Chronic periodontitis is a long-term inflammatory disease that affects the gums, periodontal ligament and bone supporting the teeth. It usually develops gradually when plaque and calculus remain around and below the gum line.
Without appropriate treatment, the condition may cause gum recession, progressive bone loss, loose teeth and eventually tooth loss.
Terminology note: “Chronic periodontitis” is an older diagnostic term. Under the current classification system, chronic and aggressive periodontitis are grouped under periodontitis, which is classified according to its stage, grade and extent.
How Does Periodontitis Develop?
Periodontitis often begins as gingivitis, the earliest stage of gum disease. Gingivitis commonly causes redness, swelling and bleeding of the gums but does not usually involve bone loss.
If gingivitis is not controlled, bacteria can spread below the gum line. The gums may separate from the teeth, forming spaces known as periodontal pockets. These pockets collect additional bacteria and calculus, resulting in the gradual destruction of the tissues and bone supporting the teeth.
What Causes Periodontitis?
The primary cause is the accumulation of bacterial plaque. Factors that may increase the risk or progression of periodontitis include:
- Poor oral hygiene
- Smoking or tobacco use
- Uncontrolled diabetes
- Family history or genetic susceptibility
- Irregular dental examinations and professional cleaning
- Hormonal changes
- Stress
- Certain medications
- Conditions that weaken the immune system
- Poorly positioned teeth that are difficult to clean
- Defective or poorly fitting dental restorations
Common Signs and Symptoms
Periodontitis may progress without significant pain, particularly during its earlier stages. Warning signs include:
- Bleeding while brushing or flossing
- Red, swollen or tender gums
- Persistent bad breath
- Gum recession
- Teeth appearing longer
- Pus between the teeth and gums
- Deep periodontal pockets
- Increased tooth sensitivity
- Spaces developing between the teeth
- Loose or shifting teeth
- Changes in the way the teeth meet
- Discomfort while chewing
Bleeding gums should not be considered normal. Early assessment can help prevent further damage.
How Is Periodontitis Diagnosed?
Diagnosis generally involves:
- Reviewing the patient’s medical and dental history
- Examining the gums for inflammation and recession
- Measuring periodontal pocket depths
- Assessing bleeding on probing
- Checking tooth mobility and bite
- Taking dental radiographs to evaluate bone loss
- Identifying risk factors such as smoking and diabetes
Under the current classification, the stage describes the severity and complexity of the disease, while the grade estimates its rate of progression and considers relevant risk factors.
How Is Periodontitis Treated?
Treatment depends on the severity and progression of the condition.
- Oral-Hygiene Improvement: Patients receive personalised guidance on brushing, interdental cleaning and controlling plaque at home.
- Scaling and Root Planing: Scaling and root planing is a non-surgical deep-cleaning procedure. Plaque and calculus are removed from below the gum line, and the root surfaces are cleaned and smoothed to support gum healing.
- Antimicrobial Treatment: Local or systemic antimicrobial medicines may be considered in selected cases. Antibiotics are not required routinely for every patient.
- Periodontal Flap Surgery: If deep pockets and deposits remain after non-surgical treatment, flap surgery may be recommended. The gums are gently lifted to provide direct access for cleaning the roots and supporting bone.
- Regenerative Procedures: Bone grafts, membranes or other regenerative materials may be used in suitable cases to encourage the repair of tissues damaged by periodontitis.
- Supportive Periodontal Maintenance: After active treatment, regular maintenance appointments are essential. These visits allow the dental team to monitor the gums, clean difficult areas and identify signs of recurrence.
Can Periodontitis Be Completely Cured?
Damage caused by periodontitis may not always be completely reversible. However, the infection and inflammation can usually be controlled with appropriate professional treatment, effective daily oral hygiene and regular maintenance.
Periodontitis is a long-term condition that requires continued monitoring. Even after successful treatment, it may return if plaque control and followup care are neglected.
How Can You Protect Your Gum Health?
The risk of periodontal disease can be reduced by:
- Brushing twice daily with fluoride toothpaste
- Cleaning between the teeth every day
- Attending regular dental and periodontal examinations
- Receiving professional cleaning as recommended
- Avoiding smoking and tobacco products
- Maintaining good control of diabetes
- Eating a balanced diet
- Following the prescribed periodontal-maintenance schedule
Protect Your Gums and Preserve Your Natural Teeth
Periodontitis can progress silently and cause permanent damage to the structures supporting the teeth. Early diagnosis and timely treatment can help control the disease, preserve bone and improve the chances of retaining natural teeth.
If you experience bleeding gums, persistent bad breath, gum recession, pus discharge or loose teeth, arrange a periodontal examination without delay.