Periodontitis, commonly known as gum disease, is a serious oral health condition that affects not only your gums but also the bones and tissues that support your teeth. Left untreated, it can lead to gum recession, tooth loss, and even impact your overall health. But what exactly causes periodontitis, how can you recognize its symptoms, and what treatments are available to manage or reverse it? This blog provides an in-depth look at everything you need to know about periodontitis, including its causes, warning signs, stages, and the most effective treatment options.

What is Periodontitis?

According to the American Academy of Periodontology, Periodontitis is a severe gum infection that damages the soft tissue and destroys the bone supporting your teeth. If left untreated, it can lead to tooth loss and has been linked to various systemic health conditions. Periodontitis begins as gingivitis, a milder form of gum disease characterized by inflammation and bleeding gums. When gingivitis is not managed, it progresses to periodontitis, causing pockets to form between the teeth and gums, where bacteria accumulate and cause further damage.

This condition is primarily caused by the buildup of plaque—a sticky film of bacteria—on the teeth. Over time, plaque hardens into tartar, which can only be removed by professional dental cleaning. Early diagnosis and treatment of periodontitis are essential to prevent complications and maintain oral health.

For comprehensive management of periodontitis, regular dental checkups and a proactive oral hygiene routine are crucial.

Signs and Symptoms of Periodontitis

Periodontitis is a progressive gum disease that often starts with mild symptoms, but as it advances, it can lead to severe dental and systemic health issues. Recognizing the signs early is crucial for effective intervention. 

The symptoms often worsen over time if left untreated, leading to tooth loss and potential systemic health issues. Early intervention by a dental professional can halt the progression of periodontitis and restore oral health.

Here’s a detailed look at the key symptoms:

Swollen or Puffy Gums

One of the earliest signs of periodontitis is swollen or puffy gums. Inflammation occurs as the immune system reacts to bacterial toxins in plaque. This swelling may cause discomfort and make the gums appear red or purplish instead of their healthy pink color.

Bleeding Gums

Gums that bleed during brushing or flossing are a clear warning sign of gum disease. Bleeding is not normal and indicates that the gums are irritated or infected. Left unaddressed, this can progress to more severe stages of periodontitis.

Bad Breath (Halitosis)

Persistent bad breath, or a constant bad taste in the mouth, is a common symptom caused by bacterial buildup in the gum pockets. As bacteria break down food particles and tissue, they release foul-smelling compounds, contributing to halitosis.

Gum Recession

As periodontitis progresses, the gums begin to recede, exposing more of the tooth’s surface or its root. This makes teeth appear longer and can lead to increased sensitivity. Gum recession also creates a space where bacteria can accumulate, exacerbating the problem.

Loose or Shifting Teeth

Periodontitis damages the bone and connective tissue that hold teeth in place. As the disease advances, teeth may become loose, shift, or even fall out. Patients may notice changes in their bite or the way their teeth fit together when they chew.

Pain When Chewing

Pain or discomfort while eating is another sign of advanced periodontitis. This may be due to inflammation, infection, or the movement of loose teeth during chewing.

Formation of Pockets Between Teeth and Gums

In severe cases of periodontitis, the gums pull away from the teeth, creating deep pockets. These pockets collect food particles, bacteria, and plaque, making them difficult to clean and accelerating the progression of the disease.

General Impact on Oral Health

As periodontitis advances, it not only damages the gums and teeth but can also lead to abscesses or pus-filled pockets. These are painful and require immediate professional attention to prevent further complications.

Why Early Detection Matters

Many of these symptoms can appear gradually, and it’s easy to overlook them in the early stages. However, periodontitis is a progressive disease, meaning that without prompt treatment, the damage becomes more extensive and harder to reverse. Regular dental checkups are essential for identifying and addressing symptoms before they escalate.

What Causes Periodontitis? 

Periodontitis is primarily caused by poor oral hygiene, which allows plaque—a sticky bacterial film—to build up on the teeth and gums. When plaque is not removed through regular brushing and flossing, it hardens into tartar, which irritates the gums and provides a haven for bacteria. Over time, these bacteria trigger inflammation, eventually leading to gum disease and, if untreated, periodontitis.

