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Periodontitis – Causes, Symptoms and Treatment

Periodontitis is a serious bacterial infection of the tissues supporting the teeth. If left untreated, it can lead to tooth loss and systemic health complications.

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Things worth knowing about "Periodontitis"

Periodontitis is a serious bacterial infection of the tissues supporting the teeth. If left untreated, it can lead to tooth loss and systemic health complications.

What is Periodontitis?

Periodontitis is a severe, chronic inflammatory disease affecting the periodontium – the supporting structures of the teeth, including the gums, periodontal ligament, alveolar bone, and root cementum. It is one of the most prevalent chronic conditions worldwide and a leading cause of tooth loss in adults. Periodontitis begins as gingivitis (inflammation of the gums) and, if untreated, progresses to deeper tissue destruction and bone loss around the teeth.

Causes

Periodontitis is primarily caused by a bacterial dental plaque biofilm that accumulates on and around the teeth. Key pathogenic bacteria include Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia. Several risk factors can promote the development and progression of the disease:

Poor oral hygiene
Smoking and tobacco use
Diabetes mellitus
Genetic predisposition
Stress and a weakened immune system
Hormonal changes (e.g., during pregnancy)
Certain medications (e.g., immunosuppressants, calcium channel blockers)

Symptoms

Periodontitis often progresses slowly and without significant pain, making early detection challenging. Common signs and symptoms include:

Bleeding gums during brushing or spontaneously
Red, swollen, or tender gum tissue
Gum recession (teeth appearing longer than usual)
Persistent bad breath (halitosis)
Tooth mobility or loosening
Pain when chewing
Formation of periodontal pockets between the teeth and gums

Diagnosis

Periodontitis is diagnosed by a dentist or periodontist using a combination of clinical and radiographic assessments:

Periodontal probing: Measurement of pocket depths at multiple sites around each tooth using a periodontal probe.
Bleeding on probing: An indicator of active gum inflammation.
Dental X-rays: Used to evaluate the extent of bone loss around the tooth roots.
Microbiological testing: May be used in selected cases to identify specific bacterial strains.

Treatment

Treatment of periodontitis is tailored to the severity and stage of the disease and typically involves multiple phases.

Non-Surgical Therapy

The foundation of treatment is scaling and root planing (SRP), a deep-cleaning procedure that removes plaque and calculus (tartar) from below the gumline and smooths the root surfaces to reduce bacterial reattachment. This is accompanied by thorough patient education on oral hygiene practices.

Antibiotic Therapy

In cases of aggressive or generalized periodontitis, adjunctive antibiotic therapy (commonly metronidazole combined with amoxicillin) may be prescribed to further reduce the bacterial load.

Surgical Therapy

When deep periodontal pockets or significant bone loss persist after non-surgical treatment, surgical interventions may be required. These include flap surgery (to allow direct access for cleaning) and bone regeneration procedures to restore lost supporting tissue.

Supportive Periodontal Therapy

Following active treatment, regular periodontal maintenance appointments (every 3 to 6 months) are essential to prevent disease recurrence and maintain long-term results.

Systemic Connections

Periodontitis is not solely a dental condition. Emerging evidence links it to a range of systemic diseases, including cardiovascular disease, diabetes mellitus, preterm birth, and potentially Alzheimer's disease. The chronic oral inflammation associated with periodontitis can elevate systemic inflammatory markers, potentially contributing to or worsening other health conditions.

References

Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. Journal of Clinical Periodontology. 2018;45(Suppl 20):S149–S161.
Papapanou PN, et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Journal of Periodontology. 2018;89(Suppl 1):S173–S182.
World Health Organization (WHO). Oral Health – Key Facts. 2023. Available at: www.who.int/news-room/fact-sheets/detail/oral-health

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