Definition of Periodontitis
What is periodontitis? Periodontitis is also known as periodontal disease or an advanced stage of gum disease. The meaning of the name describes the condition: Perio = “around”, dont = “tooth”, itis = “inflammation of.” So periodontitis is the inflammation and infection of the area surrounding the root of the tooth. It is a severe condition that simply begins as gingivitis but ultimately leads to the destruction of gum attachment, bone and results in tooth loss if left untreated.
What causes periodontitis? Periodontitis is a natural immune response to bacteria along and underneath the gumlines around the teeth. When plaque biofilm is not removed effectively, antibodies from the immune system seek the bacteria out in order to destroy it. When initial symptoms of gingivitis are left untreated, the condition worsens into periodontitis. Simple swelling becomes an area of more advanced infection, causing the destruction of gum and bone attachment around the teeth.
Periodontitis may be due to:
- Inadequate oral hygiene
- Lack of professional preventive care (routine cleanings)
- Susceptibility from conditions such as:
- A family history of periodontitis
- Uncontrolled systemic health conditions/li>
- Badly misaligned teeth.
One drop of human saliva can easily contain 50 to 100 million bacteria, and a diseased mouth can contain bacteria into the billions. As bacteria grow, they accumulate - both dead and alive - and form a sticky, nearly invisible layer called plaque. As plaque grows, it appears as a whitish-gray color. Usually, the formation of this plaque is along the teeth and gum line. If this plaque continues to grow unchecked, it becomes calcified and turns into tartar - also known as calculus. Calculus builds a wedge between the tooth and gum line, and can cause openings called pockets. Pockets are measured by how deep they are from the gum line. Stage 1 periodontitis - called gingivitis - is 2 to 3 millimeters deep, stage 2 periodontitis is 4 to 5 millimeters, and stage 3 periodontitis is 6 millimeters and deeper.
As the gum tissue comes into contact with the spreading plaque and calculus, the infection intensifies. Swelling and redness/irritation begins, the gums become weakened, and bleeding can occur. Once bleeding has started, the bacteria get an additional source of food and can begin to multiply at an alarming rate.
Early Signs And Symptoms of Periodontists
Periodontitis is often a silent disease as those who suffer from it rarely experience pain, and may not even be aware there is a problem. The early stages of gum disease are seldom painful, and carry with them very few warning signs. Some of the early warnings to look for are slight bleeding while brushing, softening of the gums, and discoloration of the gums - darker red/irritated in appearance rather than a light, healthy pink. As the disease progresses, more noticeable signs may become more predominant.
Periodontitis is more than just gingivitis. Here are some warning signs to watch for if you suspect you may be developing the condition:
- Bleeding Gums – Healthy gums should never bleed. Bleeding during brushing or flossing that persists for more than two weeks is a sign of gum infection such as periodontitis or more advanced gingivitis.
- Bad Breath – The bacteria involved in periodontitis often contribute to halitosis, or breath malodor. Because the problem exists deep under the gums, mouthrinses, gums or mints do not easily cover it up.
- Swollen, Red Gums – Gumlines become inflamed and red along the margins of the teeth when gum disease exists. Mild inflammation, often localized to just one area, is typical of gingivitis. More advanced periodontitis often involves more widespread inflammation and redness.
- Receded Gums – As periodontitis advances, the gums become detached from the teeth and creep down the surface of the roots, leaving exposed root surfaces. This makes teeth appear longer than normal.
- Sore Teeth – Infection around the tooth may make chewing or applying pressure to the tooth uncomfortable.
- Shifting Or Loose Teeth – When gum detachment or bone loss has occurred, it may cause the teeth to be mobile or shift out of their natural position.
- Drainage Of Pus – During very advanced stages of periodontitis, there may be signs of pus that drains along the gumlines when the tooth or gums is depressed. Pus usually appears clear, white or yellow.
