Signs and symptoms of periodontitis can include:
- Swollen gums
- Bright red or purplish gums
- Gums that feel tender when touched
- Gums that pull away from your teeth (recede), making your teeth look longer than normal
- New spaces developing between your teeth
- Pus between your teeth and gums
- Bad breath
- Bad taste in your mouth
- Loose teeth
- A change in the way your teeth fit together when you bite
There are different types, or classes, of periodontitis. Chronic periodontitis is the most common class, affecting mostly adults, though children can be affected, too. Aggressive periodontitis usually begins in childhood or early adulthood and affects only a small number of people.
When to see a dentist
Healthy gums are firm and pale pink. If your gums are puffy, dusky red and bleed easily, or show other signs or symptoms of periodontitis, see your dentist soon. The sooner you seek care, the better your chances of reversing damage from periodontitis, potentially preventing other serious health problems.
It's thought that periodontitis begins with plaque — a sticky film composed mainly of bacteria. Plaque forms on your teeth when starches and sugars in food interact with bacteria normally found in your mouth. Brushing and flossing your teeth removes plaque. But plaque re-forms quickly, usually within 24 hours.
Plaque that stays on your teeth longer than two or three days can harden under your gumline into tartar (calculus). Tartar also may form as a result of the mineral content of your saliva. Tartar makes plaque more difficult to remove and acts as a reservoir for bacteria. You can't get rid of tartar by brushing and flossing — you need a professional dental cleaning to remove it.
The longer that plaque and tartar remain on your teeth, the more damage they can do. Initially, they may simply irritate and inflame the gingiva, the part of your gum around the base of your teeth. This is called gingivitis, the mildest form of periodontal disease.
Ongoing inflammation eventually causes pockets to develop between your gums and teeth that fill with plaque, tartar and bacteria. Bacteria deposit endotoxin — a byproduct of their own metabolism — which is responsible for much of the inflammation around teeth. In time, these pockets become deeper and more bacteria accumulate, eventually advancing under your gum tissue. These deep infections cause a loss of tissue and bone. If too much bone is destroyed, you may lose one or more teeth.
Factors that can increase your risk of periodontitis include:
- Poor oral health habits
- Tobacco use
- Older age
- Decreased immunity, such as that occurring with leukemia, HIV/AIDS or chemotherapy
- Poor nutrition
- Certain medications
- Hormonal changes, such as those related to pregnancy or menopause
- Substance abuse
- Poor-fitting dental restorations
- Problems with the way your teeth fit together when biting
Some complications associated with gum disease include:
- Tooth loss
- Coronary artery disease
- Premature, low birth weight babies
- Poorly controlled diabetes
- Respiratory problems
- Rheumatoid arthritis
Some research suggests that the bacteria responsible for periodontitis can enter your bloodstream through your gum tissue, affecting your lungs, heart and other parts of your body. For instance, bacteria may travel to the arteries in your heart, where they might trigger a cycle of inflammation and arterial narrowing that contributes to heart attacks.
The best way to prevent periodontitis is to follow a program of good oral hygiene, one that you begin early and practice consistently throughout life. That means brushing your teeth at least twice daily — in the morning and before going to bed — and flossing at least once a day. Better yet, brush after every meal or snack or as your dentist recommends.
A complete cleaning with a toothbrush and floss should take three to five minutes or so. Flossing before you brush allows you to clean away the loosened food particles and bacteria.
Also, see your dentist or dental hygienist regularly for cleanings, usually every six to 12 months. If you have risk factors that increase your chance of developing periodontitis — such as having dry mouth, taking certain blood pressure medications or smoking — you may need professional cleaning more often.