Periodontitis: Symptoms, Causes, Treatment

What are the symptoms of periodontitis?

Periodontitis is a severe gum infection that damages the soft tissue and can destroy the bone supporting your teeth. It typically develops from untreated gingivitis (mild gum inflammation) and progresses to affect deeper parts of the tooth structure. Below are the detailed symptoms of periodontitis:

Early Symptoms (Gingivitis Stage)

Before periodontitis fully develops, symptoms often begin with gingivitis. Recognizing these early signs can help prevent the progression to periodontitis:

• Red, swollen gums: Gums appear red or purplish and are swollen due to inflammation.
• Bleeding gums: Gums may bleed easily, especially during brushing or flossing.
• Tenderness or discomfort in the gums: The gums may feel sore or tender to the touch.
• Bad breath (halitosis): A persistent unpleasant odor from the mouth, which doesn’t go away with regular brushing.
• Receding gums (gingival recession): The gums may start to pull away from the teeth, creating the appearance of longer teeth.

Advanced Symptoms (Periodontitis Stage)

Once periodontitis develops, the symptoms become more severe and may involve deeper tissues and bone.

1. Gum Recession

• Description: As periodontitis progresses, the gums pull back from the teeth, exposing the tooth roots.
• Signs: Teeth appear longer than they used to, and sensitive areas of the tooth may become visible.
• Effect: Exposed roots make the teeth more vulnerable to decay, sensitivity, and discomfort when eating or drinking hot, cold, or sweet foods.

2. Formation of Deep Pockets Between Teeth and Gums

• Description: As the gums pull away from the teeth, deep pockets form between the gums and the teeth.
• Signs: These pockets are spaces where food particles, plaque, and bacteria accumulate, worsening the infection.
• Effect: The pockets become deeper as the infection progresses, making it difficult to clean the areas effectively.

3. Pus Between Gums and Teeth

• Description: In severe cases, pus may form around the base of the teeth, signifying an advanced infection.
• Signs: A whitish or yellowish discharge may appear when pressing on the gums, or there may be a foul taste in the mouth due to the drainage of pus.
• Effect: Pus indicates the presence of an active bacterial infection, requiring immediate attention.

4. Loose or Shifting Teeth

• Description: The infection damages the bone supporting the teeth, leading to tooth mobility.
• Signs: Teeth may feel loose or wobbly, particularly when chewing or applying pressure.
• Effect: Teeth can shift positions, altering your bite and making it difficult to chew or speak properly. In extreme cases, teeth may fall out or need to be extracted.

5. Chronic Bad Breath (Halitosis)

• Description: As the infection deepens, bacteria in the pockets produce toxins and foul-smelling compounds.
• Signs: Persistent bad breath that doesn’t improve with brushing, flossing, or mouthwash use.
• Effect: The odor can become socially embarrassing and difficult to manage without addressing the underlying infection.

6. Swollen or Inflamed Gums

• Description: Gums may remain red, swollen, and tender due to ongoing inflammation.
• Signs: Gums can feel soft or spongy and may bleed easily when touched.
• Effect: This inflammation contributes to the destruction of the supporting tissues and can lead to discomfort.

7. Tooth Sensitivity

• Description: Increased tooth sensitivity may develop due to gum recession and exposure of the tooth root.
• Signs: Discomfort or sharp pain when consuming hot, cold, sweet, or acidic foods and drinks.
• Effect: This sensitivity can become chronic and may worsen over time if the infection is not treated.

8. Pain or Discomfort While Chewing

• Description: As periodontitis progresses, chewing can become painful due to loose teeth, inflamed gums, and bone loss.
• Signs: Pain or discomfort when eating, particularly harder foods, or feeling like your bite is misaligned.
• Effect: This can make eating uncomfortable and lead to dietary changes to avoid pain.

9. Changes in Tooth Alignment (Malocclusion)

• Description: Periodontitis can cause the teeth to shift positions due to bone and gum tissue loss.
• Signs: The teeth may no longer fit together properly when you bite down, causing changes in your bite (malocclusion).
• Effect: This misalignment can make it difficult to chew, lead to jaw pain, or even cause speech difficulties.

