Periodontitis: Early Symptoms and Advanced Gum Disease
Medically reviewed by Edmund Khoo, DDSMedically reviewed by Edmund Khoo, DDSPeriodontitis (gum disease) occurs when the gums become infected and inflamed due to a buildup of plaque and tartar on the teeth. This condition—which is common among older adults in the United States—progresses in stages from mild to severe.While periodontitis is not curable, it is manageable if caught early with proper treatment and at-home oral hygiene habits. This article discusses periodontitis stages, treatment, and management tips.
Illustration by Mira Norian for Verywell Health
Periodontitis Stages and SymptomsPeriodontitis progresses in stages. Based on data from 2009 to 2014, experts estimated that 4 in 10 U.S. adults ages 30 or older had mild, moderate, or severe forms of periodontitis.How Mild Periodontitis StartsPeriodontitis initially starts with gum inflammation (gingivitis), which is reversible. You will first notice gums bleeding when brushing or flossing, along with plaque. Plaque is a buildup of food and bacteria on the teeth that can happen without regular brushing, flossing, and dental cleanings.After this point, the early or mild stage of periodontitis begins. During this time, the gums start to pull away (recede) from the teeth. Small pockets of bacteria will also form in between gums and teeth. More bleeding occurs during brushing and flossing, and bone loss may develop.Progressive PeriodontitisIf not treated, periodontitis progresses to moderate gum disease. During this stage, additional gum recession occurs, along with more bleeding and pain while brushing. Bacteria in the area lead to an infection that can spread deeper into the teeth and may trigger an inflammatory immune system response throughout the rest of the body.At this time, there may be bone loss, and your teeth might start to feel loose.Advanced PeriodontitisThe gums, bones, and tissue surrounding the teeth become destroyed in advanced-stage gum disease.Common symptoms of advanced periodontitis include:Pain while chewingBad breathBad taste in the mouthTooth lossAt this point, surgical procedures are often needed to treat severe infection and inflammation.Goal of Periodontitis TreatmentPeriodontitis treatment focuses on reducing inflammation, removing plaque from the tooth surface, and eliminating the pockets of bacteria on the gums.Once periodontitis progresses past the gingivitis (initial gum infection) stage, it is no longer reversible, but it can still be managed and treated to reduce the chances of further complications.How Does Periodontitis Develop?Periodontitis commonly develops in people with inadequate oral hygiene or dental care.In addition, several other factors make it more likely to develop gum disease. For example, in a 2009 to 2014 survey of U.S. adults ages 30 or older, the following factors were found to increase the chances of developing periodontitis:Poor oral hygiene: This is still the number one cause.Genetics: Having a family history of gum disease can make it more likely to develop periodontitis despite good oral hygiene habits.Smoking status: Of current smokers in the survey, 62% had periodontitis.Age: About 60% of adults ages 65 or older develop periodontitis.Medication side effects: Oral birth control, certain heart disease medications, and some antidepressants have been shown to impact oral health and periodontitis development.Stress: Research suggests that chronic stress can impact the body's ability to fight off infections that lead to oral health diseases like periodontitis.Social and structural determinants can also impact the risk of gum disease. The same survey showed that periodontitis disproportionately impacted nearly 57% of non-Hispanic Black adults and 60% of Mexican American adults ages 30 and older.Income status plays a role. Periodontitis was seen in 60% of those surveyed who reported living below 100% of the federal poverty level. Periodontitis and Health ConditionsCertain health conditions like diabetes, which is common among adults with periodontitis, are linked to developing gum disease. Other health conditions and circumstances that may be related to periodontitis include:Heart diseaseHaving obesityTeeth grinding or jaw clenchingMalocclusion (having misaligned teeth)PregnancyMenopauseExperts theorize that inflammation may be a key factor behind these links.
Why Is a Periodontitis Diagnosis Important?Oral health impacts a person's overall health, including the development of certain chronic diseases. The good news is, periodontitis can be controllable if discovered early. This is why it's so important to get a timely diagnosis—which starts with a dental checkup.During a dental checkup, a dentist or other dental healthcare provider will ask questions about your medical history, including whether you are living with certain health conditions like diabetes or whether you have ever smoked—as both of these factors can lead to periodontitis.Then, they may perform a couple of tests to come to a diagnosis. These include:Gum examination, in which your gums are closely looked at with a measuring instrument for signs of inflammation and pockets of tissue between the tooth and gumX-ray, which involves taking images of the teeth and mouth to determine whether bone loss has progressedBacterial culture, in which a swab of the mouth is analyzed to see if it is high in bacteria that may predispose to periodontitis.It's also possible that you may be referred to a periodontist, a specialist in diagnosing and treating gum disease. Accessing Dental CareFor people who don't have access to dental insurance, know that free or low-cost dental care may be available in your area if needed.The Department of Health and Human Services (HHS) provides information on resources such as community health centers, dental schools, or clinical trials that offer such services.
Treatment Based on Periodontitis StageOptions for periodontitis treatment are mostly based on the stage of the gum disease. For example, your dental healthcare provider may recommend:Scaling and root planing, which is a nonsurgical procedure that deep cleans the affected tooth and root surfaces for various stages of periodontitisPrescription medications like a mouth rinse or topical formula placed on the gums for mild periodontitisOral antibiotics, if needed, to help clear severe gum infections in moderate to advanced periodontitisSurgical procedures to clean bacterial pockets under the gums in moderate to advanced periodontitisGum graft surgery to place external tissue to cover exposed roots for advanced periodontitisTooth extraction (removal) and placement of tooth implants in advanced periodontitis casesPermanent Periodontitis Changes and ComplicationsPeriodontitis can cause complications and permanent tooth changes if it's not treated in a timely manner.Complications can include:Tooth lossTooth shifting or flaring (sticking out at an angle)Tooth abscess, which is a pus pocket from a bacterial infectionJawbone infectionSoft tissue infectionIrreversible jawbone deteriorationOral health issues like periodontitis can also significantly impact a person's quality of life. Daily actions like chewing, talking, and having confidence in social settings may be affected by periodontitis.How to Prevent and Manage PeriodontitisPeriodontitis can be preventable, and it can be managed once it has been diagnosed. Some of the keys include practicing healthy oral hygiene habits, promoting overall wellness, and seeking regular dental care.The main oral hygiene tactics experts recommend for preventing periodontitis include:Brushing your teeth after meals and before bedFlossing once a dayGetting regular dental exams twice a yearOther lifestyle changes to reduce risk factors include eating a well-balanced diet and not smoking.To manage your oral health with a periodontitis diagnosis, your dental health professional will likely recommend a treatment plan that includes examinations every several months to monitor the stage of periodontitis. Preventing Periodontitis at HomeThe best ways to prevent periodontitis involve caring for your teeth and gums at home. While brushing, flossing, and maintaining a well-balanced diet may seem tedious, remember that just a few minutes per day on preventive tactics now can save money and time and prevent diagnoses like gum disease in the future.
SummaryPeriodontitis is gum inflammation and infection. The damage done by active periodontitis is not reversible, but it can be treated to prevent further damage. This common condition has symptoms like gum bleeding, pain, loose teeth, and bad breath. It often develops in older adults, particularly when oral hygiene and dental checkups are lacking.Periodontitis progresses in stages, leading to permanent complications like tooth loss if not treated early. Because it's also linked to the development of health conditions like diabetes and heart disease, it's important to get a diagnosis from a dental healthcare provider as soon as possible if you think you might have periodontitis—in addition to keeping up with at-home oral hygiene habits. Read the original article on Verywell Health.
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