In this article:
- Periodontitis is the advanced stage of gingivitis. It is caused by the increased buildup of oral bacteria below the gum line, triggering a serious infection.
- Chronic periodontitis can severely damage the periodontal structures and cause complete tooth loss.
- The best way to prevent the onset of periodontitis is to practice proper oral hygiene daily.
- Certain dietary modifications may also help in reducing the severity and progress of periodontal diseases.
- Smoking can make you increasingly prone to periodontitis, aside from hampering your overall health in general.
- Your dentist/oral hygienist may recommend certain surgical interventions to correct severe, irreversible periodontal damage.
Periodontal disease refers to a group of inflammatory conditions that damage the gum tissue, tooth ligaments, and underlying alveolar bone in the mouth, thereby weakening the support structure of the teeth.
According to the American Academy of Periodontology, there are four different stages of periodontal disease, namely:
- Stage I periodontitis (mild disease)
- Stage II periodontitis (moderate disease)
- Stage III periodontitis (severe disease)
- Stage IV periodontitis (very severe disease)
Prevalence of Periodontitis
Periodontitis (pyorrhea) is one of the most commonly reported health complaints all over the world. This condition primarily affects the adult population, and its risk increases with age.
A report from the Centers for Disease Control and Prevention (CDC) throws light on the overwhelming prevalence of periodontitis among American adults.
- Nearly 47.2% or 64.7 million American adults aged 30 years or above are diagnosed with some form of periodontitis.
- The prevalence of periodontitis increases to 70.1% in older adults who are 65 or above. (1)
Forms (Types) of Periodontitis
There are many forms of periodontitis. The most common ones include the following:
Chronic periodontitis: This is the most prevalent form of periodontitis. It can occur at any age, but it mostly affects adults.
A person with long-term periodontitis suffers from prolonged inflammation within the periodontal tissues that hold the teeth in place.
As the periodontal bacteria continue to grow, the infection gradually spreads to the tooth root (cementum), alveolar bone, and periodontal ligaments that connect the cementum to the underlying bone.
This condition is characterized by a gradual gum recession, which leads to the formation of spaces between the tooth and the gum.
As the disease progresses, the attachment between the tooth and gums becomes weakened, which can ultimately result in complete tooth loss.
Unlike aggressive periodontitis which comes on suddenly and rapidly, the damage brought on by chronic periodontitis is rather slow and can be reversed with proper and timely treatment.
Aggressive periodontitis: As the name suggests, aggressive periodontitis is marked by a rapid onset of bone destruction and tooth attachment loss.
This type of periodontitis usually affects young people who are otherwise systematically healthy, but it can occur in older adults as well.
This form of periodontitis can cause considerable damage to the tooth ligaments and supporting alveolar bone within a short duration and is, therefore, more serious.
Necrotizing periodontal disease: Necrosis is defined as the death of body tissue caused by a lack of blood supply.
Thus, necrotizing periodontal disease is characterized by the death of the gingival tissues, periodontal ligament, and supporting bone when they do not receive sufficient blood.
Necrosis of the periodontal tissue paves the way for a severe infection. This type of periodontitis typically occurs in people with a suppressed immune system.
What Causes Periodontitis?
Periodontitis is mainly caused by the accumulation of plaque and calculus or tartar on the surfaces of teeth.
Plaque is a soft, sticky film of oral bacteria and sugars that forms on the surfaces of teeth and the soft tissues of the oral mucosa. Improper or inadequate oral hygiene is primarily responsible for the accumulation of bacterial plaque.
If you do not brush your teeth thoroughly enough, the soft biofilm remains intact and gradually gathers mineral deposits from the saliva and gingival crevicular fluid (GCF). The precipitation of minerals in plaque hardens it over time.
The hardened plaque is referred to as tartar or dental calculus and is much harder to remove. The buildup of tartar on the tooth promotes more attachment of plaque (which contains bacteria) because of its rough texture.
If the growth of oral bacteria is allowed to continue, an inflammatory response is triggered. The inflammatory response causes deterioration of the connective tissue and alveolar bone that anchor the teeth.
This causes the gum margin to pull away from the teeth and increases the depth of the space (periodontal pockets), which is a clinical sign of periodontal disease.
