Definition

By Mayo Clinic staff

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Periodontitis

Periodontitis (pair-e-o-don-TI-tis) is a serious gum infection that destroys the soft tissue and bone
that support 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. Daily brushing and flossing and regular professional dental cleanings can greatly reduce
your chance of developing periodontitis.

Symptoms
By Mayo Clinic staff

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Periodontitis

Signs 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 may be affected as well. Aggressive periodontitis
usually begins in childhood or early adulthood and affects only 1 to 2 percent of the population.
When to see a dentist
Healthy 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 and preventing other serious health problems.

Causes
By Mayo Clinic staff
It's thought that periodontitis begins with plaque. This sticky film is composed mainly of bacteria.
Plaque forms on your teeth when starches and sugars in food interact with bacteria normally found
in your mouth. Brushing 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 makes plaque more difficult to remove and acts as a reservoir for bacteria.
What's more, you usually can't get rid of tartar by brushing and flossing you need a professional
dental cleaning to remove it.
The longer 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. But ongoing inflammation eventually
causes pockets to develop between your gums and teeth that fill with plaque, tartar and bacteria. 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 factors
By Mayo Clinic staff
Factors 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 or HIV/AIDS or chemotherapy
Poor nutrition
Certain medications
Hormonal changes, such as those related to pregnancy or menopause
Substance abuse
Ill-fitting dental restorations

Complications
By Mayo Clinic staff
The most obvious outcome of untreated periodontitis is:
Tooth loss
You might be surprised by some other complications associated with gum disease, including:
Coronary artery disease
Stroke
Low birth weight babies
Poorly controlled diabetes
Respiratory problems
Research suggests that the bacteria responsible for periodontitis can be inhaled or 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 can trigger a cycle of
inflammation and arterial narrowing that contributes to heart attacks.

Tests and diagnosis

By Mayo Clinic staff
Diagnosis 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 check the health of your gum tissue, your dentist may use a metal probe to measure the depth of
the gingival sulcus, the groove between your gums and your teeth. The probe is inserted beside your
tooth beneath your gumline, usually at several sites throughout your mouth. The measurements can
help determine how severe your periodontitis is.

Treatments and drugs

By Mayo Clinic staff
There are several ways to treat periodontitis, depending on its severity. The goal of periodontitis
treatment is to thoroughly clean the pockets of bacteria and to prevent more damage. Treatment may
be performed by a periodontist, a dentist or a dental hygienist. Treatment is most successful when
you adopt a daily routine of good oral care.
Nonsurgical treatments
If your periodontitis isn't advanced, treatment can include 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.
Antibiotics. The use of antibiotics to treat periodontitis remains open to debate. Your
periodontist or dentist may recommend using topical or oral antibiotics to help control
bacterial infection. Topical antibiotics are generally the treatment of choice. They can
include antibiotic mouth rinses or insertion of threads and 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 treatments
If you have advanced periodontitis, your gum tissue may not respond to nonsurgical treatments and
good oral hygiene. In that case, your 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 planing. Because periodontitis often causes bone loss, the
underlying bone may be recontoured before the gum tissue is sutured back in place. The
procedure generally takes from one to three hours and is performed under local anesthesia.
Soft tissue grafts. When you lose gum tissue to periodontal disease, your gumline recedes,
making your teeth appear longer than normal. You may need to have damaged tissue
replaced. 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
cosmetically 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.
Bone grafting may be performed during a technique called guided tissue regeneration.
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 specialized
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.

Prevention
By Mayo Clinic staff
The 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. 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, you may need
professional tooth cleaning more often.