What periodontitis is

Periodontitis is the stage of gum disease at which the inflammatory process has moved past the gum tissue itself and started to damage the deeper structures — the periodontal ligament and the alveolar bone that anchor each tooth.

The visible signs at the surface may still be similar to gingivitis, but underneath, the connective tissue that binds the gum to the tooth begins to break down. As it does, the shallow crevice around each tooth deepens into a "periodontal pocket" that traps more plaque and is harder to clean, which drives the process further.

Severity staging

The current classification (2017 consensus) describes periodontitis on two axes — stage (how much damage has occurred) and grade (how quickly it's progressing). Practically, patients hear:

  • Stage I – Initial: shallow bone loss and pockets around 4 mm.
  • Stage II – Moderate: pockets 5 mm, bone loss visible on X-ray but limited to the outer third of the root.
  • Stage III – Severe with potential for additional tooth loss: pockets 6 mm+, bone loss reaching the middle third of the root, some tooth mobility.
  • Stage IV – Severe with potential for loss of the dentition: significant bone loss, multiple missing teeth, complex rehabilitation required.

Signs

  • Gums that bleed easily and consistently.
  • Persistent bad breath or a metallic taste.
  • Teeth that look longer as gum recedes.
  • Visible spaces opening up between teeth.
  • Teeth that shift or feel loose.
  • A change in how upper and lower teeth fit together when you bite.
  • Pus or a small abscess near the gum line.

Who's at risk

Anyone can develop periodontitis, but risk is unevenly distributed. The strongest risk factors are:

  • Smoking and tobacco use — the single largest modifiable risk factor.
  • Uncontrolled diabetes — bidirectional relationship.
  • Genetic susceptibility — an estimated 30% of the population is more vulnerable.
  • Age — cumulative exposure over decades.
  • Poor oral hygiene combined with infrequent professional cleanings.
  • Certain immunocompromising conditions — HIV, some autoimmune disorders.
  • Stress — likely mediated through immune function and behavioral change.

Diagnosis

Periodontitis is diagnosed through a combination of periodontal probing (pocket depths of 4 mm or more with attachment loss), bleeding on probing, and radiographic evidence of bone loss. A thorough exam will also record recession, mobility, furcation involvement (bone loss where a tooth's roots divide), and any missing teeth thought to be caused by periodontal disease.

Treatment

Non-surgical: scaling and root planing

The mainstay treatment for most cases. Using specialized instruments (hand scalers and ultrasonic devices), the clinician removes plaque and tartar from the tooth surface both above and, critically, below the gum line, then smooths the root so the gum can reattach. It's usually done under local anesthesia across one or two visits.

Adjunctive therapies

  • Locally delivered antibiotics placed directly into deep pockets.
  • A short course of systemic antibiotics, particularly for aggressive forms.
  • Sub-antimicrobial-dose doxycycline for its anti-collagenase effect.

Surgical options

Where non-surgical treatment doesn't sufficiently reduce pocket depths, surgical options include flap surgery, osseous surgery to reshape damaged bone, and various regenerative procedures using bone grafts, membranes, or growth factors.

Maintenance

The most important — and most under-discussed — part of periodontitis treatment is what happens afterwards. Treated periodontitis is not "done"; it's controlled. Most patients move to a 3-month periodontal maintenance schedule, at least initially, to catch recurrence early. Consistency at this stage is what determines long-term outcomes.

Whole-body implications

Periodontitis has documented associations with cardiovascular disease, diabetes control, adverse pregnancy outcomes, and several other conditions. The exact causal mechanisms are still being worked out, and it's important not to overstate what's known. But the trend in the evidence has been consistent: chronic oral inflammation is not confined to the mouth.

FAQ

Can periodontitis be cured?
Not in the sense of full reversal — bone that has been lost does not spontaneously regrow. But periodontitis can be arrested and stabilized indefinitely with appropriate treatment and maintenance.
Will I lose my teeth?
Not necessarily. Many people live with well-managed periodontitis for decades without losing teeth. The key is prompt treatment and consistent follow-up care.
How often will I need cleanings?
After treatment, most people move to a 3-month periodontal maintenance interval, at least initially, rather than the standard 6-month cleaning schedule.
Is scaling and root planing painful?
It's typically performed with local anesthesia, so it's well tolerated during the procedure. Some soreness and sensitivity for a few days afterwards is normal.
Does periodontitis affect the rest of my body?
There is well-documented association with cardiovascular disease and diabetes, and emerging associations with several other conditions. Association is not the same as causation, but the case for treating periodontitis for reasons beyond the mouth continues to strengthen.