Symptoms of Periodontitis
Periodontitis is typically accompanied by the following symptoms in its advanced stages:
- Swollen, tender gums
- Receding gum line, which makes your teeth appear unusually long
- Bright red or purplish gums
- Appearance of pockets between the teeth
- Foul breath
- Bleeding gums
- Pus between the teeth and the gums
- Loose teeth
- Pain while chewing
- Increased teeth sensitivity and toothache
- Changes in the way your teeth fit together when you bite
- Changes in the fit of partial dentures
The following factors can make you more prone to periodontitis:
- Genetic factors
- Poor or inadequate oral hygiene
- Tobacco use
- Viral and yeast infections
- Hormonal fluctuations in women during menstruation and pregnancy
- Inadequate or nutritionally deficient diet
- Ill-fitting dental restoration
- Crooked teeth that are difficult to clean
- Dry mouth
- Compromised immunity due to certain systemic illnesses, such as diabetes, rheumatoid arthritis, and osteoporosis, among others, or the use of immunosuppressive drugs
- Long-term diabetes
- Certain medications such as steroids, oral contraceptives, chemotherapy drugs, as well as specific types of anti-epileptics and calcium channel blockers
Diagnosing periodontitis begins with a thorough examination of your oral cavity to assess the state of your gums and underlying bone structures.
Your dentist or oral health specialist will use a probe to gauge the spaces between the tooth and gum. This will help him/her determine the extent of damage and proceed with the treatment accordingly.
The dentist may also order a dental x-ray to evaluate the destruction or loss of alveolar bone.
Most cases of periodontitis are addressed through a multifaceted treatment strategy, which usually involves antibiotic medication along with professional teeth cleaning. When these noninvasive measures fail to deliver the desired results, the dentist may have to perform surgery to resolve the periodontal damage.
The routinely prescribed drug treatment for periodontitis includes a combination of:
- Oral antibiotics, such as penicillin, to curb the growth of bacteria
- Doxycycline-containing topical gels or fibers that are filled in the gum pockets to gradually kill the bacteria
- Medicated mouthwashes that contain an antimicrobial agent called chlorhexidine to give your oral cavity a thorough rinse and control the spread of infection
Medication for periodontitis is usually prescribed in conjunction with certain nonsurgical clinical procedures that aim to remove the plaque and tartar deposits from:
- The surfaces of teeth above the gums
- The surfaces of teeth below the gums (which may include the roots)
Conventional periodontal therapy usually involves the following:
- Scaling: Scaling is the careful removal of all plaque, tartar, and stains on the teeth as well as below the gum line by a dentist or dental hygienist. The dentist/dental hygienist may use an ultrasonic scaler or hand instruments or a combination of both.
- Planing: Root planing is a treatment procedure whereby a dentist/dental hygienist removes the plaque and tartar from the root surfaces of the teeth to provide a good site to allow for healing of the supporting tissues of the teeth.
The process usually begins with numbing (administration of anesthetic) the treatment area using a local anesthetic and then smoothing the root surfaces so that your gums can reattach to your teeth.
This procedure is usually done using hand instruments (curettes) and ultrasonic scalers. It is designed to remove the infected tooth structures – the parts of the cementum or dentine that have been contaminated with plaque, tartar, or such kinds of bacterial toxins.
Smoothing the rough spots allows a clean surface for the formation of new tooth attachment. After the procedure, you are likely to experience some degree of discomfort, but it will generally resolve within 2 days.
- Polishing: Tooth polishing is another dental procedure that not only serves an aesthetic purpose but can also help prevent oral diseases as it provides a smooth surface that prevents attachment of plaque and tartar.
Unlike scaling, tooth polishing is a painless way to smooth and clean the outer dental surfaces. (3) Polishing is usually done in conjunction with scaling and root planing.
Preliminary nonsurgical periodontal treatment may be unsuccessful in curing a particularly bad case of diseased gum pockets.
In such severe cases of periodontitis when the bacterial infection has infiltrated deep into the gingiva, the dentist will most probably recommend any of the following surgeries.