If you have any of the above signs, you could be significantly farther down the path of serious periodontitis than you think, and close to the potential loss of your teeth.
Stages And Types Of Periodontitis
While periodontitis is a specific condition, there are various periodontitis classification categories that help identify the type of infection when being described among dental professionals. These classifications usually describe to what degree the infection has advanced, and how much of the mouth has been affected.
Mild Periodontitis/Early Periodontitis
This is the earliest form of periodontitis. Clinical findings show mild gum detachment with mild bleeding. There may be minimal bone loss evident on dental X-rays.
Moderate periodontitis exists when gum pockets measure between four and six millimeters in depth and there is clinical evidence of bone loss evident on the X-rays.
Severe periodontitis involves advanced bone loss with gum pockets deeper than six millimeters found during a dental examination. Bone has often receded so much that the furcation – division – of the back molar teeth are involved.
This is the most common form of periodontitis. It is related to the duration of the disease on the tooth surfaces.
Acute infections may affect only a localized area, but are often painful and quickly advanced. Acute infections may also involve periapical abscess – around the apex of the root – of the tooth due to the invasive condition.
When periodontitis is limited to just a few teeth in the mouth without having spread to other teeth it is considered localized. You can still have localized aggressive periodontitis, so being localized doesn’t simply mean it is minor.
Generalized periodontitis affects several areas throughout the mouth. It may be a more mild form or can be generalized aggressive periodontitis.
Dangers and Health Risks of Periodontitis
Periodontitis has been linked with many other systemic health conditions. The severity of those diseases is often also directly related to the severity of periodontitis. (1) One example is periodontitis and diabetes. The higher the blood sugar levels are, the more likely you are to suffer from uncontrolled periodontitis.
When you suffer from disease conditions, it places a significant strain on your body’s ability to cope with infection. Progression of periodontitis can occur when you do not adequately manage other conditions. In contrast, periodontitis bacteria can also enter into your bloodstream and make you more likely to suffer from conditions such as heart attack and stroke.
Common health conditions associated with periodontitis include: (2,3)
- Heart attack
- Cardiovascular diseases
- Respiratory disease
- Pancreatic cancer
- Digestive disorders
- Erectile dysfunction
- Premature labor
- Low birth weight
The main cause of periodontal disease is bacteria, but the following factors may also affect the health of your gums: stress, genetics, diabetes, smoking/tobacco use, pregnancy/puberty, hormonal changes in women, clenching or grinding your teeth, and poor nutrition.
How to Prevent Periodontitis
Did you know that preventing periodontitis is the primary concern of your dental hygienist? There is a reason that she is always nagging her patients to brush and floss each day. Periodontitis begins as gingivitis, and if the symptoms aren’t addressed early on they can easily result in damaging consequences. In order to prevent periodontitis you must have exceptional oral hygiene, and reassess what you are already doing to ensure you’re doing it the right way. Here we will review everything your hygienist wants you to know about preventing the invasive dental disease known as periodontitis:
Use a soft-bristled toothbrush angled 45 degrees toward your gums, focusing on just two teeth at a time. Apply very gentle pressure and make circular motions, removing the debris near the surface of the gumlines. Consider an electric toothbrush, as those are typically more effective in removing plaque biofilm and can greatly improve your chance of preventing gum infections like periodontitis.
Flossing – Don’t Ignore it
Flossing, not brushing, removes bacteria between the teeth and under the gumlines – where periodontitis starts to begin. Neglecting to floss at least once per day can allow bacteria to settle in and calcify, harboring disease conditions. Once calcified, bacteria cannot be brushed or flossed off and must be removed by a dental professional. To floss effectively, wrap your floss tightly around the tooth and slide up and down under the gums as far as it will go when gentle pressure is applied. Bleeding is a sign of infection so don’t let that stop you. Healthy gums do not bleed, and it may take flossing daily for up to two weeks before areas of gum infection stop bleeding.
