Causes, incidence, and risk factors

Periodontitis occurs when inflammation or infection of the gums (gingivitis) is untreated or treatment is delayed. Infection and inflammation spreads from the gums (gingiva) to the ligaments and bone that support the teeth. Loss of support causes the teeth to become loose and eventually fall out. Periodontitis is the primary cause of tooth loss in adults. This disorder is uncommon in childhood but increases during adolescence.

Plaque and tartar accumulate at the base of the teeth. Inflammation causes a pocket to develop between the gums and the teeth, which fills with plaque and tartar. Soft tissue swelling traps the plaque in the pocket. Continued inflammation eventually causes destruction of the tissues and bone surrounding the tooth. Because plaque contains bacteria, infection is likely and a tooth abscess may also develop, which increases the rate of bone destruction.

Symptoms

• Breath odor

• Gums that appear bright red or red-purple

• Gums that appear shiny

• Gums that bleed easily (blood on toothbrush even with gentle brushing of the teeth)

• Gums that are tender when touched but are painless otherwise

• Loose teeth

• Swollen gums

Note: Early symptoms resemble gingivitis.

Signs and tests

Examination of the mouth and teeth by the dentist shows soft, swollen, red-purple gums. Deposits of plaque and calculus may be visible at the base of the teeth, with enlarged pockets in the gums. The gums are usually painless or mildly tender, unless a tooth abscess is also present. Teeth may be loose and gums may be receded.

Dental x-rays reveal the loss of supporting bone and may also show the presence of plaque deposits under the gums.

Treatment

The goal of treatment is to reduce inflammation, eliminate pockets if present, and address any underlying causes. Rough surfaces of teeth or dental appliances should be repaired. General illness or other conditions should be treated.

It is important to have the teeth cleaned thoroughly. This may involve use of various instruments or devices to loosen and remove deposits from the teeth (scaling). Meticulous home oral hygiene is necessary after professional tooth cleaning to limit further destruction. The dentist or hygienist will demonstrate brushing and flossing techniques. It is often recommended that patients with periodontitis have professional tooth cleaning more frequently than twice a year.

Surgery may be necessary. Deep pockets in the gums may need to be opened and cleaned. Loose teeth may need to be supported. Your dentist may need to remove a tooth or teeth so that the problem doesn't get worse and spread to nearby teeth.

Expectations (prognosis)

Some people find the removal of dental plaque from inflamed gums to be uncomfortable. Bleeding and tenderness of the gums should go away within 1 or 2 weeks of treatment. (Healthy gums are pink and firm in appearance.)

You need to follow careful oral hygiene for your entire life or the disorder may return.

Complications

• Infection or abscess of the soft tissue (facial cellulitis)

• Infection of the jaw bones (osteomyelitis)

• Return of periodontitis

• Tooth abscess

• Tooth loss

• Tooth flaring or shifting

• Trench mouth

Calling your health care provider

Consult your dentist if signs of gum disease are present.

Prevention

Good oral hygiene is the best means of prevention. This includes thorough tooth brushing and flossing, and regular professional dental cleaning. The prevention and treatment of gingivitis reduces the risk of development of periodontitis.