Periodontitis
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Understanding periodontal health
Periodontitis begins when the bacteria in our mouths form plaque, which can harden into tartar if not cleaned, creating a breeding ground for more bacteria. As the bacteria grow, they can cause gum inflammation that eventually leads to gums pulling away from the teeth, forming pockets where bacteria can multiply.
Symptoms of periodontitis
The symptoms of periodontitis vary depending on the stage of the condition. It starts with inflammation but can progress over time.
First stage – inflammation
Periodontitis starts with your gums getting inflamed. During this stage, you might notice:
• Your gums bleeding when you brush or floss your teeth
• Discolouration on your teeth called plaque
• Build-up of plaque or tartar on your teeth
• Red, swollen or tender gums
Second stage – early periodontitis
In this stage, your gums might start to recede or pull away. You might also notice small pockets forming between your gums and teeth.
You’ll probably still have some bleeding when you’re brushing and flossing and possibly some bone loss.
Third stage – moderate periodontitis
If your periodontitis develops, you might have:
• Bleeding
• Pain around your teeth
• Receding gums
• Bad breath (halitosis)
• Loose teeth as your teeth will start to lose bone support
• A fever as the infection can lead to an inflammatory response in your body
Fourth stage – advanced periodontitis
With advanced periodontitis, the connective tissue that helps to keep your teeth is damaged and begins to break down.
This can cause:
• Severe pain while you’re chewing and eating
• Severe bad breath
• A bad taste in your mouth
• Tooth loss
What causes periodontitis?
In a healthy mouth, there are many types of bacteria, most of which don’t cause any harm. If you look after your teeth and gums and maintain good oral hygiene, you can keep the bacteria controlled. However, if you neglect your dental care, the bacteria can grow and multiply, leading to problems like periodontitis.
Periodontitis starts like this:
- The bacteria in our mouths form plaque, a sticky clear substance that covers the teeth
- If this isn’t cleaned, the plaque can harden into tartar – providing a breeding ground for more bacteria
- As the bacteria grow and multiply, they can trigger inflammation in our gums
- Over time, this inflammation can make your gums pull away from the teeth, forming pockets where bacteria can multiply
Certain factors can increase your chances of developing periodontitis. These include:
- Smoking
- Type two diabetes
- Obesity
- Hormonal changes like menstruation, pregnancy or the menopause which can make your gums more sensitive
- Conditions that affect your immune system like HIV
- Medications that affect your saliva
- Genetics
- A poor diet, including having a vitamin C deficiency
Gum disease tends to be more common among people who smoke, and smoking can make conditions like periodontitis worsen at a faster rate. Gum disease typically starts when bacterial plaque builds up along the gum line.
For people who smoke, managing and treating gum disease can be more difficult due to them having weakened immune responses and reduced oxygen levels in their bloodstream, which can prolong the healing process for damaged gums.
People who smoke may also find it trickier to spot symptoms of gum disease, as smoking can hide certain symptoms. For example, bleeding gums while brushing or flossing, a common sign of gum disease, may not show as noticeably in people who smoke because of the effect that nicotine has on blood flow to your gums.
It’s important to have regular dental check-ups, as dentists can detect and address gum disease before it gets worse.
Quitting smoking can lead to healthier gums and teeth, but we understand that it can be difficult, so we’ve put together our top tips to help you overcome your cravings and quit.
You can access the NHS Stop Smoking Service at selected Boots pharmacies for support or the Boots Online Doctor Stop Smoking Treatment Service2 can also help you access treatment to support your journey to quitting.
Receding gums can happen when gum tissue pulls away from your tooth. If you have receding gums, you might have:
- Bleeding from your gums
- Red gums
- Bad breath
- Painful gums
- Visible gum shrinkage
- Loose teeth
- Exposed tooth roots
A dentist can diagnose receding gums by examining your gums and measuring them using a probe.
Treating receding gums depends on how severe it is. You might be prescribed antibiotics if there are signs of infection or topical treatments to help soothe any discomfort.
Complications of periodontitis
If left untreated, periodontitis can damage the foundation of your teeth, including your jaw bones. This can lead to tooth loss or the need to have some teeth removed.
