Periodontitis disease: periodontitis stages and treatments

Gum disease is an infection of the tissues that surround and support your teeth. It is a major cause of tooth loss in adults. Because gum disease is usually painless, you may not know you have it. Also referred to as periodontal disease, gum disease is caused by plaque, the sticky film of bacteria that is constantly forming on our teeth.Treatment depends on type and condition of gum disease. The first step would be to do a thorough cleaning. Your dentist may also recommend medications. In extreme cases surgery may be recommended.

What is periodontitis? 

What is periodontitis

Periodontitis is a very common serious gum infection that means inflammation of soft tissue around the teeth. It damages to soft bones and tissue supporting teeth. All periodontal diseases, including periodontitis, effect on periodontium. This is an ongoing disease that occurs slowly and destroy the bone tissue around the teeth. Microorganism like bacteria, attach to the surface of the teeth and then multiply. Those patients with high immune system react them to inflammation. Untreated periodontitis will lead to teeth loss, increasing the risk of heart attack or the other health problems.

Bacteria plaque (a sticky, colorless membrane that create over the tooth surface) is the most common reason of periodontal disease. Periodontitis is the knowledge of prevention, diagnosis and treatment of gum and structural disease that protect of teeth. Usually, periodontitis is predictable and occur due to inappropriate oral hygiene.


Periodontitis disease has several different types and the most commons types are:

  • Chronic periodontitisis the most common type among adults, although kids can be affected, too. Increasing numbers of mouth plaque is the cause of this type and over the time cause to get worse and if doesn’t treat, leads to gums destruction, boons and teeth loos.
  • Aggressive periodontitisusually begins in childhood or early adulthood and less people are affected by this disease. It mostly effects on family and if doesn’t treat, rapidly leads to progression of bone and teeth loose.
  • Necrotizing periodontal disease is described by the death of gum tissue, tooth ligaments and supporting bone caused by lack of blood supply(necrosis), terminating in severe infection. Generally, those who have malnutrition or weak immune system (like HIV infection, cancer treatment etc.) are more expose by this disease.

What is the cause of periodontitis?

Bacteria plaque is the cause of periodontitis. Plaque is a sticky substance that create on the surface of teeth a couple of hours after brushing. It is interesting to know that body reaction to bacterial infection makes most of the problems. Immune system’s cells when are trying to remove bacteria, produce a substance that causes inflammation, gum destruction, periodontal ligament or alveolar bone. This procedure, leads to swollen, bleeding gums, signs of gingivitis (that is the first stage of periodontal disease) and loosing of the teeth that is a symptom of sever periodontitis (the advanced stage).

It’s another issue if plaque create on tooth surface, it becomes hardened and calcified and turn into calculus that usually called tartar. Since calculus is rougher than tooth enamel or cementum (it is a layer that cover the tooth root), by continuing collection, more plaque will attach to tooth. Using a tartar control toothpaste can to reduce the collection procedure around the tooth. It doesn’t have any effect on those tartar   that have already collected between tooth and gum spaces.

Risk factors

Certain factors increase the risk for periodontal disease:

  • Diabetes
  • Poor oral hygiene
  • Stress
  • Heredity
  • Crooked teeth
  • Underlying immuno-deficiencies—e.g., AIDS
  • Fillings that have become defective
  • Taking medications that cause dry mouth
  • Bridges that no longer fit properly
  • Female hormonal changes, such as with pregnancy or the use of oral contraceptives

Smoking and periodontist

Mostly smokers are affected with periodontist than nonsmokers. The success probability of periodontist treatments (such as implant and gum or bone grafts) are less developed in smokers than nonsmokers due to slow cure procedure for smokers’ body tissues. The procedure of periodontist disease and even tooth loos are faster in smokers than nonsmokers. 90 percent of those who are not responded by periodontist treatment are smokers.

Warning signs

Warning signs

The following are warning signs of periodontal disease:

  • Bad breath or bad taste that won’t go away
  • Red or swollen gums
  • Tender or bleeding gums
  • Painful chewing
  • Loose teeth
  • Sensitive teeth
  • Gums that have pulled away from your teeth
  • Any change in the way your teeth fit together when you bite
  • Any change in the fit of partial dentures

What is the difference between gingivitis and advanced periodontal diseases?

Gingivitis and periodontitis are “stages” of periodontal, or gum, disease. Gingivitis is the earliest form of gum disease marked by inflamed, swollen, bleeding and red gums. Gingivitis is reversible, but if not treated can progress to the more advanced stage called periodontitis where gums pull away from teeth allowing bacteria to cause infection that can damage teeth and their supporting bones. Periodontitis is actually the leading cause of tooth loss.

Periodontitis can cause permanent damage. Follow a strict oral hygiene routine to catch gingivitis early and avoid the progression to more serious gum disease.

How is Periodontal Disease Diagnosed?

Your dentist will check teeth for pockets using a periodontal probe at each checkup. When teeth are healthy, the pocket depth surrounding your teeth is generally 3mm or less. The more serious the disease, the deeper the pocket. It can also be determined from dental X-rays by checking the amount of bone supporting the teeth.

What if is not Treated?

Bad breath and a little blood may seem like minor inconveniences, but the long-term consequences are much more severe. The infection may spread to other areas of your body, creating serious health problems. Studies have linked gum disease to potentially life-threatening conditions, including stroke, diabetes, obesity and Alzheimer’s disease. Less dangerous, but no less importantly, gum disease is also the leading cause of adult tooth loss. Gum disease is the number one cause of tooth loss in adults 35 and older.

