A periodontal disease – also known as periodontitis – is a bacterial condition. Unlike gingivitis, it affects not only the gums but also the supporting structures of the teeth. In the worst case, it can lead to individual teeth falling out.
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Inflammation : Periodontitis resulting from gum inflammation
Gum inflammation — known as gingivitis — is quite common and affects almost every adult at least once in their lifetime. It develops as a result of poor oral hygiene. Bacteria settle along the gum line and can trigger an inflammatory response there. The first signs can be bleeding gums and bad breath.
Gingivitis is usually harmless and heals quickly with improved dental and oral hygiene. However, if it persists, it can gradually develop into periodontitis. In periodontitis, the bacteria spread from the gums to the tooth socket. The inflammation spreads and affects the entire periodontium.
Gum pockets as a breeding ground for bacteria
At the point where the tooth meets the gum, there are naturally small gum pockets that are only a few millimetres deep. As the inflammation progresses, these gum pockets can become larger.
This causes the gums to pull away from the tooth in patches, creating a deeper pocket. These pockets are the perfect breeding ground for bacteria, as they can multiply there almost undisturbed. Toothbrushes and dental floss cannot reach these gum pockets.
Food particles, which the bacteria feed on, also get trapped in the pockets, providing them with ideal living conditions. The bacteria then penetrate deeper and deeper into the periodontium.
Bone loss and tooth loss
Eventually, the bacteria can reach, attack and damage the jawbone and cementum.
In addition, the body responds to the infection with various inflammatory and immune responses, which serve to fight off the bacteria but also attack the body’s own tissues and lead to bone loss.
The result is that the teeth can no longer be held in place, and they may fall out.
Key facts:
- Gum pockets deepen, creating a sheltered environment for bacteria
- Bacteria multiply unchecked and penetrate deeper into the periodontium
- Bone loss caused by bacterial infection and the body’s own immune response can lead to tooth loss
Causes : Causes and risk factors for periodontitis
Apart from genetic factors and other underlying systemic conditions (such as diabetes), the most common cause of gum disease is poor oral hygiene, which leads to an excessive build-up of bacteria in the mouth. Periodontitis is usually preceded by gingivitis.
Risk factors you can influence – here’s what you can do:
- Poor oral hygiene: Brush your teeth thoroughly twice a day to remove plaque and food debris – this will also help prevent tooth decay.
- Smoking: 70 per cent of people who suffer from periodontitis are regular smokers. The reason: nicotine impairs blood circulation, which means the body is only able to fight gum infections to a limited extent.
- Tartar: If necessary, have your dentist remove any tartar. This forms when dental plaque ‘hardens’. This creates small grooves in which bacteria can easily become trapped.
- Contagion: It is possible to catch periodontitis. You should therefore avoid sharing your toothbrush and not eat with the same cutlery as your partner or child.
Risk factors beyond our control:
- Genetic predisposition: Periodontitis often runs in families.
- Hormonal fluctuations: During pregnancy and puberty, the risk of bacterial infections in the mouth increases.
- Underlying conditions: Certain medical conditions can also increase the risk of periodontitis. Diabetes mellitus reduces blood flow, which has a negative effect on the body’s defences. In people with HIV, the immune system is weakened and is less able to respond to infections.
Treatment : Periodontitis – treatment at the dentist
Diagnosis comes before treatment. Your dentist can first use the Periodontal Screening Index (PSI) to determine how advanced the periodontitis is. X-rays of the jaw are also taken to identify any possible bone loss. The treatment steps can then be worked out from there.
When it comes to treating gum disease, there are various escalation levels depending on the severity, from which the dentist can choose:
- At the start of treatment, a basic course of therapy is usually begun.
- If this isn't sufficient, further steps can be taken, such as a minor surgical procedure.
Primary aims of periodontitis treatment are to limit bacterial infection and thereby halt inflammation of the gums and periodontal tissues, whilst preserving the tissue.
Basic treatment for periodontitis
First, the teeth and gum pockets need to be cleaned and plaque removed. To do this, the dentist or a member of the trained practice staff – often a dental hygienist – will first carry out a basic treatment:
In what’s known as closed curettage, a local anaesthetic is usually needed. The dentist or dental hygienist then removes the plaque from the necks of the teeth and the gums, either manually or using mechanical instruments (e.g. ultrasonic).
In some cases, a laser may also be used. There are different systems that remove affected tissue or have an antibacterial effect. Antibiotics may also be needed.
This basic treatment is often enough to stop the infection progressing and reduce symptoms. If periodontitis has been diagnosed, short, regular recall appointments (around every 3 months) are important.
Surgical treatment for periodontitis
If the periodontitis is very aggressive or advanced, or if the inflammation could not be fully stopped with closed periodontal treatment, open treatment in the form of surgery is needed.
First, particularly deep gum pockets are gently opened so that bacteria can be tackled directly and diseased tissue can be identified and removed. The gum can then be placed back against the tooth and secured with surgical stitches, ideally helping to reduce the build-up of bacteria in the future.
If the tooth-supporting structures are already affected and the stability of the teeth is at risk, a tissue graft may be needed. The tissue is either taken from the mucous membrane on the palate, or sliding flaps from healthy gum tissue are used.
If the bone has been affected, it can be replaced with the patient’s own bone tissue or other bone replacement materials.
There are now many promising treatment methods that can be used depending on the severity of the periodontitis. To achieve long-term success after treatment by the dentist, the patient’s cooperation is essential.
That’s because only thorough oral hygiene and dental care can prevent the condition from returning.
Prevention : Preventing periodontitis
To help avoid the need for periodontal treatment or surgery in the first place, the following preventive measures can help:
- Regular and thorough dental care (brushing your teeth morning and evening, flossing/interdental brushes, mouthwash).
- A healthy diet and avoiding sugary drinks throughout the day.
- Attending six-monthly preventive check-ups at the dentist.
- Regular professional tooth cleaning.
- Reducing nicotine use or stopping smoking.
- If periodontitis has been diagnosed: regular appointments for supportive periodontal therapy (SPT).
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Health risks : Complications associated with periodontitis
If periodontitis is left untreated, it can lead not only to tooth loss but also to other serious complications:
- Studies show links between periodontitis and cardiovascular disease, as germs can travel through the bloodstream to the coronary arteries.
- The airways can also be affected; in some cases, the pathogens can trigger pneumonia.
Regular checks are important:
Consistent dental treatment and regular follow-up care can minimise these risks
Bioniq® : Dental care suitable for periodontitis
Bioniq® Repair Toothpaste Plus Gum Protection
Toothpaste containing 20% biomimetic enamel (hydroxyapatite/HAP) for daily oral care and healthy gums
- Improves gum health
- Suitable for periodontitis
- Smooth, strong, and healthy teeth
Knowledge : Other topics
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Dr. Joachim Enax
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Dr. Joachim Enax is an expert in biomimetic oral care and oral health. As a PhD chemist, he is an experienced scientist in the research and development of innovative active ingredients for oral care and in promoting dental health. He is the author of numerous scientific publications in the field of teeth and oral care.
Karoline Bauch
Corporate Communications Officer
Karoline Bauch is an expert in science communication specialising in the Oral Care sector and acts as the editorial contact for all matters relating to dentistry, oral health and prevention.