Periodontitis can also lead to:
• Your teeth shifting position which can affect the way you eat
• Sensitive teeth if your gums are receding, the roots of your teeth can be exposed
• An increased likelihood of developing heart disease and diabetes
If you’re pregnant and you have periodontitis, you might also have a higher risk of complications like developing preeclampsia (a serious condition that can affect some pregnant women) and your baby having a low birth weight.
How is periodontitis diagnosed?
Regular visits to the dentist are important to catch the signs of periodontitis early on. Your dentist can monitor your gum health and intervene if you’re showing any signs of periodontitis.
During your dental check-up, your dentist might gently measure any pockets in your gums by using a tool called a probe. This process doesn’t usually cause any pain. If you do have any plaque or tartar, your dentist can remove these by giving you a professional clean. They might also offer you a dental x-ray to check the health of your teeth and the supporting bone structure.
Treating periodontitis
The good news is that periodontitis can be treated and if you look after your teeth and gums, the damage can be stopped. The main treatment of periodontitis focuses on reducing plaque build-up from your teeth and gums.
Reducing plaque build-up is a lifelong commitment. You’ll need to visit your dentist regularly for professional care but daily maintenance at home with a toothbrush is key to help make sure that your teeth stay clean.
There isn’t a cure for periodontitis – only maintenance to help prevent further bone loss and damage. Most of this maintenance needs to be done at home.
Oral hygiene
You can speak to your dental team about how to look after your teeth and gums. They can advise you on brushing and flossing techniques as well as recommendations for products like electric toothbrushes, water flossers or mouthwashes.
Professional cleaning
If you get your teeth professionally cleaned, your dentist or dental hygienist will remove plaque and tartar, polish your teeth and apply fluoride to your teeth. If you have deep pockets, they might also try scaling and root planning to help remove tartar and smooth out the surfaces of your teeth.
Antibiotics
If your periodontitis is severe or persistent, your dentist might prescribe antibiotics.
Surgery
If your periodontitis is severe or in an area that’s difficult to reach, your dentist might suggest flap surgery to clean beneath the gums.
Preventing periodontitis
When it comes to your teeth and gums, preventing periodontitis is always better than having to treat it, so it’s important to have the advice at hand to look after your teeth and gums. To prevent periodontitis you need to keep your gums and teeth healthy. To help with your oral and dental hygiene, you should:
- Brush your teeth with fluoride toothpaste twice a day
- Think about using an electric toothbrush to help you clean your teeth more effectively
- Floss daily to help remove plaque from between your teeth. You can also use an interdental brush or water flosser
- Avoid smoking or using other products that contain tobacco
A guide to common dental concerns
Frequently asked questions
If your gums are healthy, they’ll be firm, pink and be able to keep your teeth securely in place. Your gums shouldn’t bleed if they’re touched or during eating, brushing or flossing.
It’s important to know that gum disease doesn’t always have obvious symptoms so you might not actually know if your gums are in good condition. You should have regular dental check-ups to make sure that your teeth and gums are healthy.
It’s important to speak to your dentist if you think you have periodontitis, as you’ll need professional dental care to help control the condition. Maintaining good oral hygiene is also key to help prevent further damage from periodontitis. You can find out more about treating periodontitis in the “Treating periodontitis” section of the page.
If your gum disease is in early stages (gingivitis) you can reverse this. If you have periodontitis and you’ve lost bone around your teeth due to infection, this is too advanced to reverse, but it can be managed with treatment and good oral hygiene.
Gingivitis is the inflammation of the gums while periodontitis is a long-term inflammation that affects not only the gums but also the tissues and in some cases the bone around the teeth. Gingivitis is the early stage of gum disease and periodontitis is advanced gum disease.
1Subject to availability. Eligibility criteria may apply. Charges may apply.
2Access to prescription-only treatment is subject to an online consultation with a clinician to assess suitability. Subject to availability. Charges apply.
22Eligibility criteria apply. Charges may apply. Available in selected pharmacies, subject to availability.
25Subject to availability. Eligibility criteria may apply. Charges may apply. The service is available in selected stores across England only, for those aged 18 years & over and meet the suitability criteria. The service does not provide a diagnosis of diabetes.
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