Periodontitis Treatment

Usually by accurate assessment and appropriate treatment method, it’s possible to stop the periodontist progress. The key of a successful treatment is exercise and repetition of oral hygiene practices and removing bacteria plaque that are the main causes of disease progress.

When gingivitis progresses to periodontitis, treatment becomes much more complicated. Only your dentist and hygienist can perform periodontal treatment, which involves special dental procedures, and can require oral surgery. If your dentist determines that you have periodontitis, the treatment will depend on the severity of the infection. Some options include:

Antibiotic treatment

In some cases, antibiotics are prescribed for active or persistent gum infection that are not treated by observing oral hygiene measurement or without microbiological test. A low-dose doxycycline pill can help prevent overactive enzymes from breaking down gum tissue after periodontal disease treatment.

Professional cleaning

Professional cleaning

All the tooth soft deposit can be cleaned from reachable areas and clean and brush tooth by fluoride. By considering the progress rate seen in mouth plaque control and gum health, further training and cleaning procedure will be done in later appointment in case of need. The next step is to illuminate all tartar and bacteria deposits from the root surface and gingival pockets by dentist.

Tooth Scaling and Root Planning

Tooth Scaling and Root Planning

 During this two-step procedure to treat periodontitis, your dental professional will scrape off the tartar that has built up on teeth both above and below the gum line (tooth scaling). Next, your dental professional will smooth rough spots on the tooth roots, making it more difficult for bacteria to collect and cause more plaque and tartar buildup.

Flap Surgery

 If the gum inflammation and pockets next to the teeth persist after a deep tooth-cleaning procedure, your dentist may recommend flap surgery. Flap surgery is a common dental procedure to treat periodontitis that is performed by a specialist called a periodontist. During flap surgery, the tartar is removed from the pockets that have formed alongside the teeth. The pockets are then closed with stitches, so the gum tissue once again hugs the teeth. Reducing the pockets makes it easier and more comfortable to brush and floss your teeth.



 In severe cases of periodontitis in which bone and tissue have been destroyed, you may need bone or tissue grafts to replace the infected tissue. Your graft may involve a technique called guided tissue regeneration, in which a small piece of mesh is placed between the jaw bone and gums to allow both bone and tissue to re-grow. Guided tissue regeneration helps keep the gum tissue from expanding into the area where the bone should be, so both bone and tissue grafts have room to grow.

Doxycycline Gel

 Gel that contains doxycycline (an antibiotic) provides periodontal disease treatment by killing bacteria and shrinking the pockets that periodontal disease can cause along the gum line. Your periodontist applies the gel to the pockets after a tooth scaling/root planing procedure, and the antibiotic is released gradually over a period of about a week.

Chlorhexidine Chip

 Another periodontal disease treatment involves placing a small, antimicrobial gelatin chip in a tissue pocket along the gum line after tooth scaling/root planing, and the antimicrobial is released gradually over time.

Minocycline Microspheres

 For this type of periodontal disease treatment, the periodontist places tiny particles containing minocycline as an antibiotic in the tissue pockets after a tooth scaling/root planing procedure.

Aftercare-supportive periodontal therapy

Long term success of periodontal treatment depends on individual effort for observing oral hygiene and some ongoing assessment by a practice team to provide ordered care. After doing the first step of treatment, dentist should consider your gum condition and become sure of inflammation treatment. Regular checkup appointment is depending on diseases severity and the risk of disease progression. Usually these appointments are arranged for every three to six months.

Regular checkup appointments are very important because during these sessions doctor will ensure disease procedures is not continuing and if there is no symptom of diseases progress, it is possible to distinguish the inflammation location and treat them in early stages. Also the appropriate method of oral hygiene is trained to patient in order to prevent of inflammation.

Successful treatment of periodontal disease requires full cooperation of patient and observing oral hygiene and participate at regular checkup sessions.



Periodontal inflammation is unavoidable and can prevent of periodontitis and the progress of gum inflation by observing oral hygiene, alongside regular examination and tooth care.

Several important factors for considering mouth and teeth health are as bellow:

  • Brushing surfaces and sides of the teeth twice a day (your toothbrush should have appropriate size and other characteristic of a good brush).
  • Daily cleaning the space between teeth (where toothbrush bristles can’t reach) by dental floss and interdental brushes (depending on the size of space between teeth).
  • Flossing should be used where teeth are close together and have less or no space while interdental brushes are suitable for larger space. Special care should consider to clean around crooked or crowded teeth, around filling, crowns and dentures because plaque easily gather in these places and it’s difficult to access.
  • Antibacterial mouth washers are suitable supplement to brushing because release the bacterial growth and decrease inflammatory Mouth washers should be use after tooth brushing.
  • In case of insufficient cleaning procedure, plaque deposits create on teeth and this gathering turn to hard and fixed substance (calculus, generally known as tartar) that can’t be remove by brushing. Dentist or periodontist during the regular dental checkup, distinguish the tartar deposits and through a professional procedure clean them. After removing deposits, tooth will be polished by special pastes in order to make a smooth surface and decrease possibility of plaque gathering.
  • Eat a balanced diet. Choose a variety of foods from the basic food groups, such as breads, cereals and other grain products; fruits; vegetables; meat, poultry and fish; and dairy products, such as milk, cheese and yogurt. Limit between-meal snacks and candy. Avoid excessive use of sweetened soda pop.
  • Visit the dentist regularly. It is important to have regular dental checkups, which include a thorough periodontal exam. Professional cleaning is essential to prevent periodontal diseases. Once you have been treated for periodontal disease, these maintenance visits are especially important.
  • Avoid use of tobacco. Tobacco use can inflame gum tissue and aggravate existing periodontal disease.