10. Jawbone Loss

• Description: As the infection destroys the supporting bone around the teeth, jawbone loss may occur.
• Signs: Over time, the face may appear sunken, especially in older adults, as the jawbone deteriorates.
• Effect: Significant bone loss can result in a weakened jaw, which may complicate future dental treatments, including dentures or implants.

11. Metallic Taste in the Mouth

• Description: Some individuals with periodontitis report a persistent metallic taste, likely due to the breakdown of tissues or the presence of pus and blood.
• Signs: The taste may be noticeable throughout the day and doesn’t disappear with normal oral hygiene.
• Effect: This can contribute to unpleasant sensations while eating and further bad breath.

12. Generalized Fatigue or Malaise

• Description: In severe cases, the body’s response to the infection can cause systemic symptoms, such as fatigue or feeling unwell.
• Signs: Feeling constantly tired or experiencing low-grade fevers may occur as the body tries to fight the chronic infection.
• Effect: This can reduce overall quality of life and may indicate that the infection is spreading or affecting other areas of the body.

Progression and Complications of Untreated Periodontitis

If periodontitis is left untreated, it can lead to severe complications that affect not only oral health but overall health. Some of these complications include:

• Tooth Loss: As the infection destroys the supporting bone and tissue, teeth may become so loose that they fall out or need to be extracted.
• Abscesses: Infections in the gums or jawbone can lead to the formation of painful abscesses, which may require drainage or surgical intervention.
• Systemic Infections: Bacteria from the infected gums can enter the bloodstream and cause systemic infections, potentially leading to conditions such as endocarditis (infection of the heart’s lining) or worsening of existing conditions like diabetes.
• Increased Risk of Heart Disease and Stroke: Chronic inflammation from periodontitis has been linked to an increased risk of cardiovascular issues, including heart attacks and strokes.
• Pregnancy Complications: Pregnant women with severe periodontitis may be at higher risk for premature birth or low birth weight.

Conclusion

Periodontitis is a serious and progressive disease that starts with mild gum inflammation and can lead to severe oral and systemic health issues if left untreated. Early symptoms include swollen, bleeding gums and bad breath, but as the condition worsens, it can cause gum recession, deep pocket formation, pus, tooth mobility, and eventually tooth loss. Recognizing these symptoms early and seeking prompt dental care can prevent complications and preserve overall health.

What are the causes of periodontitis?

Periodontitis is caused by the buildup of bacteria and plaque around the teeth and gums, which leads to inflammation and destruction of the supporting structures of the teeth, including the gums, periodontal ligament, and bone. While the primary cause is bacterial infection, several factors contribute to its development and progression. Below is a detailed explanation of the causes of periodontitis:

1. Bacterial Plaque and Tartar Buildup

• Cause: Periodontitis begins with the accumulation of plaque, a sticky film of bacteria that forms on the teeth. If plaque is not removed by regular brushing and flossing, it hardens into tartar (calculus), which provides a breeding ground for more bacteria.
• Mechanism: As plaque and tartar accumulate, they irritate and inflame the gums, leading to gingivitis. If gingivitis is left untreated, the inflammation spreads below the gum line, causing the gums to pull away from the teeth and form pockets where bacteria can thrive. These bacteria produce toxins that further damage the gums and bone.
• Consequence: The bacterial infection eventually leads to the breakdown of the connective tissue and bone that support the teeth, which can cause tooth loss if not treated.

2. Poor Oral Hygiene

• Cause: Inadequate brushing, flossing, and dental cleanings allow plaque to build up on the teeth, which can lead to gingivitis and, eventually, periodontitis.
• Mechanism: Poor oral hygiene allows bacteria to flourish, causing plaque to form and harden into tartar. Once tartar is present, it becomes much more difficult to remove without professional dental cleaning, increasing the risk of gum inflammation and infection.
• Consequence: Without proper hygiene, the infection progresses deeper into the gums, leading to more severe inflammation, pocket formation, and destruction of the bone and tissues around the teeth.

