Periodontitis

Symptoms Of Periodontitis

Periodontitis often develops silently, with early signs that may go unnoticed. Recognizing symptoms early can help prevent serious gum and tooth damage. Common symptoms can include:

• Swollen, red, or tender gums (gingivitis)
• Bleeding gums during brushing or flossing
• Receding gums–teeth may appear longer
• Persistent bad breath (halitosis) or bad taste in the mouth
• Formation of deep pockets between teeth and gums
• Loose or shifting teeth
• Pain while chewing
• Pus between teeth and gums in advanced cases
• Changes in bite alignment.

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Types Of Periodontitis

Periodontal diseases are broadly classified into the following main types:

• Chronic periodontitis: The most common type, usually seen in adults, is marked by the slow progression of gum inflammation and bone loss.

• Aggressive periodontitis: Less common, occurs in younger individuals, and causes rapid gum and bone destruction.

• Periodontitis as a manifestation of systemic diseases: Gum disease linked to conditions such as diabetes, heart disease, or immune disorders.

• Necrotizing periodontal disease: A severe, painful form associated with tissue death, often seen in people with weakened immunity, malnutrition, or excessive stress.

Causes Of Periodontitis

The periodontal ligament is a soft, fibrous tissue that connects the tooth root to the surrounding jawbone, helping anchor the tooth in place while also acting as a cushion during chewing. Periodontitis develops step by step, starting from simple plaque buildup to severe gum and bone damage around the teeth. Here’s what happens in periodontitis:

• Plaque formation: Bacteria stick to the teeth and form a sticky layer called plaque. This becomes stronger over time and protects the bacteria.

• Bacterial growth and survival: The bacteria in plaque release substances that help them survive, grow, and communicate with each other, making the infection more powerful.

• Oxygen reduction: As plaque builds up, oxygen levels drop, allowing harmful bacteria that can thrive without oxygen to grow and worsen the infection.

• Immune system reaction: The body responds to the bacteria with inflammation, i.e., redness, swelling,  and bleeding gums. 

• Tissue and bone damage: The long-term immune response releases chemicals that not only attack bacteria but also damage the gums and bone around the teeth, leading to loosening and tooth loss.

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Risk Factors For Periodontitis

Poor oral hygiene is the main factor that can cause periodontitis. Apart from this, other factors that can increase the risk of periodontitis include:

Modifiable risk factors 

• Smoking: Significantly raises risk and reduces the effectiveness of treatment

• Diabetes: Higher susceptibility in those with uncontrolled blood sugar levels

• Psychological stress: Stress may weaken the immune response and lower the likelihood of good oral hygiene

• Environmental factors: Poor nutrition, excessive alcohol use, and socioeconomic challenges can also increase the risk.

Non-modifiable risk factors 

• Genetic predisposition: Genetic makeup can considerably influence how your body responds to bacterial challenges

• Ageing: Risk increases over time, but more due to cumulative effects rather than age itself

• Osteoporosis: Weak bones due to osteoporosis may speed up bone loss in the jaw, making gums and teeth more vulnerable to damage.

• Other systemic diseases: Rare conditions that impair the immune system’s ability to fight infection can lead to periodontitis.

Diagnosis Of Periodontitis

Periodontitis is usually diagnosed during a dental check-up by assessing the gums, teeth, and supporting bone. It consists of:

• Medical and dental history: To check for risk factors like smoking, diabetes, or family history of dental conditions.

• Clinical examination: The dentist looks for swollen, red, or bleeding gums, periodontal pockets, and loose teeth.

• Periodontal probing: A small measuring tool, known as a periodontal probe, is used to check the depth of gum pockets. Normal is ≤3 mm, pockets deeper than that may indicate periodontitis.

• Dental X-rays: Like a bitewing x-ray or an orthopantomogram (OPG), help detect bone loss around teeth.

• Additional tests (if needed): May include microbial testing or genetic susceptibility tests in complex cases.

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Specialist To Visit

You can also start by consulting a general dentist, who may refer you to a periodontist if advanced care is needed.

A periodontist is a dentist who specializes in the prevention, diagnosis, and treatment of gum diseases and the supporting structures of teeth.

When to see a doctor?

Visit a dentist if you have:

• Persistent bad breath or bad taste
• Red, swollen, or bleeding gums
• Pain while chewing
• Loose or shifting teeth
• Gum recession (teeth look longer)
• Pus oozing around gums or teeth. 

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Prevention Of Periodontitis

Periodontal disease is largely preventable with the right daily care and smart lifestyle choices. Here’s how you can prevent periodontitis:

Brush smart daily

• Brush twice a day for 2 minutes with a fluoridated toothpaste
• Use interdental brushes or floss to clean the spaces your brush misses
• A powered toothbrush can be your ally in that extra plaque removal.

Note: Some studies show that powered toothbrushes may be slightly more effective, especially in reducing gum inflammation. They are particularly useful for people who have difficulty using a manual toothbrush effectively, such as those with arthritis, limited hand dexterity, or developmental disabilities.

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Get regular check-ups

• Get your teeth professionally cleaned at least once or twice a year or as advised by your dentist.
• Your dentist can spot early signs of gum trouble before it gets serious.

Upgrade your oral hygiene

• Rinse with an antimicrobial mouthwash like chlorhexidine when advised.
• Remember, these rinses work with brushing, not instead of it.
• Replace your toothbrush every 3–4 months or sooner if bristles fray.