Consider a water flosser such as a WaterPik. These devices are easy to use and can access areas deeper below the gums where flossing cannot.
Routine Preventive Care
Visiting your hygienist on a recurrent schedule allows her to screen for areas of disease as well as remove any bacterial deposits. Even allowing small areas of tartar (calcified bacteria) to remain on the teeth when you skip a cleaning can allow an area to harbor ideal conditions for periodontitis.
Nutritional and holistic supplements can increase your body’s immune health and reduce the risk of developing more advanced stages of periodontitis. Essential oils and supplementing with things like CoQ10 can greatly decrease your chance of developing advanced periodontitis.
Choose Your Oral Hygiene Products Wisely
Conventional wisdom tells us to brush with fluoride toothpaste and rinse with alcohol-containing mouthwash. But research has shown that there are real potential dangers in using these substances – [click here to read more – “The 6 Hidden Dangers in Toothpaste.” For optimal oral health and hygiene it is best to use [100% pure and natural botanical ingredients] whenever possible when brushing and rinsing.
Most periodontitis conditions are addressed through conventional treatment in your dental office. The more aggressive periodontitis treatment needed, the more expensive and invasive it can become. Addressing it early on with prophylactic appointments and great home care is the best way to avoid costly conventional dental treatment.
Seeing your dentist and hygienist every six months is the first step you should take in preventing periodontitis. During these routine-cleaning appointments they can remove any calculus deposits that harbor periodontitis-causing bacteria. They will also alert you to any areas of concern, allowing you to implement at-home steps to prevent the progression of the condition. A typical cleaning is under one hundred dollars, and usually covered 100% by most dental insurance plans.
If you are suffering from periodontitis symptoms due to inadequate care or lapse in care, your dentist may prescribe a medication to help alleviate the initial infection and aid in your at-home prevention routine. These medications may be in the form of a gel, rinse or orally-administered drug. Common medications used for periodontitis include:
Fluoride: Prescription fluoride can aid in eliminating initial periodontitis symptoms related to poor oral hygiene. (4) When thinking about using any fluoride product as part of an oral hygiene program or as treatment, be sure to read our free eye-opening report about fluoride, “Why the FDA Requires a Warning Label on Your Toothpaste.”
Chlorhexidine: This antiseptic mouth rinse is usually used for up to two weeks to alleviate inflammation and kill periodontitis disease bacteria that it comes into contact with. If used for more than two or three weeks it can cause significant dental stain.
Antibiotics: Most prescription antibiotics are reserved for more severe forms of periodontitis and are only used in conjunction with other conventional treatments. They can reduce bacterial levels, increasing your body’s response to the therapy. Common antibiotics for periodontitis include Periostat and Tetracycline.
Deep Cleanings/Scaling and Root Planing
Deep cleanings are the most commonly used conventional treatment in your dental office for addressing periodontitis. These treatments address one quadrant of your mouth at a time, and usually involve local anesthesia or desensitizing techniques. Your hygienist will use advanced instrumentation techniques to access disease debris deep below your gums in order to allow the area to heal. Costs are typically $200 to $300 per quadrant, nearing $1,000 for the complete mouth.
Periodontal maintenance visits are similar to routine cleaning appointments, but are more frequent and always follow deep cleaning appointments. Typically the fees are the same as prophylactic appointments, but you may be seen every three to four months until the symptoms improve, instead of every six months as with a preventive care cleaning.
Local Antibiotic Delivery
Following in-office therapy, your doctor may decide to place a local antibiotic in areas of more advanced disease. The medication is usually in the form of a capsule and the area should not be flossed for as long as two weeks to allow the delivery of the entire dose. This method is usually only used for a few areas where there is the most concern, and costs about $30-40 per site.
Examples of commonly used local antibiotic medications include:
Crown lengthening removes the diseased, detached gum tissue and creates a shallower gum “pocket” around your tooth, allowing you to keep it cleaner and free of disease-causing bacteria. Unfortunately it also exposes the roots of your teeth and isn’t really an aesthetically pleasing treatment, but in some cases it may be necessary if you are otherwise unable to keep the area clean. The cost is usually at least a few hundred dollars per tooth.
