Periodontitis – sometimes informally called gum disease – is a chronic inflammatory disease of the tooth-supporting tissues. It affects the gums, periodontal ligament and particularly the alveolar bone that supports the teeth. If it progresses untreated, it can lead to gum recession, tooth mobility and ultimately tooth loss.
Periodontitis is one of the most common chronic diseases worldwide. It often develops gradually and without pain, which is why it may remain unnoticed for a long time. Early diagnosis and treatment can make a major difference to long-term tooth retention.
What causes periodontitis?
Periodontitis develops through a complex interaction between:
1. Bacterial biofilm (plaque)
A dysbiotic bacterial biofilm at and below the gum line triggers an inflammatory response.
2. The body's immune-inflammatory response
The host response to the biofilm contributes to destruction of the periodontal attachment and supporting bone.
3. Individual risk factors
insufficient plaque control
genetic susceptibility
smoking
diabetes mellitus, particularly when poorly controlled
stress and behavioural factors
hormonal and other systemic influences where clinically relevant
dry mouth and other local factors that can make plaque control more difficult
What are the signs of periodontitis?
Periodontitis may be preceded by gingivitis (inflammation of the gums). Warning signs can include:
bleeding gums
redness or swelling
bad breath
teeth appearing “longer” because of gum recession
sensitive exposed root surfaces
tooth mobility or migration
abscesses or recurrent swelling
In many cases, however, there may be little or no pain for a long time despite continuing tissue damage.
What happens as the disease progresses?
A dysbiotic biofilm persists around and below the gum line
the immune system maintains an inflammatory response
periodontal attachment can be progressively lost
supporting alveolar bone can be resorbed
teeth may lose support and become mobile
without control, advanced disease can result in tooth loss
Periodontitis is a chronic condition, but it can usually be brought under control and stabilised with appropriate treatment and long-term maintenance.
How is periodontitis diagnosed?
At our practice, assessment is systematic and may include:
measurement of probing depths
assessment of bleeding on probing (BOP)
checking tooth mobility
radiographic assessment of bone levels where indicated
evaluation of local anatomical and restorative factors
risk assessment in line with current periodontal principles
Modern periodontal treatment
Treatment follows a structured, evidence-based sequence:
1. Initial anti-infective treatment (cause-related therapy)
removal and control of bacterial deposits
subgingival instrumentation where periodontal pockets are present
optimisation of home oral hygiene
management of modifiable risk factors such as smoking and diabetes
2. Re-evaluation
After the initial healing phase, often around 6–12 weeks, inflammation, probing depths and remaining treatment needs are reassessed.
3. Surgical treatment when indicated
For persistent deep pockets or suitable complex defects, treatment may include:
access surgery
regenerative procedures using selected biomaterials, membranes or enamel matrix derivatives where appropriate
correction or management of anatomical niches and periodontal defects
4. Long-term stabilisation (supportive periodontal care)
Long-term stability depends strongly on:
individualised recall intervals, often every 3–6 months for higher-risk patients
review of home plaque control
professional supportive periodontal care
ongoing risk-factor management, including smoking and diabetes
Without maintenance, the risk of recurrence and further attachment or tooth loss is substantially higher.
Scientific background on periodontitis
The central biological mechanisms of periodontitis are well studied:
Periodontitis is associated with a dysbiotic biofilm and a susceptible host inflammatory response. Hajishengallis and colleagues describe how disruption of host–microbe homeostasis can drive periodontal tissue destruction.¹
Smoking is a major modifiable risk factor for periodontitis and is associated with more severe disease and poorer treatment outcomes.²
Diabetes and periodontitis have a bidirectional association; poor glycaemic control is associated with greater periodontal risk and can complicate treatment.³
Long-term supportive periodontal care is a central part of preventing recurrence and reducing tooth loss after active therapy.⁴
Regenerative approaches such as enamel matrix derivatives or guided tissue regeneration can improve outcomes in appropriately selected periodontal defects compared with non-regenerative surgery alone.⁵
Frequently asked questions (FAQ) about periodontitis
Can periodontitis be cured?
It is a chronic susceptibility rather than a condition that is simply “cured”, but disease activity can often be controlled and the tissues stabilised. Regular supportive care remains important.
Why do my gums bleed?
Bleeding is a common sign of gingival inflammation. Persistent or spontaneous bleeding should be assessed rather than ignored.
Does periodontitis have to hurt?
No. Periodontitis is often painless until it is advanced, which is why periodontal measurements are important even when there are few symptoms.
Can periodontitis affect general health?
Periodontitis is associated with several systemic conditions, including diabetes and cardiovascular disease. These associations do not mean that periodontitis is the sole cause, but they support coordinated medical and dental risk management where appropriate.
Can lost gum or bone grow back?
Inflammation can be controlled, but lost periodontal tissues do not routinely regenerate completely. Selected defects may benefit from regenerative treatment, depending on their anatomy and biological conditions.
References
Hajishengallis G. Periodontitis: from microbial immune subversion to systemic inflammation. Nat Rev Immunol. 2012. PMID: 22193206.
Bergström J. Tobacco smoking and risk for periodontal disease. J Clin Periodontol. 2003. PMID: 12834507.
Löe H. Periodontal disease: the sixth complication of diabetes mellitus. Diabetes Care. 1993. PMID: 8372688.
Axelsson P, Lindhe J. The significance of maintenance care in the treatment of periodontal disease. J Clin Periodontol. 1981. PMID: 6947991.
Sculean A et al. Regenerative periodontal therapy with enamel matrix derivative. Periodontol 2000. 2015. PMID: 25867980.