3. Smoking and Tobacco Use

• Cause: Smoking and using other forms of tobacco are major risk factors for periodontitis.
• Mechanism: Tobacco use reduces blood flow to the gums, impairing the immune response and the body’s ability to fight infections. It also promotes the growth of harmful bacteria and reduces the healing capacity of gum tissues.
• Consequence: Smokers are more likely to develop periodontitis and experience faster progression of the disease. Smoking also reduces the effectiveness of treatments for periodontitis.

4. Genetics and Family History

• Cause: Genetic factors play a role in an individual’s susceptibility to gum disease. Some people are genetically predisposed to developing periodontitis, even with good oral hygiene.
• Mechanism: Specific genetic factors can affect the immune response to bacterial infections, making some individuals more prone to inflammation and tissue destruction in response to plaque buildup.
• Consequence: People with a family history of periodontitis are at a higher risk of developing the disease and may require more frequent dental care to prevent it.

5. Hormonal Changes

• Cause: Hormonal fluctuations, especially in women, can increase the risk of gum disease. This is particularly evident during puberty, pregnancy, and menopause.
• Mechanism: Hormonal changes can increase blood flow to the gums, making them more sensitive and susceptible to inflammation and infection. Pregnancy, in particular, can lead to pregnancy-related gingivitis, which, if left untreated, can develop into periodontitis.
• Consequence: Women experiencing hormonal changes are at higher risk for gum inflammation, and if oral hygiene is not maintained during these periods, they can develop periodontitis.

6. Chronic Illnesses

• Cause: Certain chronic illnesses, particularly diabetes, are closely linked to the development and severity of periodontitis.
• Mechanism: Diabetes, especially when poorly controlled, weakens the immune system and impairs the body’s ability to heal, making it more difficult to fight infections, including gum infections. High blood sugar levels can also contribute to the growth of harmful bacteria in the mouth.
• Consequence: Diabetic individuals are more susceptible to infections, including periodontitis, and may experience more rapid progression of the disease. Additionally, periodontitis can make it harder to control blood sugar levels, creating a vicious cycle between gum disease and diabetes.

7. Medications

• Cause: Some medications can contribute to the development of periodontitis by affecting saliva flow or causing changes in gum tissue.
• Mechanism: Certain medications, such as antihistamines, antidepressants, and blood pressure drugs, can reduce saliva production, leading to dry mouth (xerostomia). Saliva is important for washing away bacteria and food particles, so a lack of saliva increases the risk of plaque buildup. Other medications, such as anti-seizure drugs and immunosuppressants, can cause abnormal growth of gum tissue, making it easier for plaque to accumulate.
• Consequence: These medications increase the risk of gum infections and may lead to periodontitis if proper oral hygiene is not maintained.

8. Weakened Immune System

• Cause: Conditions that weaken the immune system, such as HIV/AIDS or leukemia, can make individuals more prone to developing gum infections, including periodontitis.
• Mechanism: A weakened immune system reduces the body’s ability to fight off bacterial infections, including those in the gums. This can lead to more severe inflammation and faster progression of periodontitis.
• Consequence: People with compromised immune systems need to take extra care of their oral health to prevent gum disease from developing or worsening.

9. Nutritional Deficiencies

• Cause: Poor nutrition, particularly a lack of essential vitamins and minerals, can contribute to the development of periodontitis.
• Mechanism: Deficiencies in nutrients like vitamin C, which is important for maintaining healthy gums and tissues, can impair the body’s ability to repair and maintain gum tissue. Inadequate intake of nutrients can also weaken the immune system, making the body more susceptible to infections.
• Consequence: Malnutrition or specific nutrient deficiencies can contribute to the severity and progression of periodontitis.