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Build healthy habits

• Set reminders to brush and floss until it becomes second nature.
• Manage risks like diabetes to keep gums healthy.
• Keep a gum-friendly diet with more fruits, veggies, and water, and less sugar.

Treatment Of Periodontitis

Periodontitis treatment aims to control infection, protect teeth, and restore gum and bone health. A periodontist will recommend a plan depending on how severe the condition is. It can consist of:

1. Nonsurgical treatments

• Scaling and root planing (SRP): A deep cleaning procedure where plaque and tartar are removed from below the gumline. It also smoothens the tooth root so the gums can reattach better. 

• Antibiotics: Used to reduce harmful bacteria. These can be topical gels (doxycycline gel and minocycline microspheres) placed in gum pockets or oral antibiotics for more severe infections. Examples of oral antibiotics include:

  • Amoxicillin 
  • Metronidazole

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• Laser therapy: Lasers can precisely remove diseased tissue and bacteria. Though it is not a standard procedure, it can improve healing and reduce discomfort after deep cleaning.

2. Surgical treatments

• Flap surgery (pocket reduction): The gums are lifted to remove tartar from deep pockets and then sutured back for a snug fit. This makes cleaning easier at home.

• Bone grafts: If periodontitis has affected the bone, grafts made from your own bone, donor bone, or synthetic materials are used to help regrow what’s lost. Hydroxyapatite-based grafts are often used.

• Soft tissue grafts: If your gums have receded, tissue from the roof of your mouth is placed over the exposed root. This reduces sensitivity and improves appearance.

• Guided tissue regeneration (GTR): A special membrane is placed between gum tissue and bone to encourage new bone growth in severely damaged areas.
  
  

Complications Of Periodontitis

If left untreated, periodontitis doesn’t just damage your gums and teeth; it can also affect your overall health. Complications can include:

Local complications

• Gum recession: Gums pull away from the teeth, making them appear longer and causing sensitivity.

• Loose teeth or tooth loss: Ongoing destruction of bone and ligaments leads to mobile teeth and eventually tooth loss.

• Periodontal abscess: An abscess is a localized, pus-filled pocket in the gums that is painful and may spread infection.

• Difficulty chewing: As teeth start moving or become loose, chewing food becomes painful and less effective.

Systemic complications

Periodontal bacteria and inflammation spread beyond the mouth – can become serious

• Diabetes complications: Poorly controlled blood sugar worsens gum disease, and vice versa. Periodontitis makes diabetes harder to manage.

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• Cardiovascular disease: Bacteria from infected gums may enter the bloodstream, contributing to atherosclerosis, heart attack, or stroke.

• Adverse pregnancy outcomes: Severe periodontitis has been linked to preterm birth and low-birth-weight babies.

• Respiratory infections: Inhaling bacteria from infected gums can increase the risk of pneumonia and chronic lung conditions.

• Rheumatoid arthritis and other inflammatory disorders: Shared inflammatory pathways make people more prone to worsening joint disease.
  
  

Alternative Therapies For Periodontitis

Alternative options do not replace scaling and root planing (SRP) or standard periodontal care; they’re add-ons that may improve outcomes in selected cases. These include:

Probiotics

Short- to medium-term use of probiotics alongside SRP can yield small extra gains in periodontal health, though effects are seen only by 6–12 months. Evidence is mixed, and more research is required to confirm the efficacy.

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Omega-3 fatty acids + low-dose aspirin 

This is an adjunct to debridement, especially in people with type 2 diabetes mellitus. This combo has improved clinical parameters and inflammatory markers.

Note: Always consult your doctor and screen for allergies, drug interactions (e.g., aspirin with anticoagulants), and systemic conditions before use.

Antimicrobial photodynamic therapy (aPDT)

Using a special light with a photosensitizer can sometimes help reduce gum bleeding and deep pockets when combined with cleaning treatments, but studies show mixed results, and more research is needed.

Curcumin (Turmeric)

Curcumin gels or irrigants placed below the gums with SRP have shown modest improvements in plaque and probing depths in small trials. However, formulations and protocols vary, and more research is required.

Aloe vera

Mouthwash or allover gel has shown reductions in plaque comparable to non-alcoholic chlorhexidine in the short-term use, with fewer reported side effects.

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Living With Periodontitis

Managing periodontitis is a lifelong commitment, not just a one-time treatment. With the right care, you can control the disease, protect your gums, and maintain a healthy smile. Here are a few tips that can help:

1. Religiously follow oral care routine

• Brush twice daily with a soft-bristle toothbrush
• Floss or use interdental brushes to clean between teeth
• Use antimicrobial mouthwash if prescribed by your dentist.

2. Make healthy lifestyle choices

• Quit smoking, as it worsens gum damage
• Eat a balanced diet rich in vitamins and minerals for gum health
• Manage conditions like diabetes, which increase gum disease risk.

3. Focus on maintenance

• Schedule dental checkups every 3–4 months after treatment
• Get routine scaling done, as it helps control bacteria buildup
• Use toothpaste or gels formulated for gum care containing fluoride or antimicrobial agents as suggested by your dentist.

4. Watch for warning signs

• Stay alert for gum bleeding, swelling, or bad breath, as these may indicate relapse
• Report loose teeth or bite changes to your dentist early.

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