Periodontitis

Overview

Periodontitis (per-e-o-don-TIE-tis), also called gum disease, is a serious gum infection that damages the soft tissue around teeth. Without treatment, periodontitis can destroy the bone that supports your teeth. This can cause teeth to loosen or lead to tooth loss.

Periodontitis is common but can usually be prevented. It's often the result of not taking care of your mouth and teeth. To help prevent periodontitis or improve your chance of successful treatment, brush at least twice a day, floss daily and get regular dental checkups.

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.

When to see a dentist

Follow your dentist's recommended schedule for regular checkups. If you notice any symptoms of periodontitis, make an appointment with your dentist as soon as possible. The sooner you get care, the better your chances of reversing damage from periodontitis.

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.

Risk factors

Factors that can increase your risk of periodontitis include:

• Gingivitis.
• Poor oral health care habits.
• Smoking or chewing tobacco.
• Hormonal changes, such as those related to pregnancy or menopause.
• Recreational drug use, such as smoking marijuana or vaping.
• Obesity.
• Poor nutrition, including a low vitamin C level.
• Genetics.
• Certain medicines that cause dry mouth or gum changes.
• Conditions that lower immunity, such as leukemia, HIV/AIDS and cancer treatment.
• Certain diseases, such as diabetes, rheumatoid arthritis and Crohn's disease.

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.