Periodontitis: What It Is, Symptoms and Treatment

Gum health is often the overlooked part of oral health. We talk about tooth decay, orthodontic treatment and the appearance of the smile, but rarely about what supports the teeth: the gums and the surrounding bone. When these supporting structures are affected, the condition is known as periodontitis, which can have serious consequences if it is not identified in time.

What Is Periodontitis?

Periodontitis is a chronic inflammatory disease that affects the tissues supporting the teeth: the gums, periodontal ligament and alveolar bone. In most cases, it develops from untreated gingivitis, as the initial inflammation of the gums progresses and begins to affect deeper structures.

Unlike gingivitis, which is reversible with appropriate care, periodontitis causes loss of periodontal attachment and, in more advanced stages, bone loss. This damage is largely irreversible, which makes early diagnosis particularly important.

From Gingivitis to Periodontitis: How the Disease Progresses

Periodontitis does not develop overnight. In the early stages, inflammation is limited to the gums and does not affect the supporting bone. This is known as gingivitis, a reversible condition when treated promptly through appropriate oral hygiene and professional scaling.

When gingivitis is left untreated, the inflammation may progress and begin to involve the periodontal ligament and alveolar bone, leading to periodontitis. At this stage, periodontal attachment has already been lost, and the disease tends to progress in episodes, with periods of greater inflammatory activity alternating with more stable phases. Without treatment, it may eventually lead to loose teeth and, ultimately, tooth loss.

Understanding this progression helps explain why early diagnosis, while the condition is still at the gingivitis stage, is the most effective way to prevent periodontitis.

Causes and Risk Factors

Plaque and Tartar

The main cause of periodontitis is the accumulation of bacterial plaque along the gumline. When plaque is not removed through brushing and flossing, it mineralises and becomes tartar, also known as calculus. This rough surface encourages further bacterial accumulation and makes effective cleaning more difficult.

Smoking

Smoking is one of the most significant risk factors for periodontitis. In addition to impairing the immune response of the gum tissues, it can mask clinical signs such as bleeding, which often delays diagnosis.

Smokers have a significantly higher risk of developing periodontitis and frequently respond less favourably to treatment, as nicotine reduces the blood supply to the gums and compromises the tissues’ ability to heal. Stopping smoking is therefore one of the most effective measures for slowing the progression of the disease.

Genetic and Systemic Factors

There is a genetic component that makes some people more susceptible to periodontal disease, even when they maintain good oral hygiene. Systemic conditions such as diabetes also increase the risk of developing periodontitis and can make the disease more difficult to control.

The Relationship with General Health

Periodontitis does not only affect the mouth. There is a well-established two-way relationship between periodontal disease and diabetes. Poorly controlled diabetes increases the risk and severity of periodontitis, while periodontal inflammation may make blood glucose levels more difficult to manage.

Periodontitis has also been associated in several studies with an increased risk of cardiovascular disease, although the exact nature of this relationship is still being investigated. For these reasons, maintaining periodontal health should be regarded as an integral part of general healthcare rather than as an isolated aspect of dental care.

Most Common Symptoms

Bleeding Gums

Bleeding when brushing or flossing is often the first warning sign. Many people underestimate this symptom and may associate it with brushing too vigorously, when it actually indicates active inflammation within the gum tissues.

Bleeding gums should never be ignored, regardless of how mild the bleeding may appear.

Gum Recession

As the disease progresses, the gums may recede, making the teeth appear longer. Gum recession can also cause tooth sensitivity, particularly to cold temperatures, and may expose part of the tooth root that would normally be protected by the gum.

Loose Teeth

In more advanced stages, the loss of supporting bone may cause the teeth to become loose and, in the most severe cases, may result in tooth loss.

Diagnosis

Periodontitis is diagnosed through a clinical examination, which includes measuring the depth of the periodontal pockets and assessing bleeding and tooth mobility. Dental X-rays are also commonly used to evaluate how much supporting bone remains around the teeth.

The diagnosis should be made by a dental professional with experience in periodontology, as the extent and severity of the disease can vary considerably from one person to another.

Treatment

Scaling and Root Planning

Initial treatment usually involves the mechanical removal of bacterial plaque and tartar, including deposits below the gumline, through a procedure known as root planning.

The aim is to remove the factors causing irritation and allow the gum tissues to heal.

Periodontal Surgery

In more advanced cases, surgery may be required to access deeper areas, reduce periodontal pockets or, in specific situations, encourage bone regeneration.

Prevention and Ongoing Care

Preventing periodontitis is based on three main principles: thorough daily oral hygiene, regular dental check-ups and the management of risk factors such as smoking.

Once periodontitis has been diagnosed and treated, ongoing monitoring is essential, as it is a chronic condition that can become active again without appropriate maintenance.

In practical terms, this means brushing twice a day, using dental floss or an interdental brush every day, and attending periodontal maintenance appointments as frequently as recommended by the dentist. For people who have already been treated for periodontitis, these appointments are usually scheduled every three to six months.

Regular maintenance appointments are essential for identifying any early signs of the disease becoming active again and adjusting treatment before further bone loss occurs.

If you notice persistent bleeding from your gums, loose teeth or changes in the appearance of your smile, the most appropriate step is to arrange a dental assessment.

An early diagnosis can often make a significant difference to how effectively the condition is controlled.