PeriodontitisDefinitionPeriodontitis (per-e-o-don-TIE-tis) is a serious gum infection that damages the soft tissue and destroys the bone that supports your teeth. Periodontitis can cause tooth loss or worse, an increased risk of heart attack or stroke and other serious health problems.

Periodontitis is common but largely preventable. Periodontitis is usually the result of poor oral hygiene. Brushing at least twice a day, flossing daily and getting regular dental checkups can greatly reduce your chance of developing periodontitis.

SymptomsSigns and symptoms of periodontitis can include:

Swollen gums

Bright red or purplish gums

Gums that feel tender when touched

Gums that pull away from your teeth (recede), making your teeth look longer than normal

New spaces developing between your teeth

Pus between your teeth and gums

Bad breath

Bad taste in your mouth

Loose teeth

A change in the way your teeth fit together when you bite

There are different types, or classes, of periodontitis. Chronic periodontitis is the most common class, affecting mostly adults, though children can be affected, too. Aggressive periodontitis usually begins in childhood or early adulthood and affects only a small number of people.

When to see a dentistHealthy gums are firm and pale pink. If your gums are puffy, dusky red and bleed easily, or show other signs or symptoms of periodontitis, see your dentist soon. The sooner you seek care, the better your chances of reversing damage from periodontitis, potentially preventing other serious health problems.

CausesIt's thought that periodontitis begins with plaque — a sticky film composed mainly of bacteria. Plaque forms on your teeth when starches and sugars in food interact with bacteria normally found in your mouth. Brushing and flossing your teeth removes plaque. But plaque re-forms quickly, usually within 24 hours.

Plaque that stays on your teeth longer than two or three days can harden under your gumline into tartar (calculus). Tartar also may form as a result of the mineral content of your saliva. Tartar makes plaque more difficult to remove and acts as a reservoir for bacteria. You can't get rid of tartar by brushing and flossing — you need a professional dental cleaning to remove it.

The longer that plaque and tartar remain on your teeth, the more damage they can do. Initially, they may simply irritate and inflame the gingiva, the part of your gum around the base of your teeth. This is called gingivitis, the mildest form of periodontal disease.

Ongoing inflammation eventually causes pockets to develop between your gums and teeth that fill with plaque, tartar and bacteria. Bacteria deposit endotoxin — a byproduct of their own metabolism — which is responsible for much of the inflammation around teeth. In time, these pockets become deeper and more bacteria accumulate, eventually advancing under your gum tissue. These deep infections cause a loss of tissue and bone. If too much bone is destroyed, you may lose one or more teeth.

Risk factorsFactors that can increase your risk of periodontitis include:

Gingivitis

Heredity

Poor oral health habits

Tobacco use

Diabetes

Older age

Decreased immunity, such as that occurring with leukemia, HIV/AIDS or chemotherapy

Poor nutrition

Certain medications

Hormonal changes, such as those related to pregnancy or menopause

Substance abuse

Poor-fitting dental restorations

Problems with the way your teeth fit together when biting

ComplicationsSome complications associated with gum disease include:

Tooth loss

Coronary artery disease

Stroke

Premature, low birth weight babies

Poorly controlled diabetes

Respiratory problems

Rheumatoid arthritis

Asthma

Some research suggests that the bacteria responsible for periodontitis can enter your bloodstream through your gum tissue, affecting your lungs, heart and other parts of your body. For instance, bacteria may travel to the arteries in your heart, where they might trigger a cycle of inflammation and arterial narrowing that contributes to heart attacks.

Preparing for your appointmentFollow 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.

Here's some information to help you get ready for your appointment and know what to expect from your dentist.

What you can doPrepare a list of questions to ask your dentist, such as:

What's likely causing my symptoms?

What kinds of tests, if any, do I need?

What's the best course of action?

Will my dental insurance cover the treatments you're recommending?

What are the alternatives to the approach you're suggesting?

Are there any restrictions that I need to follow?

What steps can I take at home to keep my gums and teeth healthy?

Are there any brochures or other printed material that I can have?

What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your dentistYour dentist may ask you questions about your symptoms, such as:

When did you first start experiencing symptoms?

Have your symptoms been continuous or occasional?

How often do you brush your teeth?

Do you use dental floss? How often?

Do you see a dentist regularly?

What medical conditions do you have?