10. Bruxism (Teeth Grinding) and Malocclusion

• Cause: Grinding your teeth (bruxism) or having a misaligned bite (malocclusion) can contribute to the development of periodontitis.
• Mechanism: Bruxism and malocclusion place excessive pressure on the teeth and gums, which can damage the tissues supporting the teeth. This stress can make the gums more vulnerable to bacterial infection.
• Consequence: People who grind their teeth or have an improper bite may experience faster progression of periodontitis due to the added strain on their gum tissues and supporting structures.

11. Stress

• Cause: Chronic stress can increase the risk of periodontitis.
• Mechanism: Stress weakens the immune system and makes it more difficult for the body to fight off infections, including those in the gums. It can also lead to poor oral hygiene habits or neglect of dental care.
• Consequence: People under high levels of stress are more prone to developing infections, including gum disease, and may experience faster progression of periodontitis.

12. Poor Diet (High Sugar and Processed Foods)

• Cause: A diet high in sugary and processed foods can increase the risk of developing gum disease, including periodontitis.
• Mechanism: Sugary foods feed harmful bacteria in the mouth, leading to the production of acids that contribute to plaque buildup. Processed foods often lack the nutrients needed to maintain healthy gums and immune function.
• Consequence: A diet lacking in essential nutrients and high in sugars promotes the growth of plaque, which can eventually lead to periodontitis if not managed with good oral hygiene.

Conclusion

The primary cause of periodontitis is bacterial plaque and tartar buildup around the teeth and gums, but many other factors, such as poor oral hygiene, smoking, genetics, chronic illnesses, medications, and hormonal changes, can contribute to its development. Addressing these causes through good oral hygiene, regular dental care, and healthy lifestyle choices is crucial to preventing and managing periodontitis.

How is the diagnosis of periodontitis made?

The diagnosis of periodontitis involves a combination of clinical evaluation, patient history, and diagnostic tests. Here’s a detailed overview of the diagnostic process:

1. Patient History:

• Symptom Review: The dentist will ask about symptoms such as bleeding gums, bad breath, gum recession, tooth mobility, and any changes in oral health.
• Medical and Dental History: Information about overall health, existing medical conditions, medications, lifestyle factors (e.g., smoking), and previous dental issues is collected.

2. Clinical Examination:

• Visual Inspection: The dentist examines the gums and teeth for signs of inflammation, bleeding, swelling, and other visible symptoms.
• Periodontal Probing: Using a periodontal probe, the dentist measures the depth of the gum pockets around each tooth. Healthy pockets are typically 1-3 mm deep. Pockets deeper than 4 mm indicate periodontal disease.
• Assessment of Gum Recession: The extent of gum recession and its impact on tooth roots and supporting bone is evaluated.
• Check for Tooth Mobility: The dentist assesses if any teeth are loose due to the loss of supporting bone and gum tissue.
• Assessment of Gum Color and Texture: Gums may be examined for color changes (e.g., red, purple) and texture changes (e.g., smooth, irregular).

3. Diagnostic Tests:

3.1 X-Rays:

• Dental X-Rays: Periapical or panoramic X-rays are used to visualize bone loss around the teeth and detect changes in bone structure that are characteristic of periodontitis. X-rays help assess the extent of bone loss and identify areas of damage.
• Cone Beam Computed Tomography (CBCT): In more complex cases, a CBCT scan may be used to provide a 3D view of the bone and surrounding tissues for a more detailed assessment.

3.2 Microbiological Testing:

• Bacterial Culture: In some cases, if the response to standard treatments is inadequate, a sample of plaque or pus may be collected and analyzed to identify specific bacteria involved.

3.3 Salivary Diagnostics:

• Saliva Tests: These tests can sometimes be used to detect markers of periodontal disease, such as elevated levels of certain bacteria or inflammatory markers.

3.4 Periodontal Charting:

• Recording Data: A comprehensive periodontal chart is created, recording measurements of pocket depths, gum recession, and tooth mobility. This chart helps track changes over time and monitor the progress of treatment.