Gum Flap Surgery
If periodontitis disease conditions are so extreme that they have extended deeply below the gumlines, it may be necessary for a specialist to perform what is called flap surgery. The gums are retracted in order to access the bacteria buildup on the root of the tooth. This debris is removed and the gums are sutured back into place. Surgery costs can be up to several thousand dollars depending on how large of an area is affected.
Bone Or Gum Grafting
When bone or gum loss has been significant enough to risk the development of tooth mobility, gum or bone grafting may be needed. These are more invasive surgical procedures but they can aid in the structural stability of teeth that might be at risk for tooth loss. The fee can cost several hundred dollars and is priced per tooth.
Teeth that are misaligned are more prone to develop gum disease symptoms. Orthodontics can correct the position of the teeth and it has been proven to be part of a comprehensive approach to managing periodontal disease. (5) By moving the teeth into an appropriate position, they are easier to keep clean and reduce the risk of disease. Treatment usually averages a few thousand dollars.
Natural And Home Remedies
There are many ways to treat periodontitis symptoms on your own. Preventive natural and home remedies are actually some of the most significant periodontitis treatment when it comes to improving your oral health. Your dentist and hygienist can provide professional services at limited appointments in their office, but unless you are taking a proactive approach to your own health on a daily basis, you will not benefit as much. To truly improve your periodontitis you must make significant changes in the way you treat the condition at home.
Holistic Dental Options Could Save Your Teeth… and Your Money
Most holistic options for treating periodontitis are fairly inexpensive, which can save you hundreds if not thousands of dollars on professional treatments. However, not making a point to treat periodontitis on your own will ultimately result in the need for advanced professional intervention.
Home Remedy Options
If you’ve been looking for a periodontitis remedy, there are several methods that you can use conjunctively or alone to improve the health of your mouth
Advanced Hygiene Practices
- Making significant changes in the way you brush your teeth does more than you think. Angle the brush 45 degrees toward the gumlines and brush in circular motions focusing on just two teeth at a time. Use only a soft-bristled brush and apply only enough pressure to cause a gentle blanching of the tissues. Brush other areas as well, including the tongue and cheeks to remove excess bacteria from the mouth.
- Consider an electric toothbrush. Electric toothbrushes can remove a significantly larger amount of bacteria than manual toothbrushes. (5)
- Floss every single day. Brushing alone does not remove periodontitis bacteria that rest between the teeth or deep below the gumlines. Wrap the floss in a “c” shape around each tooth and gently slide up and down under the gums several times.
- Consider a water flosser or other irrigation device. Water flossers can remove plaque biofilm in concave areas of the tooth or deep below the gums (in cases of severe periodontitis) when normal flossing cannot. (7)
- Antiseptic, over-the-counter mouthrinses can help decrease the amount of bleeding associated with periodontitis. However, avoid mouthrinses that contain alcohol, as it can dry out the mouth, which can lead to more bacterial growth in the long run. It is best to go with a 100% pure botanical mouthwash that kills the harmful bacteria that lead to gum problems.
- Warm salt-water rinses are a good way to reduce swelling associated with oral irritation such as periodontitis.
- Ibuprofen may be taken to alleviate any discomfort associated with inflammation, as it is an anti-inflammatory drug.
There are several types of natural supplements that have been shown to be effective in treating periodontitis symptoms. Not only are they easy to use, but also they are usually fairly inexpensive, especially compared to conventional treatment.
Vitamin And Nutritional Supplements
CoQ10 may be one of the most effective supplements available for the treatment of periodontitis. According to the Mayo Clinic, CoQ10 significantly aids in the reduction of gum disease symptoms.
Vitamin A is found in oils such as olive and sunflower oil. The nutrient promotes a healthy immune system and is shown to improve healing of oral infections when used as a supplement.
