But keep in mind, people who smoke may not have any signs of bleeding even if they have periodontitis.

Does it cause sore throat?

No. But a severe oral infection can potentially lead to other types of secondary infections inside of your mouth and throat.

Does it cause ulcers?

Aggressive gum disease is sometimes shown to cause ulcerative gingivitis (“ANUG” or “trench mouth”) and pus. Usually this stage of infection is quite severe.

Will it last forever?

Unless you treat the infection and remove the germs that are causing it, periodontitis will continue to exist until all of your teeth fall out.

Will it cause weight loss?

No. But if your teeth hurt too much to eat, you might find that your appetite decreases or you’re only eating soft, processed foods. If you’re having trouble eating because of your teeth and gums being sore, make sure you talk to your dentist.

Will it cause nausea?

The only situations where periodontitis might cause nausea is if there is severe bleeding in your gums and you’re ingesting it.

Does it cause TMJ or jaw pain?

No. Usually periodontitis doesn’t cause cysts or any type of muscular pain. If you’re experiencing symptoms of TMJ, ask your dentist about wearing a bruxism (grinding) splint at night.

Can it cause tooth pain?

Yes. Periodontitis pulls the gums away from your teeth, stretching the tiny ligaments around the root. When pressure is applied (during chewing) it will stretch those ligaments and make your teeth sore. Plus, if your gums are receding, the exposed roots can be extremely sensitive!

Is it transmittable?

No. While germs can spread from person to person, periodontitis will only develop if you don’t have a good oral care plan.

Is it covered by insurance?

Preventative cleanings during your six-month checkups are usually covered close to 100 percent by your insurance. These visits help prevent periodontitis. But once you have gum disease, the percentage of coverage for more aggressive treatment usually tapers off. It pays to prevent periodontitis from the start!

Is it a germs infection?

Yes. Germ plaque biofilm forms on your teeth throughout the day and after meals. You have to remove those germs with regular brushing and flossing to prevent them from invading your tissues and causing an infection.

Is it an autoimmune disease?

People with autoimmune disorders are more at-risk for periodontitis because of how hard it is for their bodies to fight off infections. However, good oral hygiene (including daily flossing) can prevent periodontitis from taking over their mouth.

Does it cause heart problems?

Having periodontitis increases your chances of suffering a heart attack or stroke. It can also interfere with healthy blood pressure levels due to plaque accumulation inside of your blood vessels. 

How long will it last?

Periodontitis is one of those infections that will continue to exist until the germs are cleaned away and prevented from accumulating again. It can take weeks or months to fully treat the disease and requires continued maintenance thereafter. Daily preventative care is crucial to keep it from coming back.

Click here to learn how to kill the cause behind your gum problems.

References:

1. Amabile N., Susini G., Pettenati-Soubayroux I., Bonello L., Gil J-M., Arques S., Bonfil J.J., Paganelli F. (2008). Severity Of Periodontal Disease Correlates To Inflammatory Systemic Status And Independently Predicts The Presence And Angiographic Extent Of Stable Coronary Artery Disease.; Journal of Internal Medicine, 263, 6, 644-652.
2. Jepsen S, Kebschull M, Deschner J.; Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz.Relationship Between Periodontitis And Systemic Diseases].[Article in German] 2011 Sep;54(9):1089-96.
3. Zuo Z, Jiang J, Jiang R, Chen F, Liu J, Yang H, Cheng Y.; Effect Of Periodontitis On Erectile Function And Its Possible Mechanism.; J Sex Med. 2011 Sep;8(9):2598-605.
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5. Harrel SK, Nunn ME; The Effect Of Occlusal Discrepancies On Periodontitis. II. Relationship Of Occlusal Treatment To The Progression Of Periodontal Disease.; J Periodontology, (April 2001) 72, 4, 495—505.
6. Moritis K, Jenkins W, Hefti A, Schmitt P, McGrady M.; A Randomized, Parallel Design Study To Evaluate The Effects Of A Sonicare And A Manual Toothbrush On Plaque And Gingivitis.; J Clin Dent. 2008;19(2):64-8.
7. Barnes CM, Russell CM, Reinhardt RA, Payne JB, Lyle DM.; Comparison Of Irrigation To Floss As An Adjunct To Tooth Brushing: Effect On Bleeding, Gingivitis, And Supragingival Plaque.; J Clin Dent. 2005;16(3):71-7.
8. S Asikainen, C Chen, S Alaluusua, and J Slots; Can One Acquire Periodontal germs And Periodontitis From A Family Member?;JADA September 1, 1997 128(9): 1263-1271
9. E Silva M, Moreira P, da Costa G, Saraiva A, de Souza P, Amormino S, da Costa J, Gollob K, Dutra W.; Association Of CD28 And CTLA-4 Gene Polymorphisms With Aggressive Periodontitis In Brazilians.; Oral Dis. 2012 Oct 18. doi: 10.1111/odi.12036. [Epub ahead of print]

Article Written By Sharon Boyd Sharon has been a Registered Dental Hygienist since 2001. She also holds a Bachelor of Science degree in Human Relations and Business. In 2011, she began implementing her dental knowledge into freelance writing services that aided dentists, product designers, continuing education providers and web marketing firms for their online and distribution purposes. She has since bridged her services into the medical and cosmetic surgery fields. Website

Article Reviewed by Dr. Lara Coseo Lara T. Coseo, DDS, is a 2004 graduate of Baylor College of Dentistry.  She has 13 years of experience practicing general dentistry.  She currently serves as a part-time faculty instructor at Texas A&M College of Dentistry and writes dental website content and blog material. Website | Linked In | Instagram