- Gingivectomy: Gingivectomy is a surgical procedure wherein a gum specialist (periodontist) or oral surgeon removes the infected gum tissue and temporarily covers the operated site with putty to protect your gums while they heal.
After the surgery, you are generally advised to consume a soft diet and avoid hot beverages to keep the putty in place and prevent potential gum injuries.
- Gingivoplasty: The surgical removal of diseased gum pockets during gingivectomy can disfigure your gum line, which necessitates the need for the surgical reshaping of the gum tissue around the teeth.
This procedure is known as gingivoplasty, which is usually performed to correct any structural abnormalities in your gum line to make it appear natural.
- Gingival grafting: Sometimes, the infection spreads so deep into the gum tissue that it becomes impossible to salvage it. In such extreme cases of periodontitis, once your doctor removes the diseased periodontal pockets, there isn’t enough gingival tissue left to stitch the gum line back together.
The periodontist has no choice but to extract healthy gum tissue from another part of the mouth and close the open wound. The graft helps solidify the foundation of the teeth and improves the appearance of your gum line.
- Periodontal pocket reduction: The most stringent oral hygiene routine and professional dental cleaning can be ineffective in eliminating the bacteria in deep-seated periodontal pockets.
In such a case, your oral hygienist may recommend a procedure known as periodontal pocket reduction.
As the name implies, this surgical technique aims to reduce the pocket depth by folding back the gum tissue. The periodontist cuts into the pocket to remove the disease-causing bacteria and then stitches the gum tissue back into place.
Preventive Self-Care Tips
Here are some oral hygiene habits that may help reduce the risk or severity of periodontitis:
- Use an appropriately sized and soft-bristled toothbrush that is in good condition and a fluoride-containing toothpaste to clean the outer and inner sides of the teeth as well as the chewing surfaces, at least two times a day.
- Floss once a day to remove the gunk stuck between your teeth. While a dental floss is suitable for cleaning the tight spaces where the teeth join together, an interdental brush is preferable for cleaning the larger gaps between your teeth.
- People with crooked or crowded teeth as well as those with dental fillings, crowns, and dentures need to be extra cautious with the oral care regime, as they are more prone to plaque accumulation in spaces that can be relatively hard to clean.
- Given that tobacco use is associated with an increased risk of periodontal disease, you must give up unhealthy habits such as cigarette smoking and chewing tobacco in the interest of preserving your oral health.
- People with diabetes must regulate their blood sugar levels to prevent the onset of gum disease.
- Regular checkups allow your periodontist to closely monitor your oral health and catch any sign of gum disease right at its onset. It is recommended to visit your dentist for a thorough checkup every 6 months at the very least.
Moreover, if you have recently recovered from some form of gum disease, it is vital that you keep visiting your periodontist for regular follow-ups to prevent a recurrence.
- Oil pulling is an age-old, Ayurvedic therapy that involves rinsing your mouth with an edible oil such as sesame oil, coconut oil, and olive oil, among others.
You first have to swish the oil in your mouth for 5-10 minutes, and then spit it out. The swishing action may help dislodge and remove the harmful oral bacteria.
Although there is some scientific support for the use of oil pulling to promote periodontal health, further studies are needed to conclusively establish the beneficial effects of this alternative practice. (4)(5)
Note: Gum disease is a slow-progressing disease process that can result in serious periodontal damage if not treated properly and promptly. You are advised to go for a dental checkup as soon as you notice any of the common symptoms of periodontitis.
Only a dentist will be able to assess the true extent of your problem and provide the appropriate treatment.
You must follow your dentist’s advice and use the under-given home therapies merely as an adjunct to the prescribed treatment.
Home Therapies for Periodontitis
Here are a few complementary interventions that may help alleviate the symptoms of periodontitis to a certain degree and enhance the effectiveness of the standard treatment prescribed by your doctor.
1. Salt Water Rinse
Rinsing your mouth with a warm saline solution may help preserve your oral health.
Salt is credited with considerable antiseptic and antibacterial properties that can help disinfect your mouth. Aside from combating the bacteria responsible for periodontitis, salt is also known to relieve the inflammation and pain associated with this condition.
A study conducted on 30 participants found salt water to be as effective as a traditional chlorhexidine-containing mouthwash in reducing dental plaque and oral microbial scores.