Plaque and Tartar Buildup

The primary cause of periodontitis is the accumulation of plaque—a sticky film of bacteria—on the teeth. When plaque is not adequately removed through daily brushing and flossing, it hardens into tartar (calculus). Tartar provides a rough surface where bacteria thrive, leading to inflammation of the gums (gingivitis), which can then progress to periodontitis if untreated.

Smoking and Tobacco Use

Tobacco use is one of the most significant risk factors for periodontitis. Smoking weakens the immune system, making it harder for the body to fight infections, including gum infections. It also impairs healing, meaning gum damage caused by periodontitis may take longer to repair.

Genetics and Family History

Studies suggest that genetics play a role in an individual’s susceptibility to periodontitis. Even with excellent oral hygiene, some people are genetically predisposed to developing gum disease. A family history of periodontal issues can increase one’s risk.

Systemic Diseases

Certain systemic conditions, such as diabetes, rheumatoid arthritis, and cardiovascular disease, are strongly linked to periodontitis. For example, diabetes can reduce the body’s ability to fight infections, while inflammation associated with periodontitis can worsen diabetic symptoms. This bidirectional relationship emphasizes the need for managing both conditions simultaneously.

Hormonal Changes

Fluctuations in hormone levels, such as those that occur during puberty, pregnancy, and menopause, can make gums more sensitive and prone to inflammation. Pregnancy gingivitis is a well-documented condition that can escalate into periodontitis if not managed effectively.

Medications and Dry Mouth

Certain medications, including antihistamines, antidepressants, and blood pressure drugs, can reduce saliva production. Saliva plays a crucial role in washing away food particles and neutralizing harmful bacteria. A dry mouth increases the risk of plaque buildup, leading to gum disease.

Poor Nutrition

A diet lacking essential nutrients, such as vitamin C, can impair gum health. Vitamin C is vital for maintaining healthy connective tissue and promoting wound healing. Deficiencies in other nutrients may also weaken the immune system, making it harder for the body to combat bacterial infections in the gums.

Stress and Lifestyle Factors

Chronic stress can suppress the immune system, making the body more susceptible to infections, including periodontitis. Additionally, habits such as grinding or clenching teeth (bruxism) can exacerbate the damage caused by gum disease.

Ineffective Oral Hygiene Practices

Inconsistent or improper brushing and flossing allow plaque to accumulate, creating the ideal environment for bacteria to thrive. Without regular professional dental cleanings, tartar buildup and gum disease become more likely.

Stages of Periodontitis

Periodontitis does not develop overnight; it is a continuum that worsens without proper care. Each stage is interconnected, with gingivitis serving as the gateway condition that, if left untreated, leads to progressive destruction. This underscores the importance of routine dental care and preventive measures. Early intervention can disrupt this continuum, halting periodontitis in its tracks. Conversely, neglecting the symptoms—such as bleeding gums or bad breath—can lead to advanced stages that require invasive procedures. Recognizing the progression as a gradual but preventable process empowers patients to take control of their oral health and avoid the devastating effects of advanced periodontal disease.

1. Gingivitis

Gingivitis is the initial, reversible stage of gum disease. At this point, plaque accumulates along the gumline, causing inflammation, redness, and swelling. You might notice bleeding during brushing or flossing. Importantly, the damage in this stage is still limited to the gums, and with proper oral hygiene and professional cleanings, it can be fully reversed before it progresses to periodontitis. You can read about the details on how periodontitis is different from full grown periodontitis, you can read this article.

2. Early Periodontitis

In this stage, the inflammation spreads beyond the gums, beginning to affect the bone and connective tissue that support the teeth. Small pockets may form between the teeth and gums, allowing bacteria to accumulate and intensify the infection. Symptoms may include mild gum recession, persistent bad breath, and slight discomfort. Prompt dental intervention can halt the progression and prevent further damage.

3. Moderate Periodontitis

As periodontitis advances, the infection becomes more severe, leading to further destruction of gum tissue and bone. Gum recession becomes more pronounced, and pockets deepen. Teeth may begin to loosen due to the loss of supporting structures. At this stage, symptoms like pain during chewing and increased tooth sensitivity become noticeable. Treatment may involve scaling and root planing, a deep-cleaning procedure to remove bacteria and tartar from below the gumline.

