Description, Causes and Risk Factors:

Periodontitis is very common, and is widely regarded as the second most common disease Worldwide, after dental decay, and in the United States has a prevalence of 30-50% of the overall population, but only about 10% have severe forms. Periodontitis is highly prevalent, affecting 53% of 18-19 year-old American adults and 98% of individuals over 60 years of age.

Periodontitis means "inflammation around the tooth" - it is a serious gum infection that damages the soft tissue and bone that supports the tooth. All periodontal diseases, including periodontitis, are infections which affect the periodontia. The periodontium is the tissue around a tooth, tissues that support the tooth. With periodontitis, the alveolar bone around the teeth is slowly and progressively lost. Microorganisms, such as bacteria, stick to the surface of the tooth and multiply - an overactive immune system reacts with inflammation.

Periodontitis occurs when inflammation or infection of the gums (gingivitis) is untreated or treatment is delayed. Infection and inflammation spreads from the gums (gingiva) to the ligaments and bone that support the teeth. Loss of support causes the teeth to become loose and eventually fall out. Periodontitis is the primary cause of tooth loss in adults. This disorder is uncommon in childhood but increases during adolescence.

Plaque and tartar build up at the base of the teeth. Inflammation causes a pocket to develop between the gums and the teeth, which fills with plaque and tartar. Soft tissue swelling traps the plaque in the pocket. Continued inflammation leads to damage of the tissues and bone surrounding the tooth. Because plaque contains bacteria, infection is likely and a tooth abscess may also develop, which increases the rate of bone destruction.

Although the destructive cycle that starts with the accumulation of plaque is the most common cause of periodontitis, a number of other factors can contribute to or aggravate the condition. These include:

    Tobacco use. Smoking is the most significant risk factor for periodontitis. Chewing tobacco also contributes to periodontitis. Tobacco use in any form damages your immune system, putting you at greater risk of periodontitis.

  • Heredity. Sometimes you may do everything right and still develop periodontitis. In that case, you — along with close to one-third of the population — may have inherited a predisposition to gum problems.

  • Drugs. Hundreds of prescription and over-the-counter antidepressants, cold remedies and antihistamines contain ingredients that decrease your body's production of saliva. Because saliva has a cleansing effect on your teeth and helps inhibit bacterial growth, this means that plaque and tartar can build up more easily. Other drugs, especially anti-seizure medications, calcium channel blockers and drugs that suppress your immune system, sometimes cause an overgrowth of gum tissue (gingival hyperplasia), making plaque much tougher to remove.

  • Diabetes. A number of health problems can take a toll on your gums. One of the most significant of these is diabetes, which makes you more prone to many infections, including gum infections. But the relationship between diabetes and periodontitis doesn't end there. Gingivitis and periodontitis impair your body's ability to utilize insulin, making diabetes harder to control. And because diabetes and periodontitis may make you more susceptible to heart attack and stroke, having both conditions increases your risk of cardiovascular disease.

  • Hormonal changes. Changes in hormone levels that occur during pregnancy, menopause or even menstruation can make your gums more susceptible to periodontitis,

  • Nutritional deficiencies. A poor diet, especially one deficient in calcium, vitamin C and B vitamins, can contribute to periodontitis. Calcium is important because it helps maintain the strength of your bones, including the bones that support your teeth. Vitamin C helps maintain the integrity of connective tissue. It's also a powerful antioxidant that counters the tissue-destroying effects of free radicals — substances produced when oxygen is metabolized by your body.

You need to follow careful Oral hygiene for your entire life or the disorder may return.


Symptoms may include the following:

    Redness or bleeding of gums while brushing teeth, using dental floss or biting into hard food (e.g. apples) (though this may occur even in gingivitis, where there is no attachment loss).

  • Gum swelling that recurs.

  • Halitosis, or bad breath, and a persistent metallic taste in the mouth.

  • Gingival recession, resulting in apparent lengthening of teeth.

  • Deep pockets between the teeth and the gums.

  • Loose teeth, in the later stages (though this may occur for other reasons as well).


The dentist will first take a medical history to reveal any past or present periodontal problems, any underlying diseases that might be contributing to the problem, and any medications the patient is taking. The dentist will also ask questions about the patient's daily oral hygiene regimen (brushing, flossing).

Periodontal Screening and Recording (PSR). PSR is a painless procedure used to measure and determine the severity of periodontitis:

    The dentist uses a mirror and a periodontal probe, a fine instrument calibrated in millimeters (mm), which is used to measure pocket depth.

  • The probe is held along the length of the tooth with the tip placed in the pocket. The tip of the probe will then touch the point where the connective tissue attaches to the tooth.

  • The dentist will "walk" the probe to six specified points on each tooth, three on the buccal (cheek) and three on the lingual (tongue) sides. The dentist measures the depth of the probe at each point.

  • Pocket depths greater than 3 mm indicate disease.

Imaging: Dental x-rays reveal the loss of supporting bone and may also show the presence of plaque deposits under the gums.


The goal of treatment is to reduce inflammation, remove "pockets" in the gums, and treat any underlying causes of gum disease. Rough surfaces of teeth or dental appliances should be repaired.

It is important to have the teeth cleaned thoroughly. This may involve use of various tools to loosen and remove plaque and tartar from the teeth. Proper flossing and brushing is always needed, even after professional tooth cleaning, to reduce your risk of gum disease. Your dentist will show you how to brush and floss properly. Patients with periodontitis should have professional tooth cleaning more than twice a year.

Sometimes, though, you may have more advanced periodontitis — the depth of the pockets between your gums and teeth is more than 5 mm — and your gum tissue may not respond to nonsurgical treatments. In that case, your options include:

    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 re-contoured 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 gum line recedes, making your teeth appear longer than normal. Replacing the damaged tissue — which is usually accomplished by removing a small amount of tissue from your palate and attaching it to the affected site — serves several purposes: It helps reduce further gum recession; it covers exposed roots, protecting them from decay and making them less sensitive to heat and cold; and it gives your teeth a more cosmetically pleasing appearance.

  • Bone grafting. This procedure is performed when disease 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. Not only does the graft help prevent tooth loss by holding your tooth in place, it serves as a platform for the re-growth of natural bone. In that case, it's usually performed in conjunction with a technique called guided tissue regeneration.

  • Guided tissue regeneration. This allows bone destroyed by bacteria to re-grow. 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. Another cutting-edge technique involves the application to a diseased tooth root of a gel that contains the same proteins found in tooth enamel. This fools your body into thinking a new tooth is being formed, stimulating the growth of healthy bone and tissue.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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