However, salt water rinse should not be considered a standalone treatment for oral diseases such as periodontitis, but as an adjunctive tool to be used in conjunction with routine mechanical measures for plaque control. (6)
For all its benefits, an excess of salt can end up damaging the oral cells. Thus, you must use the correct concentration of salt when making this rinse for it to be effective as an oral care measure.
Salt water rinse is regarded as a safe, effective first-line remedy for a wide array of oral health issues, but only when used as part of a proper oral hygiene regimen. This homemade mouthwash not only helps combat the periodontitis-causing bacteria but may also help alleviate the symptomatic discomfort to a certain degree.
Turmeric owes its yellow color and much of its therapeutic potential to its main active compound called curcumin, which is known to exhibit antibacterial and anti-inflammatory effects.
Turmeric may help treat a range of oral health problems, including periodontitis. Curcumin can help bring down the inflammatory response associated with periodontitis by curbing the release of inflammatory cytokines.
Multiple studies have shown that the application of curcumin along with full mouth scaling and root planing (SRP) is more effective in inhibiting the growth of plaque-forming bacteria than SRP alone. (7)(8)(9)(10)
Turmeric can work as a beneficial topical agent to improve various periodontal parameters such as pain and inflammation by reducing the oral bacteria when used in conjunction with other traditional treatments for chronic periodontitis.
3. Guava Leaves
Guava packs a lot of antioxidant properties due to its rich reserve of vitamin C. Plus, it is known to exhibit antiplaque, anti-inflammatory, and analgesic properties, all of which can be optimized in the treatment of periodontitis.
The therapeutic benefits of guava leaves for periodontal health are primarily attributed to two flavonoids, guaijaverin and quercetin.
A 2014 study published in Pharmacognosy Reviews demonstrated the bacteriostatic property of guaijaverin found in guava leaves, which may be useful in inhibiting the growth of periodontitis-causing bacteria.
The efficacy of guava leaves for plaque removal has been well established by recent clinical research, which justifies its use in a wide variety of oral care products and as an adjunct tool for the treatment of periodontitis. (11)
4. Hydrogen Peroxide
Hydrogen peroxide is credited with potent antibacterial properties that may help reduce the oral microbial count and thereby reduce the incidence or severity of gum disease.
According to a 2011 review published in the International Journal of Dental Hygiene, the long-term use of hydrogen peroxide-containing mouthwashes in conjunction with your daily oral hygiene regimen can inhibit plaque accumulation and thereby mitigate early-stage periodontal inflammation. (12)
Mouthwashes containing hydrogen peroxide may help reduce the harmful plaque-inducing bacteria in the mouth when used for a prolonged period as part of your daily oral care routine.
5. Herbal Mouthwashes
Green tea contains a polyphenol called catechin, which is known to inhibit the growth and adherence of periodontal bacteria, making it a credible antiplaque agent. (14)
A 2014 clinical trial found green tea-containing mouthwashes to be as effective as those containing chlorhexidine gluconate for plaque removal. (15)
Holy basil is another herb that is often used in mouth rinses and other oral hygiene products for its antibacterial activity. The regular use of this kind of herbal mouthwash can enhance the effectiveness of your daily oral hygiene routine.
It helps to disinfect the mouth and treat a number of periodontal concerns that may result from an overgrowth of oral bacteria, such as bleeding gums, toothaches, and pus or pain in the gums. (16)
This was corroborated by a 2014 triple-blind randomized clinical trial that found basil mouthwash to be equally effective in inhibiting plaque and gingivitis as chlorhexidine, which is considered to be the gold standard of mouthwashes. (17)
Tea Tree Oil
Tea tree oil is known to exhibit antibacterial, antiseptic, and fungicidal properties that may help preserve and promote your oral health. A number of mouthwashes contain this active ingredient for its ability to inhibit the adhesion of oral bacteria to the periodontal surfaces.
Thus, rinsing your oral cavity with a tea tree-containing mouthwash may help reduce the formation of bacterial plaque. Consequently, it prevents or alleviates the early symptoms of periodontitis such as gingival bleeding and inflammation. (18)(19)
Note: Tea tree oil is an extremely potent liquid that can trigger a number of adverse side effects if ingested. Swish the tea tree mouthwash around your mouth, gargle with it if you must, but make sure to spit it out completely thereafter.