4. Advanced Periodontitis

In the final stage, periodontitis causes significant damage to the gums, bones, and ligaments. Teeth may shift, become visibly loose, or fall out entirely. The deep pockets harboring bacteria can lead to abscesses or pus formation, causing severe pain. Advanced periodontitis can also increase the risk of systemic health issues like heart disease and diabetes. Treatment at this stage may include surgical interventions such as flap surgery, bone grafting, or even tooth extraction.

Who Diagnoses Periodontitis?

A periodontist is a dental specialist with advanced training in preventing, diagnosing, and treating diseases that affect the gums and the supporting structures of the teeth, including the bones and connective tissues. Their expertise also extends to the placement and maintenance of dental implants, as well as performing advanced surgical procedures to restore oral health and aesthetics.

Periodontists first complete dental school to earn a DDS (Doctor of Dental Surgery) or DMD (Doctor of Medicine in Dentistry) degree. Following this, they undergo an additional three years of specialized training in periodontology and dental implantology. This rigorous education focuses on mastering both non-surgical and surgical techniques for managing periodontal disease, bone grafting, soft tissue grafting, and advanced cosmetic and restorative procedures.

Types of Periodontitis

Periodontitis is not a one-size-fits-all condition; it comes in different types, each with unique causes, progression patterns, and treatment approaches. Understanding these variations helps in tailoring care to individual needs.

1. Chronic Periodontitis

This is the most common form of periodontitis, typically affecting adults, although it can occur at any age. Chronic periodontitis progresses slowly and is primarily caused by the long-term buildup of plaque and tartar.

Symptoms: Gum recession, deep pockets, and gradual bone loss.

Treatment: Scaling and root planing, improved oral hygiene, and sometimes surgical interventions.

2. Aggressive Periodontitis

Aggressive periodontitis is less common and progresses much faster than the chronic form. It often affects younger individuals and can have a genetic component.

Symptoms: Rapid loss of gum attachment and bone, even in people with relatively good oral hygiene.

Treatment: May require antibiotics alongside scaling and root planing or surgery.

3. Periodontitis as a Manifestation of Systemic Diseases

This type occurs in individuals with underlying systemic conditions, such as diabetes, heart disease, or immune system disorders. These conditions can exacerbate gum inflammation and increase susceptibility to periodontitis.

Symptoms: Similar to chronic periodontitis but often more severe due to systemic factors.

Treatment: Managing the underlying disease is critical in addition to periodontal therapy.

4. Necrotizing Periodontal Diseases

This rare and severe type of periodontitis is often seen in individuals with compromised immune systems, such as those with HIV/AIDS or malnutrition. It is characterized by tissue death (necrosis) of the gums, ligaments, and even the bone.

Symptoms: Severe pain, bad breath, and visible tissue damage.

Treatment: Immediate professional care, including antibiotics and specialized cleaning, is essential.

Treatment Options for Periodontitis

When periodontitis is diagnosed, treatment is essential to stop the disease’s progression, manage symptoms, and preserve the health of the gums and supporting bone. According to the Academy of Periodontology, the treatment for periodontitis varies depending on the severity of the condition, and can be classified into non-surgical and surgical options.

Non-Surgical Treatments

1. Scaling and Root Planing (Deep Cleaning)

Scaling and root planing is a common and effective non-surgical treatment for periodontitis, especially in the early to moderate stages. Scaling involves the removal of plaque and tartar from above and below the gumline, while root planing smooths the tooth roots to help prevent bacteria from accumulating and reattaching to the roots. This procedure helps in reducing gum inflammation and promoting reattachment of the gums to the teeth.

2. Antibiotics

In some cases, your dentist or periodontist may prescribe antibiotics to help control infection. These may come in the form of oral antibiotics or antimicrobial mouthwashes that reduce bacteria in the mouth. Topical antibiotics can also be applied directly to the infected gum areas during scaling and root planing. Antibiotics are especially useful when gum disease is difficult to control with just mechanical cleaning.

3. Laser Therapy

Laser treatment can be used in some cases to remove infected tissue and promote healing. Laser therapy reduces discomfort and swelling compared to traditional deep-cleaning methods, and it can effectively target bacteria in the gums and deep periodontal pockets.

