What Is Periodontitis? Symptoms and Treatment Options

Gum disease usually progresses without pain, which makes it hard to notice. Slight bleeding while brushing is easily dismissed in daily life, yet it may be the first sign of a process beginning in the tissues that hold the teeth in the jaw. Periodontitis is the stage at which gum inflammation is no longer confined to the gums but has advanced into the connective tissue and jawbone beneath. In this article we explain what periodontitis is, the symptoms it produces, how it is diagnosed and the stages its treatment involves.

What Is Periodontitis?

Periodontitis is a disease in which the tissues surrounding the tooth and attaching it to the jawbone — the gums, the periodontal ligament and the alveolar bone — undergo destruction through an inflammatory process. At the start, bacterial plaque accumulating on the tooth surface causes inflammation in the gums. This stage is known as gingivitis, and no tissue loss has occurred yet. If plaque is not brought under control and hardens into tartar, however, the inflammation advances below the gum margin. The gum begins to detach from the tooth, a space known as a periodontal pocket forms between them, and bacteria find a sheltered area there that a brush cannot reach. As the process advances, the bone supporting the tooth recedes. This is the essential distinction between periodontitis and gingivitis: gingivitis is reversible, whereas bone lost in periodontitis does not return on its own — the aim becomes halting progression and preserving the remaining tissue.

What Are the Symptoms of Periodontitis?

The early stage of the disease is usually silent; pain often appears only at an advanced stage. Signs to watch for include:

• Recurrent gum bleeding while brushing or flossing
• Redness, swelling and tenderness of the gums
• Persistent bad breath or an unpleasant taste in the mouth
• Gums receding so that the teeth look longer
• New gaps opening up between the teeth
• Discharge from the gum margin
• Loose teeth or a sense that they shift position when biting

Persistent bad breath can be misleading when assessed on its own; gum disease is one of several possible causes. Our article on the causes of bad breath offers a fuller picture. A sense of looseness in the teeth, on the other hand, is a finding that should not be delayed; we discuss it separately in what to do about loose teeth.

Risk Factors

Periodontitis is not explained by oral hygiene alone; a person's immune response and general health also shape how the disease progresses. The leading risk factors are:

• Inadequate oral care: Failing to remove plaque regularly is the principal trigger.
• Smoking: It reduces blood flow in the gum tissue, both accelerating the disease and masking symptoms by suppressing bleeding.
• Diabetes: Blood sugar control and gum health influence each other in both directions; see our article on diabetes and oral health for detail.
• Genetic predisposition: Risk is higher in people with a family history of gum disease.
• Hormonal changes: Gum tissue can become more susceptible to inflammation during pregnancy and menopause.
• Clenching and grinding: Excessive chewing forces may accelerate breakdown in already weakened supporting tissue.

How Is It Diagnosed?

Periodontitis is not diagnosed by visual examination alone; it relies on measurement. Using a periodontal probe — a thin instrument with a marked tip — the dentist measures the pocket depth between the gum and the tooth in millimetres. In a healthy sulcus this depth is generally in the 1–3 mm range; higher values indicate pocket formation. Whether the site bleeds during probing is also recorded, as this shows whether the inflammation is active. Radiographs are then used to assess the level of the jawbone — the presence, extent and pattern of bone loss directly determine the treatment plan. The degree of tooth mobility and the amount of gum recession are recorded as well; gum recession is often the visible face of this picture.

Treatment of Periodontitis

Treatment is not a single procedure but a series of consecutive stages. The aims are to eliminate the inflammation, reduce pocket depth and maintain the result over the long term.

Initial (Non-Surgical) Treatment

The first stage is removing bacterial plaque and tartar from above and below the gum line. Deposits above the gum are removed with scaling. Hardened deposits attached to the root surface inside the pocket are cleaned through root surface planing (subgingival curettage), usually carried out region by region under local anaesthesia. At the same stage a personalised oral care programme is put together and the use of interdental brushes or floss is demonstrated. In many people, most of the inflammation subsides at this stage.

Surgical Treatment

If deep pockets persist at the re-evaluation carried out a few weeks after initial treatment, surgical options come onto the agenda. In flap surgery the gum is lifted to give direct access to the root surface so deeper areas can be cleaned. Where the pattern of bone loss is suitable, methods such as grafting or guided tissue regeneration may aim to recover part of the lost support. These decisions are made individually, site by site.

Maintenance (Supportive) Therapy

This is the most frequently skipped stage of periodontal treatment, yet it shapes the outcome more than any other. Once treatment is complete, patients are usually recalled every three to six months; pocket depths are re-measured at these visits and deposits removed. Disease reactivation is common in cases that are not followed up regularly, because bacterial plaque is a structure that continuously reforms.

Tooth Loss and the Options That Follow

In advanced periodontitis, teeth without sufficient remaining support may have to be extracted. Leaving the gap for a long period can cause neighbouring teeth to tilt and the opposing tooth to over-erupt. Once gum health is under control, options such as implant treatment or a bridge are considered. The sequence matters here: prosthetic work carried out before gum disease is controlled has a lower long-term success rate.

Prevention

Preventing periodontitis rests on removing plaque thoroughly every day. Brushing twice daily for two minutes, including along the gum margin; cleaning between the teeth with floss or an interdental brush; stopping smoking; and attending a dental check-up at least once a year are the most effective steps. Bleeding gums are not something to get used to; if it recurs, it should be assessed.

The information in this article is intended for general guidance only; a clinical examination is required for a personalized diagnosis and treatment plan.

Frequently Asked Questions

Can periodontitis be reversed?

The inflammation the disease causes can be brought under control with treatment, but bone that has been lost does not return to its former state on its own. In suitable cases, regenerative methods may recover part of that loss. The main goal of treatment is therefore to halt progression and preserve the existing support.

Is root surface planing a painful procedure?

Because the procedure is performed under local anaesthesia, pain is not expected during the session. Mild tenderness or sensitivity to heat and cold may follow for a few days and usually settles on its own.

Will my teeth look longer after gum treatment?

As inflammation subsides and gum swelling decreases, part of the root surface previously covered by oedema may become visible. This is not a side effect of treatment but the healed tissue revealing its true position. For areas that bother you aesthetically, you can discuss further options with your dentist.