Herbal mouthwashes can only be helpful against periodontal bacteria when used as an adjunct to your regular oral hygiene measures and other treatments if needed. This remedy does not work as a monotherapy for periodontitis. The research elaborating upon its antiplaque benefits is noteworthy but needs to be validated by more rigorous, broad-based studies.
Omega-3 polyunsaturated fatty acids (PUFAs) can work as protective agents against periodontal disease when consumed as part of your regular diet or through supplementation.
Foods that are rich in DHA and EPA omega-3s have shown considerable therapeutic potential to oral health. Omega-3 PUFAs may help deter the activity of plaque-causing bacteria to keep your gums healthy and your teeth securely rooted, thereby preventing the clinical outcome of periodontitis. (20)
You can derive your required dose of omega-3 fatty acids by including fish in your diet, preferably sardines, herring, salmon, mackerel, and tuna.
If you fail to meet your omega-3 requirement through dietary intake alone, your doctor can start you on a supplement, which usually comes in the form of fish oil liquid or capsules. But it is essential that you stick to the doctor-prescribed dosage rather than self-medicate if you wish to avoid any undue complications or side effects later. (21)(22)(23)
7. Role of Diet
Your oral health is affected by what you put in your mouth. Hence, it is very important to consume a well-balanced and nutritionally sound diet.
Healthy eating is not solely about your food choices, but also about other factors concerning the regularity or timing of your meals.
People who are in the habit of mindless snacking between meals often end up consuming unhealthy foods and beverages that can negatively affect their gums and teeth as well as their overall health.
So, it is best if you stick to a regular dietary schedule and avoid unnecessary binges or overeating.
Periodontitis Versus Gingivitis
Gingivitis is a precursor to periodontitis, also known as gum disease. The key differences between these two conditions are as follows:
- Gingivitis is characterized by inflammation of the gums that occurs due to a buildup of oral plaque, without any actual sign of periodontal infection.
Periodontitis, on the other hand, refers to the destruction of the supporting structures of the teeth. Gingivitis can make your gums increasingly swollen, tender, and prone to bleeding when you brush or floss.
Periodontitis causes your gums to recede, making your teeth appear abnormally long and exposing the sensitive roots of your teeth to germs and food debris.
- Gingivitis causes early-stage tooth decay and paves the way for periodontitis when left untreated. Periodontitis is an advanced stage of gum infection wherein the bacterial plaque extends deep into the gum line and weakens the foundation of your teeth by destroying the supportive gum tissue and bone structure.
The eventual outcome of unchecked periodontitis is loosening of the teeth or complete tooth loss. In fact, periodontitis is regarded as the number one cause for tooth loss in adults.
Is Periodontal Disease Contagious?
Periodontal disease is essentially an inflammatory response to bacterial buildup inside the mouth, particularly under the gum line. While the inflammation itself is noncontagious, the periodontal bacteria that cause it can be transmitted to other people through infected saliva.
Thus, it is important to exercise necessary precautions if any of your friends or someone in your family is diagnosed with periodontal disease.
To minimize the risk of contracting periodontitis through salivary exchange, you must avoid sharing utensils or oral health equipment with the infected person.
A lot of people undermine their oral health to such an extent that they fail to notice the early warning signs of periodontal disease.
Periodontitis itself is an advanced stage of gum disease, which means there is no room for delay when it comes to treating this condition.
If you do not address the problem timely, the disease can penetrate so deep that it can irreversibly damage the periodontal structures, leading to the following complications:
- Formation of painful periodontal abscesses
- Lengthening of the teeth such that their roots become exposed due to continued gingival recession
- Loosening or drifting of the teeth, which can make eating difficult
- Complete loss of tooth
Besides destroying the gingival tissue, periodontal ligaments, and the supporting alveolar bone, periodontal bacteria can spread further into your system and pave the way for other serious health problems.
For instance, untreated periodontitis is associated with an increased risk of heart attack, diabetes, and stroke.