Surgical Treatments

1. Flap Surgery (Pocket Reduction Surgery)

Flap surgery is recommended when non-surgical treatments do not resolve the infection or when periodontal pockets (spaces between the teeth and gums) are too deep for effective cleaning. During flap surgery, the gums are lifted back to expose the roots and underlying bone. The infected tissue is then removed, and the pockets are reduced to make it easier to keep the area clean. The gums are then sutured back into place.

2. Bone Grafting

When periodontitis has caused significant bone loss, bone grafting may be necessary to restore lost bone and support the teeth. Bone grafting involves placing bone material (either synthetic or from the patient’s own body) in areas where bone has been lost. Over time, this graft material helps stimulate the growth of new bone, improving the stability of teeth and the overall structure of the jaw. Learn more about holistic bone grafting by visiting this page.

3. Guided Tissue Regeneration (GTR)

GTR is a procedure used to encourage the regrowth of bone and tissue that may have been lost due to periodontitis. It involves placing a special membrane between the gum tissue and the bone to direct the growth of new bone and tissue in the affected area. This technique is often combined with bone grafting to provide optimal results.

4. LANAP (Laser-Assisted New Attachment Procedure)

LANAP is a minimally invasive laser treatment option for periodontitis that removes infected tissue while preserving healthy tissue. The laser promotes healing and can stimulate bone regeneration, making it an effective alternative to traditional surgery. It is particularly popular due to its faster recovery time and reduced discomfort. Dr. Horiyat is one of the only LANAP certified holistic dentists in all California. Check out this page to learn more about LANAP.

Periodontitis Home Remedies

While all the above are actual answers to treating periodontitis, there are a number of home remedies which you can use to help you with the procedure or even avert the issues entirely provided you are in the very early stages of the it. Some of these include salt water rinsing and oil pulling but you can find a full list of those by reading our other article here.

Role of Maintenance Therapy

Once periodontitis is treated, maintenance therapy is essential to prevent the recurrence of the disease. Periodontal maintenance involves regular dental cleanings (usually every 3-4 months) and exams to monitor the health of the gums and teeth. During these visits, any plaque or tartar buildup is removed, and the dentist checks for signs of gum disease. Proper oral hygiene at home, including regular brushing and flossing, is also crucial in maintaining the results of the treatment and ensuring that periodontitis does not return.

Regular follow-ups are critical for monitoring the success of the treatment, especially after more invasive procedures like surgery or bone grafting. Maintenance therapy helps keep the disease under control and preserves the long-term health of your gums and teeth.

When to See a Periodontist

While general dentists play a crucial role in maintaining your oral health, a periodontist specializes in diagnosing, treating, and preventing periodontal (gum) diseases, including periodontitis. It’s important to know when to seek the expertise of a periodontist, especially since gum disease can progress without noticeable symptoms until it reaches an advanced stage. Here are some key signs that indicate it’s time to see a periodontist:

1. Persistent Gum Bleeding

2. Receding Gums

3. Chronic Bad Breath (Halitosis)

4. Loose or Shifting Teeth

5. Deep Pockets Between Teeth and Gums

6. Sensitivity to Hot or Cold

7. History of Periodontal Disease or Family History

8. Difficulty Chewing or Pain While Eating

If you are suffering from any of the above symptoms we recommend you to head over to this blog to learn more about when to see a periodontist and then have Dr. Horiyat check you gum health as soon as possible. You can book an examination by clicking here.

Why Dr. Maryam Horiyat

Dr. Maryam Horiyat is a highly skilled and compassionate periodontist who brings extensive expertise and dedication to patient care at Aria Dental. With advanced training in periodontology and a commitment to holistic dental practices, Dr. Horiyat specializes in minimally invasive treatments like LANAP (Laser-Assisted New Attachment Procedure), a cutting-edge laser therapy for periodontitis that preserves healthy tissue while effectively addressing gum disease. 

Her exceptional education, paired with years of experience, has made her a trusted authority in periodontal health and dental implantology. Dr. Horiyat’s patient-focused approach ensures tailored treatment plans that prioritize long-term oral health, aesthetics, and overall wellness, making her the perfect choice for those seeking comprehensive periodontal care.