Periodontitis is a severe form of gingivitis, in which the inflammation of the gums extends to the supporting structures of the teeth.
Plaque and tartar build up between the teeth and gums and then spread to the bone under the teeth.
The gums swell and bleed, the breath smells bad, and teeth become loose.
Dentists take x-rays and measure the depth of pockets in the gums to determine how severe periodontitis is.
Repeated professional cleanings and sometimes dental surgery and antibiotics are needed.
More severe periodontitis occurs in people who are susceptible to a more serious infection of periodontal tissue (tissue surrounding the teeth) than occurs in simple gum inflammation (gingivitis). Many diseases and disorders, including diabetes (especially type 1), Down syndrome, Crohn disease, leukopenia (low white blood cell count), and HIV infection, can predispose a person to periodontitis. In people with HIV/AIDS, periodontitis progresses quickly. Smoking, vitamin C deficiency (scurvy), and emotional distress also are risk factors for periodontitis.
Periodontitis can affect people of any age, including young children. Some people have severe gingivitis for many years without developing periodontitis. Others may develop periodontitis, especially at early ages (20 to 30 years old), without first having significant gingivitis.
Periodontitis is one of the main causes of tooth loss in adults and is the main cause of tooth loss in older adults. Infection destroys the bone that holds the teeth in place. The erosion weakens the attachments and loosens the teeth. An affected tooth may eventually fall out or need to be pulled (extracted).
Causes of Periodontitis
Most periodontitis results in inflammation of the gums (gingivitis) initiated by long-term accumulation of plaque (a filmlike substance made up primarily of bacteria, saliva, food debris, and dead cells that is continually being deposited on teeth) and tartar (hardened plaque) on the teeth and the gums. Pockets form between the teeth and gums and extend downward between the root of the tooth and the underlying bone. These pockets collect plaque in an oxygen-poor environment, which promotes, particularly in people with susceptibility to periodontitis, the growth of aggressive forms of bacteria. The plaque and bacteria initiate chronic inflammation that damages the tissue and bone that hold teeth in place. If the disease continues, eventually so much bone is lost that the tooth may become painfully loose and the gums recede. Tooth loss typically starts in a person's 40s.
Did You Know...
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Periodontitis: From Plaque to Tooth Loss
Healthy gums and bone hold the tooth firmly in place. | |
Plaque buildup irritates the gums, and they become inflamed (gingivitis). In time, the gums pull away from the tooth, creating a pocket that fills with more plaque. | |
The pockets get deeper, and the plaque hardens into tartar. More plaque accumulates on top. | |
Bacterial infection moves down to the root of the tooth and eventually destroys the bone supporting the tooth. Without this support, the tooth loosens and falls out or requires extraction because of a periodontal abscess. |
The rate at which periodontitis develops differs considerably, even among people with similar amounts of tartar. Such differences occur because each person's plaque contains different types and numbers of bacteria and because periodontitis results from the person's unique immune system response to bacteria in the plaque. Periodontitis may cause bursts of destructive activity that lasts for months followed by periods when the disease apparently causes no further damage.
Symptoms of Periodontitis
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The early signs of periodontitis are swollen, bleeding, and red gums and bad breath (halitosis). As more and more bone is lost, the teeth loosen and shift position, and chewing becomes painful. Frequently, the front teeth tilt outward. Periodontitis usually does not cause pain unless an infection forms a collection of pus (abscess) in a pocket, the teeth loosen enough to move while chewing, or a person has HIV infection.
Diagnosis of Periodontitis
A dentist's evaluation
Sometimes x-rays
To diagnose periodontitis, dentists inspect the teeth and measure the depth of the pockets in the gums with a thin probe. X-rays are taken to see how much bone has been lost.
Treatment of Periodontitis
Treatment of risk factors
Professional cleanings
Sometimes surgery and tooth removal
Sometimes antibiotics
Modifying risk factors, such as poor oral hygiene and smoking, improves outcomes. For people who have diabetes, adequate control of blood sugar levels is important.
Unlike gingivitis, which usually disappears with good oral hygiene (daily brushing and flossing), periodontitis requires repeat professional care. People who have good oral hygiene can clean only 2 to 3 millimeters (less than 1/8 inch) below the gum line. However, dentists can clean pockets up to 6 to 7 millimeters (¼ inch) deep using scaling and root-planing techniques, which thoroughly remove plaque and tartar and the diseased root surface.
abscess) has developed. Dentists may also insert materials (filaments or gels) that contain antibiotics into deep gum pockets so that high concentrations of the medication can reach the diseased area. Periodontal abscesses cause a burst of bone destruction, but immediate treatment with surgery and antibiotics may allow much of the damaged bone to quickly grow back.
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
Mouth Healthy: This general resource provides information on oral health, including nutrition and guidance on selecting products that carry the American Dental Association's seal of approval. There is also advice on finding a dentist and how and when to see one.
National Institute of Dental and Craniofacial Research: This government site covers a wide variety of topics related to oral and dental health (in English and Spanish), including definitions of common terms and the latest information on clinical trials related to oral and dental diseases.
