Understanding Periodontitis

Periodontitis is a serious gum infection that damages the soft tissue and, without treatment, can destroy the bone that supports your teeth. It can cause teeth to loosen or lead to tooth loss. Periodontitis is common but largely preventable, generally arising from poor oral hygiene. Regular brushing and flossing, alongside professional dental cleanings, are critical to reducing the risk of developing this condition.

Symptoms of Periodontitis

Periodontitis can present with a range of symptoms that vary in severity. Some primary signs include:

• Swollen or Puffy Gums: Inflammation results in the gums becoming swollen and irritated.
• Bright Red, Dusky Red, or Purplish Gums: Healthy gums are usually pale pink. When they become infected, they can take on a darker hue.
• Gums That Feel Tender When Touched: Inflammation can lead to tenderness, causing discomfort when the gums are manually manipulated.
• Bleeding Gums: Particularly noticeable during brushing or flossing, bleeding can indicate gum disease.
• Bad Breath: Chronic bad breath or a persistent bad taste in the mouth may be a sign of periodontitis.
• Loose Teeth or Loss of Teeth: As the condition progresses, it can lead to the detachment or movement of teeth.
• Receding Gums: Gums that pull away from the teeth can make the teeth appear longer than usual.
• Pocket Formation Between Teeth and Gums: Deep spaces or pockets forming between the teeth and the gums are indicative of gum disease.

Causes of Periodontitis

Several factors contribute to the development of periodontitis:

• Plaque Formation: The primary cause is plaque, a sticky substance that forms on the teeth from bacteria. If not removed, it becomes tartar (calculus) which is harder to eliminate and harbors bacteria.
• Poor Oral Hygiene: Lack of adequate oral care can lead to plaque buildup and eventually periodontitis.
• Genetic Factors: A family history of periodontal disease can increase risk.
• Smoking and Tobacco Use: Smoking is independently associated with the onset and progression of periodontal disease.
• Certain Illnesses: Diseases like diabetes, rheumatoid arthritis, and certain cardiovascular diseases can affect gum health.
• Hormonal Changes: Changes during pregnancy, menstruation, or menopause can increase gum vulnerability.
• Medications: Drugs affecting saliva flow, such as antihistamines, decongestants, and blood pressure medications, can impact oral health.
• Nutritional Deficiencies: Particular vitamin deficiencies can impair gum health and contribute to disease development.

Causes

In most cases, the development of periodontitis starts with plaque. Plaque is a sticky film mainly made up of bacteria. If not treated, here’s how plaque can advance over time to periodontitis:

• Plaque forms on your teeth when starches and sugars in food interact with bacteria commonly found in your mouth. Brushing your teeth twice a day and flossing once a day removes plaque, but plaque quickly comes back.
• Plaque can harden under your gumline into tartar if it stays on your teeth. Tartar is more difficult to remove. You can’t get rid of it by brushing and flossing — you need a professional dental cleaning to remove it. Because plaque and tartar are filled with bacteria, the longer they stay on your teeth, the more damage they can do.
• Plaque can cause gingivitis, the mildest form of gum disease. Gingivitis is irritation and swelling of the gum tissue around the base of your teeth. Gingiva is another word for gum tissue. Gingivitis can be reversed with professional treatment and good home oral care, but only if treated early before you have bone loss.
• Ongoing gum irritation and swelling, called inflammation, can cause periodontitis. Eventually this causes deep pockets to form between your gums and teeth. These pockets fill with plaque, tartar and bacteria and become deeper over time. If not treated, these deep infections cause a loss of tissue and bone. Eventually you may lose one or more teeth. Also, ongoing inflammation can put a strain on your immune system, causing other health problems.

Risk factors

Factors that can increase your risk of periodontitis include:

• Gingivitis.
• Poor oral health care habits.
• Smoking or chewing tobacco.
• Hormonal changes, such as those related to pregnancy or menopause.
• Recreational drug use, such as smoking marijuana or vaping.
• Obesity.
• Poor nutrition, including a low vitamin C level.
• Genetics.
• Certain medicines that cause dry mouth or gum changes.
• Conditions that lower immunity, such as leukemia, HIV/AIDS and cancer treatment.
• Certain diseases, such as diabetes, rheumatoid arthritis and Crohn’s disease.

Complications

Periodontitis can cause tooth loss. The bacteria that cause periodontitis can enter your bloodstream through gum tissue, possibly affecting other parts of your body. For example, periodontitis is linked with respiratory disease, rheumatoid arthritis, coronary artery disease, preterm birth and low birth weight, and problems controlling blood sugar in diabetes.

Prevention

The best way to prevent periodontitis is to get into the habit of taking good care of your mouth and teeth. Start this routine at a young age and keep it throughout life.

• Good oral care. This means brushing your teeth for two minutes at least twice a day — in the morning and before going to bed — and flossing at least once a day. Flossing before you brush allows you to clean away the loosened food bits and bacteria. Good oral care keeps your teeth and gums clean and removes the bacteria that cause periodontal disease.
• Regular dental visits. See your dentist regularly for cleanings, usually every 6 to 12 months. If you have risk factors that increase your chance of developing periodontitis — such as having dry mouth, taking certain medicines or smoking — you may need professional cleaning more often.