What medications do you take?

Do you use tobacco products?

Depending on the extent of your periodontitis, your dentist may refer you to a specialist in the treatment of periodontal disease (periodontist).

Tests and diagnosisDiagnosis of periodontitis is generally simple. Diagnosis is based on your description of symptoms and an exam of your mouth. Your dentist will look for plaque and tartar buildup and check for easy bleeding.

To determine how severe your periodontitis is, your dentist may:

Use a dental instrument to measure the pocket depth of the groove between your gums and your teeth. Your dentist or a hygienist inserts a metal probe beside your tooth beneath your gumline, usually at several sites throughout your mouth. In a healthy mouth, the pocket depth is usually between 1 and 3 millimeters (mm). Pockets deeper than 5 mm may indicate periodontitis.

Take dental X-rays to check for bone loss in areas where your dentist observes deeper pocket depths.

Treatments and drugsThe goal of periodontitis treatment is to thoroughly clean the pockets around teeth and prevent damage to surrounding bone. Treatment may be performed by a periodontist, a dentist or a dental hygienist. You have the best chance for successful treatment when you adopt a daily routine of good oral care.

Nonsurgical treatmentsIf periodontitis isn't advanced, treatment may involve less invasive procedures, including:

Scaling. Scaling removes tartar and bacteria from your tooth surfaces and beneath your gums. It may be performed using instruments or an ultrasonic device.

Root planing. Root planing smoothes the root surfaces, discouraging further buildup of tartar and bacterial endotoxin.

Antibiotics. Your periodontist or dentist may recommend using topical or oral antibiotics to help control bacterial infection. Topical antibiotics can include antibiotic mouth rinses or insertion of gels containing antibiotics in the space between your teeth and gums or into pockets after deep cleaning.  However, oral antibiotics may be necessary to completely eliminate infection-causing bacteria.

Surgical treatmentsIf you have advanced periodontitis, your gum tissue may not respond to nonsurgical treatments and good oral hygiene. In that case, periodontitis treatment may require dental surgery, such as:

Flap surgery (pocket reduction surgery). In this procedure, your periodontist makes tiny incisions in your gum so that a section of gum tissue can be lifted back, exposing the roots for more effective scaling and root planing. Because periodontitis often causes bone loss, the underlying bone may be recontoured before the gum tissue is sutured back in place. After you heal, it's easier to clean these areas and maintain healthy gum tissue.

Soft tissue grafts. When you lose gum tissue to periodontal disease, your gumline recedes. You may need to have some of the damaged soft tissue reinforced. This is usually done by removing a small amount of tissue from the roof of your mouth (palate) or another donor source and attaching it to the affected site. This procedure can help reduce further gum recession, cover exposed roots and give your teeth a more pleasing appearance.

Bone grafting. This procedure is performed when periodontitis has destroyed the bone surrounding your tooth root. The graft may be composed of small fragments of your own

bone, or the bone may be synthetic or donated. The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone.

Guided tissue regeneration. This allows the regrowth of bone that was destroyed by bacteria. In one approach, your dentist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back instead.

Enamel matrix derivative application. Another technique involves applying a special gel to a diseased tooth root. This gel contains the same proteins found in developing tooth enamel and stimulates the growth of healthy bone and tissue.

Lifestyle and home remediesTry these measures to reduce or prevent periodontitis:

Get regular professional dental cleanings, on a schedule recommended by your dentist.

Use a soft toothbrush and replace it at least every three to four months.

Consider using an electric toothbrush, which may be more effective at removing plaque and tartar.

Brush your teeth twice a day or, better yet, after every meal or snack.

Floss daily.

Use a mouth rinse to help reduce plaque between your teeth.

Supplement brushing and flossing with an interdental cleaner, such as a dental pick, interdental brush or dental stick specially designed to clean between your teeth.

PreventionThe best way to prevent periodontitis is to follow a program of good oral hygiene, one that you begin early and practice consistently throughout life. That means brushing your teeth at least twice daily — in the morning and before going to bed — and flossing at least once a day. Better yet, brush after every meal or snack or as your dentist recommends.

A complete cleaning with a toothbrush and floss should take three to five minutes or so. Flossing before you brush allows you to clean away the loosened food particles and bacteria.

Also, 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 blood pressure medications or smoking — you may need professional cleaning more often.