4. Assessment of Risk Factors:

• Review of Contributing Factors: The dentist evaluates any risk factors such as smoking, systemic diseases, or poor oral hygiene that could contribute to the disease.

5. Clinical Diagnosis:

• Diagnosis and Classification: Based on the clinical findings, X-rays, and other diagnostic tests, the dentist will diagnose periodontitis and classify its severity (mild, moderate, or severe).

Early diagnosis and treatment are crucial to managing periodontitis and preventing further damage to the gums and supporting structures of the teeth. If you experience symptoms or have risk factors for periodontitis, it’s important to consult with a dentist for a comprehensive evaluation and appropriate care.

What is the treatment for periodontitis?

The treatment for periodontitis aims to control the infection, reduce inflammation, and prevent further damage to the gums and supporting structures of the teeth. The approach depends on the severity of the condition and may include a combination of non-surgical and surgical treatments. Here’s a detailed overview of the treatment options:

1. Non-Surgical Treatments:

1.1 Scaling and Root Planing (Deep Cleaning):

• Scaling: Removal of plaque and tartar from the tooth surfaces above and below the gumline. This helps reduce the bacterial load and inflammation.
• Root Planing: Smoothing the root surfaces to remove bacteria and toxins that contribute to gum disease and help the gums reattach to the teeth.

1.2 Antimicrobial Treatments:

• Topical Antiseptics: Application of antimicrobial agents or antiseptic solutions directly to the gums to reduce bacterial levels.
• Systemic Antibiotics: Oral antibiotics may be prescribed to help control infection, particularly if the disease is severe or does not respond to initial treatments.

1.3 Improved Oral Hygiene:

• Patient Education: Instruction on proper brushing and flossing techniques, and the use of interdental brushes to improve oral hygiene.
• Professional Cleanings: Regular dental cleanings to remove plaque and tartar, and to monitor gum health.

2. Surgical Treatments:

2.1 Periodontal Surgery:

• Flap Surgery: A procedure where the gums are lifted back to clean deep pockets of plaque and tartar, and then repositioned to fit snugly around the teeth.
• Bone Grafting: In cases of significant bone loss, bone grafts may be used to regenerate lost bone and support the teeth.
• Guided Tissue Regeneration: A technique involving the placement of a barrier membrane to encourage the regeneration of lost bone and gum tissue.

2.2 Gingival Grafting:

• Soft Tissue Grafts: Used to cover exposed tooth roots due to gum recession and improve gum coverage. This can also help reduce sensitivity.

3. Management of Contributing Factors:

3.1 Treatment of Systemic Conditions:

• Management of Diabetes or Other Conditions: Addressing systemic health conditions that can impact gum health and healing.

3.2 Smoking Cessation:

• Support and Resources: Providing resources and support to help patients quit smoking, as tobacco use can exacerbate periodontal disease.

3.3 Adjustments to Dental Restorations:

• Repair or Replacement: Fixing or replacing poorly fitting dental restorations or fillings that may contribute to plaque accumulation and gum problems.

4. Ongoing Care:

4.1 Regular Check-Ups:

• Monitoring: Regular dental visits to monitor the condition of the gums, ensure the effectiveness of treatment, and make necessary adjustments.

4.2 Periodontal Maintenance:

• Professional Cleanings: More frequent cleanings may be recommended to maintain gum health and prevent recurrence of periodontitis.

5. Addressing Risk Factors:

5.1 Nutritional Support:

• Healthy Diet: A balanced diet with adequate nutrients, particularly vitamin C, supports overall oral health and gum healing.

5.2 Stress Management:

• Stress Reduction: Managing stress through relaxation techniques or therapy may support overall health and gum healing.

Effective treatment of periodontitis requires a comprehensive approach tailored to the individual’s needs and the severity of the disease. Early intervention, ongoing care, and addressing contributing factors are crucial for managing periodontitis and maintaining oral health. If you suspect you have periodontitis, consult with a dentist or periodontist for a thorough evaluation and personalized treatment plan.