Pregnancy and periodontal disease: Pregnant women need to exercise special precautions with regards to their overall health.
There isn’t enough scientific evidence to establish a direct link between periodontitis and pregnancy-related complications, but the former is suspected to increase the risk of the latter.
Thus, like any other health problem, periodontitis should be treated with the utmost emergency during pregnancy to avoid adverse outcomes such as pre-eclampsia, premature birth, and low-birth-weight babies. (26)(27)
Periodontitis and systemic diseases: According to preliminary research, long-term periodontitis may increase the risk of several systemic diseases. However, further studies are needed to conclusively establish this correlation.
A healthy mouth has a flourishing microbial population, but periodontitis occurs when there is an overgrowth of harmful bacteria leading to an infection.
If periodontitis is not treated timely, the bacterial infection can spread from your mouth to other parts of the body and can potentially increase the risk of:
- Cardiovascular diseases
- Diabetes and insulin resistance
- Rheumatoid arthritis
- Pregnancy-related complications
Conversely, some of the above-listed conditions may hamper your body’s resistance to periodontal bacteria and render you increasingly susceptible to periodontal disease.
Does Smoking Make Periodontitis Worse?
Smoking can significantly jeopardize your oral health and general well-being. Here are a few reasons why people with periodontitis should quit this harmful habit at once:
- People who smoke are much more likely to develop gum problems, including periodontitis, than those who don’t.
- Smoking increases your risk of developing complications including a dry socket after having periodontal treatments such as tooth extractions, gum/bone grafts, dental implants, and any oral surgery due to impaired healing.
- Smokers are more likely to experience postoperative pain in the wake of an oral or gum surgery.
- Nonsmokers respond better to periodontal treatments than smokers.
- Smoking lowers your resistance to gum infections and also increases your risk of developing oral cancer.
Because smoking reduces blood supply to the gums, people who smoke are unlikely to experience gingival bleeding despite having periodontitis. Due to the absence of this noticeable symptom, their gum disease often goes undetected, in turn leading to delayed treatment.
Thus, smoking cessation is also recommended if you wish to detect periodontitis or other such gum problems early.
Your gum will bleed more once you stop smoking as the blood supply will return to normal. Your dentist or oral hygienist will suggest the proper treatment to make the bleeding stop. (32)
Can Periodontal Disease Cause an Ear Infection?
The pain emanating from an infected ear can be felt in your teeth and jaw, but this does not mean that the infection has spread to the mouth. Similarly, there isn’t any substantial proof to suggest that periodontal infections can increase the risk of ear infections. (33)
When to See a Doctor
If you or your family member suddenly develops red, swollen, bleeding gums, toothache, or foul breath for no apparent reason, visit the periodontist without delay to secure an early diagnosis and start immediate treatment.
Once you know that a person has periodontal infection, you can adopt the necessary measures to avoid the spread of infection.
Questions to ask your periodontist:
- How can I make my oral hygiene routine better or more effective?
- How often should I get a dental checkup?
- What kind of toothbrush should I use?
- What may have caused my periodontal problems?
- How long will it take for my condition to resolve?
- Is periodontitis reversible?
Questions your periodontist may ask you:
- When did you last visit your dentist?
- Did you suffer from any trauma or injury that may be responsible for your bleeding gums?
- Are you a smoker or do you use tobacco in any form?
- Are your symptoms continuous or fluctuating?
- Is there any particular factor that aggravates your periodontal symptoms?
- Are the symptoms worse at any particular time of the day?
- Are you experiencing any type of teeth sensitivity?
- What is your at-home oral care regimen, and how regular are you with it?
Periodontal disease can be hard to detect, as it often sets in without any noticeable symptoms. This makes it all the more essential for you to keep up with your regular dental checkups and periodontal examinations.
It takes the trained eye of a periodontal specialist to make a proper assessment of your dental and gum health and pick up on the hidden warning signs.
Once the dentist arrives at a conclusive diagnosis, he/she will recommend the appropriate treatment based upon the type and extent of periodontal damage.
Adhering to a proper oral hygiene regimen on a daily basis helps prevent the onset of periodontal disease and prevents it from becoming more serious or recurring in case you develop it.