Vitamin C has long been known to promote immune health. Its use has been shown to improve the healing process of periodontitis symptoms.
Essential oils are useful for applying to the area of gum infection or simply adding to a glass of water to be used as mouthwash. They can dramatically affect your healing process when suffering from periodontitis and be a tremendous benefit when added into your normal oral care routine.
Essential oils that have a significant affect on periodontitis symptoms include examples such as:
Essential oils should be used according to directions and sparingly, so as not to accidentally use too much. Typically you can add one or two drops of the oil to your toothbrush and brush in the affected area or apply it with a cotton swab.
Recommended Lifestyle Changes
Having a healthy immune system makes a huge impact on your body’s ability to respond to periodontitis. Neglecting other health conditions such as obesity or diabetes may make it harder for you to address your periodontitis concerns and symptoms because your immune system is already strained. Here are some simple tips to help fight periodontitis in a truly holistic manner:
Work Out To Fight Plaque
Stimulating your cardiovascular system can prevent plaque biofilm from accumulating in large amounts throughout your cardiovascular system. That’s right – the plaque from your mouth can also enter into your arteries and heart!
Kick The Tobacco Habit
Nearly every patient with periodontitis who also smokes will never see an improvement in their condition. No matter how dedicated they are, smoking can counteract everything good that you do for your gums.
Eat A Balanced Diet
Fibrous fruits and vegetables stimulate gum tissue as you chew, while also providing essential nutrients to the rest of your system. They actually cleanse the teeth while you eat them! When your body has healthy nutrients going in, it makes it easier for you to fight infections as they occur.
Limit Sugar And Alcohol Intake
Sugars and refined sugars often found in processed food and alcoholic beverages create an acidic environment inside of the mouth and the rest of the body. Bacteria thrive in these areas and as they feed on the sugar the result is lots and lots of plaque biofilm (think “germ poop”). The more sugar you eat, whether it be through your coffee, juice, packaged food, alcoholic drink or other source, the more bacteria that you are going to produce in your mouth. The more bacteria you have, the easier it is for your periodontitis to advance.
Your Questions About Periodontitis Answered
Can Periodontitis Be Cured?
Periodontitis can almost always be cured. Dedicated preventive routines, along with supplementation and necessary lifestyle changes can allow your body to rid itself of the infection. Depending on how advanced the condition is, you may need professional treatment ranging from maintenance visits to surgical therapies. In extremely advanced stages of the disease it may be impossible, requiring extraction of the teeth to rid the body of the chronic infection.
Can Periodontitis Be Reversed?
In some cases, yes. Unfortunately, the more the advanced the periodontitis is, the less likely you are to reverse it. You can however stop the disease process from progressing further in most cases with professional care and dedicated home routines. It is easier to reverse periodontitis when symptoms are in the beginning stages.
Is Periodontitis Contagious?
Yes. Periodontitis can be spread between close family members such as husband and wife or parent to child. (8) This is due to the bacteria passing between people through saliva, making it even more important for you to treat the condition.
I don’t have bleeding or swollen gums. Could I still have periodontitis?
Symptoms of periodontitis may not be visible for patients that smoke, have undergone radiation therapy or are taking certain medications. In these cases swelling and bleeding may not be evident, but the disease can lie deep below the gums. Other symptoms such as food packing between the teeth or under the gums, or shifting teeth may prove to be identifying factors.
Can I treat periodontitis on my own?
Mild periodontitis can be efficiently treated through dedicated oral hygiene routines and supplementation. By preventing the condition to continue, you reverse the bone loss process and may also encourage some tissue reattachment. Periodontitis is a serious condition and requires extremely dedicated oral hygiene practices on a daily basis to prevent relapse.
Does brushing and flossing alone remove the bacteria associated with periodontitis?
