Periodontitis is a serious form of gum disease that damages the tissues and bone supporting the teeth. It develops when bacteria in dental plaque trigger an inflammatory response that, in susceptible individuals, leads to the breakdown of these supporting structures.
Unlike gingivitis, which causes reversible gum inflammation, periodontitis involves the loss of periodontal attachment and supporting bone. Treatment can control the disease, help prevent further damage, and improve the chances of keeping natural teeth.
What Is Periodontitis
Periodontitis is an inflammatory disease affecting the tissues that hold the teeth in place. These include the gums, periodontal ligament, which connects the tooth roots to the surrounding bone, and the bone supporting the teeth.
As the disease develops, inflammation contributes to the breakdown of these supporting tissues. The loss of attachment can lead to deeper spaces between the teeth and gums, known as periodontal pockets, where bacterial deposits can accumulate.
Over time, continued loss of supporting bone may affect the stability of the teeth. In advanced cases, teeth can become loose or may eventually be lost.
The main difference between periodontitis and gingivitis is the loss of tooth-supporting tissues. Gingivitis is reversible with effective plaque control, while periodontitis requires treatment to control the disease and prevent further damage.
For an overview of both conditions, see our Gum Disease guide.
Although lost periodontal tissues do not generally regenerate on their own, certain surgical procedures can help restore some supporting structures in selected cases.
What Are the Stages of Periodontitis
Periodontitis is classified into four stages according to the extent of tissue destruction, tooth loss caused by the disease, and the complexity of treatment required.
Dentists also assign a grade from A to C based on evidence of disease progression and factors that affect future risk. Grade A indicates slower progression, Grade B indicates moderate progression, and Grade C indicates rapid progression.
Smoking and diabetes control are among the factors considered when determining the grade.
Stage I: Initial Periodontitis
Stage I is the earliest stage of periodontitis, with limited loss of the tissues supporting the teeth.
There may be few noticeable symptoms, and the teeth generally remain stable. The disease is identified through periodontal measurements and assessment of attachment and bone levels.
Treatment focuses on removing bacterial deposits, controlling inflammation, and preventing further periodontal destruction.
Stage II: Moderate Periodontitis
Stage II involves more extensive attachment and bone loss than Stage I, although the damage remains moderate.
Periodontal pockets may become deeper, making certain areas more difficult to clean effectively. Bleeding or gum recession may be present, but some patients have few noticeable symptoms.
Professional periodontal treatment is needed to control bacterial deposits below the gumline and reduce the risk of further tissue damage.
Stage III: Severe Periodontitis
Stage III involves severe loss of periodontal attachment and supporting bone. Some teeth may have deep periodontal pockets, bone defects, or damage around the areas where their roots divide.
Teeth may become mobile, and the risk of tooth loss is greater. Depending on the response to non-surgical treatment, additional procedures may be needed to manage persistent pockets or complex defects.
Despite the severity of the disease, overall chewing function may remain preserved without the need for complex rehabilitation.
Stage IV: Advanced Periodontitis
Stage IV involves severe periodontal destruction with additional complications that affect the stability, function, or rehabilitation of the teeth.
These may include significant tooth mobility, changes in tooth position, bite problems, difficulty chewing, or extensive tooth loss associated with periodontitis.
Treatment may require coordinated care involving a Specialist Periodontist and other dental specialists, particularly when restoring chewing function or replacing missing teeth is necessary.
The four stages describe the severity and treatment complexity of periodontitis. They do not represent a fixed sequence that every patient will experience.
What Causes Periodontitis
Periodontitis develops through an interaction between bacterial dental biofilm (plaque) and the body's inflammatory response.
When plaque accumulates around and below the gumline, susceptible individuals can develop inflammation that damages the tissues supporting the teeth.
Calculus (tartar), which forms when plaque hardens, makes bacterial deposits more difficult to remove and provides surfaces where additional plaque can collect.
Several factors can increase the risk of developing periodontitis or influence how quickly the disease progresses.
Smoking and Tobacco Use
Smoking is a well-established risk factor for periodontitis. It affects immune function and tissue healing and is associated with greater periodontal destruction and a less favorable response to treatment.
Smoking can also reduce visible gum bleeding, making periodontal inflammation less noticeable.
Diabetes
People with diabetes, particularly when blood glucose is poorly controlled, have an increased risk of developing severe periodontitis.
