Periodontitis is the advanced form of gum disease, also known as periodontal disease. In its earlier stages, periodontal disease is called gingivitis. Symptoms of gingivitis include swelling, bleeding, and reddening of the gums. Symptoms of periodontitis include loosening of the gums, loss of bone, and possible loss of teeth. These gum diseases may all also cause bad breath. Periodontitis is usually a result of infection of the gum tissue caused by bacteria. Increased risk factors include smoking, genetics, certain systemic diseases, and some medications. Dentists can diagnose periodontitis by inspecting the gingiva, or gum tissue, and with dental probes and x-rays to determine if there is bone loss surrounding the teeth.
The recommended way to prevent periodontitis is through satisfactory oral hygiene and periodic professional dental cleanings. Once it has advanced, periodontitis can be treated with antibiotics, dental deep cleanings, and dental surgery. In the United States, it is estimated that about half of all adults have some form of gum disease, with about three quarters of people over 65 suffering as well. Gum disease affects women more than men, and, in its earliest stages, gum disease may have few if any symptoms.
Once symptoms do appear, they may include redness and swelling of the gums, bleeding of the gums, bad breath, and receding gum tissue; as the disease progresses, symptoms may include loosened teeth or visibly loosened gums that no longer tightly adhere to the teeth. Because gum disease itself can be relatively painless, regular dental checkups are recommended, as early treatment of gum disease can significantly improve symptoms and dramatically reduce the risk of the disease progressing.
Periodontitis may also correlate to increased systemic inflammation, including increased risk of stroke or heart attack, arterial plaque, and high blood pressure. In elderly patients, it may also be linked to cognitive impairment. People with diabetes often have higher incidences of gingivitis and periodontitis, and there may be associations between periodontitis and erectile dysfunction, inflammatory bowel disease, heart disease, and pancreatic cancer.
The tissues that surround and support the teeth are known as the periodontium. These tissues include the gums, or gingiva; the outer layer of the tooth’s roots, or cementum; the bone in which the teeth are secured, known as the alveolar bone; and the ligaments that connect the cementum and the alveolar bone, which are known as the periodontal ligaments. Poor oral hygiene allows excessive amounts of dental plaque to accumulate at and under the gumline, which is the primary cause of gum disease, though it may also be caused by underlying medical issues, including diabetes. If left unaddressed, gingivitis can progress and turn into periodontitis, which leads to the destruction of the gums and the separation of the gum tissue from the teeth. This allows more harmful plaque and bacteria to collect under the gums, which leads to further inflammation and eventual bone loss.
Smoking may be as much of a contributing factor for periodontitis as poor oral hygiene. Smokers are more susceptible to bone loss and tooth loss than non-smokers, and smoking can have adverse effects on the treatment of periodontitis. Conditions that affect connective tissue, like Ehlers-Danlos syndrome, can also contribute to the likelihood of periodontitis, as can stress and genetics.
In addition to behavior modification, treatments for periodontitis include deep cleaning below the gumline with special dental curettes, which may require multiple dental visits and anesthesia. This allows the gum tissue to gradually heal and reattach to the teeth, if the clean oral environment is maintained with regular brushing, flossing, and other recommended hygienic treatments. Because periodontitis is often chronic, however, preventing it requires maintenance and lifestyle changes that may be untenable for some people. In these cases, periodic dental deep cleanings may be recommended, or surgical treatment may be necessary, though without some modification in oral hygiene habits, periodontitis will most likely lead to tooth loss.