Overview

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

Periodontitis is common but largely preventable. It's usually the result of poor oral hygiene. Brushing at least twice a day, flossing daily and getting regular dental checkups can greatly improve your chances of successful treatment for periodontitis and can also reduce your chance of developing it.

Symptoms

Healthy gums are firm and pale pink and fit snugly around teeth. Signs and symptoms of periodontitis can include:

  • Swollen or puffy gums
  • Bright red, dusky red or purplish gums
  • Gums that feel tender when touched
  • Gums that bleed easily
  • Pink-tinged toothbrush after brushing
  • Spitting out blood when brushing or flossing your teeth
  • Bad breath
  • Pus between your teeth and gums
  • Loose teeth or loss of teeth
  • Painful chewing
  • New spaces developing between your teeth
  • Gums that pull away from your teeth (recede), making your teeth look longer than normal
  • 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 seek care, the better your chances of reversing damage from periodontitis.

Causes

In most cases, the development of periodontitis starts with plaque — a sticky film composed mainly of bacteria. If left untreated, here's how plaque can eventually advance to periodontitis:

  • Plaque forms on your teeth when starches and sugars in food interact with bacteria normally found in your mouth. Brushing your teeth twice a day and flossing once a day removes plaque, but plaque re-forms quickly.
  • Plaque can harden under your gumline into tartar (calculus) if it stays on your teeth. Tartar is more difficult to remove and it's filled with bacteria. The longer plaque and tartar remain on your teeth, the more damage they can do. You can't get rid of tartar by brushing and flossing — you need a professional dental cleaning to remove it.
  • Plaque can cause gingivitis, the mildest form of gum disease. Gingivitis is irritation and inflammation of the part of your gum tissue around the base of your teeth (gingiva). Gingivitis can be reversed with professional treatment and good home oral care.
  • Ongoing gum inflammation can cause periodontitis, eventually causing pockets to develop between your gums and teeth that fill with plaque, tartar and bacteria. In time, these pockets become deeper, filling with more bacteria. If not treated, these deep infections cause a loss of tissue and bone, and ultimately you may lose one or more teeth. Also, ongoing chronic inflammation can put a strain on your immune system.

Risk factors

Factors that can increase your risk of periodontitis include:

  • Gingivitis
  • Poor oral health 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
  • Inadequate nutrition, including vitamin C deficiency
  • Genetics
  • Certain medications that cause dry mouth or gum changes
  • Conditions that cause decreased 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 responsible for 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 and problems controlling blood sugar in diabetes.

Prevention

The best way to prevent periodontitis is to follow a program of good oral hygiene, one that you begin early and practice consistently throughout life.

  • Good oral hygiene. That means brushing your teeth for two minutes at least twice daily — 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 particles and bacteria. Good oral hygiene prevents the development of an environment around your teeth that is favorable to specific bacteria that cause periodontal disease.
  • Regular dental visits. See your dentist or dental hygienist regularly for cleanings, usually every six to 12 months. If you have risk factors that increase your chance of developing periodontitis — such as having dry mouth, taking certain medications or smoking — you may need professional cleaning more often.