Not necessarily. If you have mild periodontitis with only minimum gum detachment or bone loss, it may be just fine. However, due to the loss of attachment with moderate or more severe forms of periodontitis, the concave root surfaces on the sides of the teeth often harbor disease bacteria that cannot be reached with typical oral hygiene methods. A water flosser may be a more efficient method of home cleansing for these areas. (7)
Could I have a genetic predisposition to periodontitis?
Genetic predisposition may play a factor in your body’s risk to develop periodontitis. (9) Many people with periodontitis identify that one or both of their parents or a sibling has suffered from the same condition. While genetics play a part, it may also be due to the bacteria spreading back and forth among family members through saliva. Simply being predisposed to the disease does not mean that you cannot effectively treat and prevent the symptoms.
My gums bleed every time I brush them. How else can I improve my periodontitis?
Many people complain that simple oral care routines at home such as brushing or flossing cause their gums to bleed or be uncomfortable. Bleeding or irritation is simply a symptom of periodontitis. You must begin cleaning the teeth correctly each day for up to two weeks before expecting symptoms such as bleeding or tenderness to go away. If they do not improve you may need professional treatment as well.
What could happen if I delay treatment for my periodontitis?
Putting off care for periodontitis could result in advancement of the disease condition into a more severe stage. As the stage of disease progresses, treatments become more invasive and costly in an attempt to retain your teeth. Otherwise, the disease continues to destroy gum attachment and bone levels, ultimately resulting in the loss of teeth.
- Amabile N., Susini G., Pettenati-Soubayroux I., Bonello L., Gil J-M., Arques S., Bonfil J.J., Paganelli F. (2008). Severity Of Periodontal Disease Correlates To Inflammatory Systemic Status And Independently Predicts The Presence And Angiographic Extent Of Stable Coronary Artery Disease.; Journal of Internal Medicine, 263, 6, 644-652.
- Jepsen S, Kebschull M, Deschner J.; Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz.Relationship Between Periodontitis And Systemic Diseases].[Article in German] 2011 Sep;54(9):1089-96.
- Zuo Z, Jiang J, Jiang R, Chen F, Liu J, Yang H, Cheng Y.; Effect Of Periodontitis On Erectile Function And Its Possible Mechanism.; J Sex Med. 2011 Sep;8(9):2598-605.
- He T, Barker ML, Goyal CR, Biesbrock AR.; Anti-Gingivitis Effects Of A Novel 0.454% Stabilized Stannous Fluoride Dentifrice Relative To A Positive Control.; Am J Dent. 2012 Jun;25(3):136-40.
- Harrel SK, Nunn ME; The Effect Of Occlusal Discrepancies On Periodontitis. II. Relationship Of Occlusal Treatment To The Progression Of Periodontal Disease.; J Periodontology, (April 2001) 72, 4, 495—505.
- Moritis K, Jenkins W, Hefti A, Schmitt P, McGrady M.; A Randomized, Parallel Design Study To Evaluate The Effects Of A Sonicare And A Manual Toothbrush On Plaque And Gingivitis.; J Clin Dent. 2008;19(2):64-8.
- Barnes CM, Russell CM, Reinhardt RA, Payne JB, Lyle DM.; Comparison Of Irrigation To Floss As An Adjunct To Tooth Brushing: Effect On Bleeding, Gingivitis, And Supragingival Plaque.; J Clin Dent. 2005;16(3):71-7.
- S Asikainen, C Chen, S Alaluusua, and J Slots; Can One Acquire Periodontal Bacteria And Periodontitis From A Family Member?;JADA September 1, 1997 128(9): 1263-1271
- E Silva M, Moreira P, da Costa G, Saraiva A, de Souza P, Amormino S, da Costa J, Gollob K, Dutra W.; Association Of CD28 And CTLA-4 Gene Polymorphisms With Aggressive Periodontitis In Brazilians.; Oral Dis. 2012 Oct 18. doi: 10.1111/odi.12036. [Epub ahead of print]