The relationship also works in the other direction. Periodontal inflammation may make blood glucose management more difficult, while effective periodontal treatment can help improve glycemic control in some patients with diabetes.
Genetic Susceptibility
Genetic factors can influence a person's susceptibility to periodontitis and the way the immune system responds to bacterial plaque.
This helps explain why periodontal destruction can differ between individuals, even when their oral hygiene habits appear similar.
Inadequate Plaque Control
When plaque is not effectively removed, bacterial deposits can accumulate around the gumline and within periodontal pockets.
Consistent brushing and interdental cleaning help control these deposits. Our Complete Daily Oral Hygiene Guide provides practical guidance on cleaning teeth and gums. However, the severity of periodontitis also depends on individual susceptibility and other risk factors.
What Are the Symptoms of Periodontitis
Periodontitis can develop without significant pain. Some patients notice few symptoms until periodontal tissue loss becomes more advanced.
Signs may include bleeding or swollen gums, persistent bad breath (halitosis), and gum recession that makes the teeth appear longer.
As the disease progresses, teeth may become loose or shift position. Spaces can develop between teeth, and some people notice changes in how their teeth fit together when biting.
Discomfort when chewing may also occur. A painful swelling or pus around a tooth may indicate a periodontal abscess that requires prompt dental assessment.
Not everyone experiences the same symptoms. A periodontal examination is necessary to confirm the diagnosis and determine the extent of the disease.
How Is Periodontitis Diagnosed
Periodontitis is diagnosed through a clinical examination of the gums and supporting tissues, together with an assessment of periodontal attachment and bone loss.
The dentist or Specialist Periodontist uses a periodontal probe, a small measuring instrument, to check the depth of the spaces between the teeth and gums. Measurements also help identify gum recession, bleeding, and loss of periodontal attachment.
Dental X-rays help assess bone levels around the teeth and identify patterns of bone loss that may not be visible during the clinical examination. A panoramic X-ray may provide an overview of the teeth and jawbone, while other dental X-rays may be needed for a more detailed periodontal assessment.
The findings help establish the stage of periodontitis, which describes its severity and treatment complexity, and its grade, which reflects the rate or estimated risk of progression.
The assessment also considers relevant factors such as smoking, diabetes, medical history, and the number of teeth affected.
Together, these findings guide an individualized treatment plan and provide a baseline for monitoring periodontal health.
Why Should Periodontitis Not Be Left Untreated
Without appropriate treatment, periodontitis can continue to damage the tissues and bone that support the teeth.
As periodontal attachment is lost, teeth may become increasingly mobile. More advanced disease can affect chewing, change the way the teeth meet, and eventually result in tooth loss.
Periodontitis does not progress at the same rate in everyone. Some patients experience relatively slow tissue loss, while others develop more rapid destruction.
Because the condition may remain painless, relying on symptoms alone can delay diagnosis.
Professional periodontal treatment can help control inflammation, limit further tissue loss, and maintain the stability of affected teeth.
How Is Periodontitis Treated
Treatment for periodontitis focuses on controlling bacterial deposits, reducing inflammation, managing periodontal pockets, and preventing further attachment and bone loss.
A Specialist Periodontist develops an individualized plan based on the stage and grade of the disease, the condition of the affected teeth, and the patient's response to treatment.
Plaque Control and Risk Management
The first step in periodontal care focuses on improving daily plaque removal and addressing factors that can affect treatment outcomes.
Patients receive guidance on effective brushing and interdental cleaning. Professional removal of plaque and calculus above the gumline is also part of this initial care.
Smoking cessation support and coordination of diabetes management may be recommended when relevant.
These measures establish the foundation for periodontal treatment but do not replace the need to clean affected areas below the gumline.
Scaling and Root Planing
Scaling and root planing is a non-surgical periodontal treatment used to remove bacterial deposits and calculus from affected tooth-root surfaces below the gumline.
A Specialist Periodontist uses appropriate instruments to clean the root surfaces and reduce the bacterial deposits associated with periodontal inflammation.
The extent of treatment depends on the periodontal findings and may require more than one appointment.
Following an appropriate healing period, the gums are reassessed. Pocket depths, bleeding, and other periodontal measurements help determine whether the disease has responded adequately or additional treatment is needed.
Periodontal Surgery
When deep periodontal pockets or complex defects remain after non-surgical treatment, periodontal surgery may be considered.
Surgery can provide better access to affected root surfaces, help reduce persistent periodontal pockets, or address certain bone defects.
In selected cases, regenerative procedures may be used to restore some of the lost supporting tissues. These techniques are suitable for particular types of periodontal defects and are not appropriate for every patient.
The decision to recommend surgery depends on the clinical findings, the response to earlier treatment, and the patient's overall periodontal condition.
Supportive Periodontal Maintenance
Periodontitis requires ongoing care even after active treatment has successfully controlled the disease.
Maintenance appointments allow the Specialist Periodontist to monitor gum inflammation, periodontal pocket depths, plaque control, and the stability of affected teeth.
Professional cleaning and localized treatment are provided according to the patient's needs. The interval between appointments is determined by their periodontal condition and individual risk factors.
At Drs. Nicolas & Asp Centers, our Specialist Periodontists provide periodontal assessment, non-surgical treatment, surgery where indicated, and ongoing periodontal care.
Can Periodontitis Be Prevented
The risk of developing periodontitis can be reduced through effective plaque control, regular dental examinations, and management of relevant risk factors.
Brushing twice daily and cleaning between the teeth every day help reduce the bacterial deposits associated with periodontal inflammation.
Avoiding tobacco use and maintaining good diabetes control are also important, particularly for people at increased risk.
For patients who have already received periodontal treatment, prevention focuses on reducing the risk of recurrence or further progression.
Successful treatment can leave the teeth with reduced but stable periodontal support. Regular maintenance is therefore important, even when the gums appear healthy and there are no noticeable symptoms.
Frequently Asked Questions
No. Gingivitis causes gum inflammation without the attachment and bone loss that define periodontitis. Periodontitis affects the deeper supporting tissues and can cause permanent periodontal damage. Both conditions involve inflammation associated with dental plaque, but they have different treatment needs.
Periodontitis can be successfully treated and brought under control, but lost supporting tissues are not generally restored through routine treatment. Even after the disease is stabilized, there remains a risk of recurrence or further progression. Ongoing periodontal maintenance is important for preserving long-term stability.
Bone lost through periodontitis does not generally regenerate on its own. However, regenerative periodontal surgery may restore some supporting bone and attachment in selected defects. The treatment options and expected outcomes depend on the type of bone defect and the patient's periodontal condition.
Yes. Loss of periodontal ligament attachment and supporting bone can increase tooth mobility. The degree of looseness depends on the remaining support and other factors affecting the tooth. A periodontal examination is needed to determine the appropriate treatment.
Maintenance intervals depend on the severity of previous disease, remaining periodontal pockets, plaque control, and individual risk factors. The European Federation of Periodontology recommends individualized supportive periodontal care at intervals of three to twelve months after active treatment. A Specialist Periodontist determines the appropriate schedule for each patient.
Yes. Drs. Nicolas & Asp Centers provides periodontal assessment and treatment, including scaling and root planing, periodontal surgery where indicated, and ongoing maintenance. Our Specialist Periodontists assess the extent of the disease and recommend appropriate care.
A Specialist Periodontist is the appropriate specialist for the assessment and management of periodontitis, particularly when there is supporting bone loss or complex periodontal disease. Our reception team can assist with arranging an appointment with the appropriate specialist.
Coverage depends on your insurance policy, the treatment required, and applicable approval conditions. At Drs. Nicolas & Asp Centers, we offer direct billing for approved services under participating insurance plans and assist with pre-approvals and paperwork. Call us at 04 394 7777 and we will be more than happy to check your coverage for you. For more information, visit our Insurance & Payment Options page.
- Tonetti, Maurizio S., Henry Greenwell, and Kenneth S. Kornman. "Staging and Grading of Periodontitis: Framework and Proposal of a New Classification and Case Definition." Journal of Clinical Periodontology, vol. 45, suppl. 20, 2018, pp. S149–S161.
- Sanz, Mariano, et al. "Treatment of Stage I–III Periodontitis—The EFP S3 Level Clinical Practice Guideline." Journal of Clinical Periodontology, vol. 47, suppl. 22, 2020, pp. 4–60.
- Herrera, David, et al. "Treatment of Stage IV Periodontitis: The EFP S3 Level Clinical Practice Guideline." Journal of Clinical Periodontology, vol. 49, suppl. 24, 2022, pp. 4–71.
