by Scholten A


Periodontitis is a severe form of gum disease. If left untreated, it can lead to tooth loss and possibly other problems.


Periodontitis is caused by untreated gingivitis. Gingivitis is inflammation of the gums due to plaque buildup on the teeth. Plaque is a filmy coating made from bacteria. Unless removed, plaque can get under the gums. Once there, plaque can create pockets around the teeth. Bacteria can collect in these pockets. This may cause ongoing inflammation. It may also damage tissues and bones that hold teeth in place.

Untreated Gingivitis
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Risk Factors

Periodontitis is more common in people over 30 years old.

Other things that raise the risk are:


Periodontitis may not cause symptoms. Those that have symptoms may have:

  • Red, swollen, tender, or bleeding gums
  • Gums that pull back
  • Loose teeth or teeth that fall out
  • Bad breath
  • Pus between the teeth
  • Change in the way teeth fit together
  • Weight loss (in older people)


The dentist will ask about symptoms and health history. A complete oral exam will be done. The exam will diagnose periodontal disease. The dentist may do x-rays to see how much damage has been done.


The goals are to remove plaque and prevent or treat infection. Treatment options depend on how severe the problem is.

Options are:

  • Instruction on caring for teeth and gums
  • A plan to quit using tobacco
  • Deep cleaning—to remove plaque above and below the gum line
  • Antibiotic pills, mouthwashes, or gum inserts—to treat an infection from bacteria

If problems are severe, surgery may be needed. Surgery may also be done to repair damaged gum tissues and bones. Options are:

  • Flap surgery —Sections of gum tissue are opened. The tooth root is exposed for deep cleaning. The gum tissue is reshaped and put back in place.
  • Bone and tissue graft—Tissue is taken from another part of the body. It is used to regrow healthy gum, bone, or connective tissue.
  • Enamel matrix application—A special gel is put on the tooth root. It helps grow healthy bone and tissue.


To risk of periodontitis can be lowered by:

  • Brushing the teeth:
    • With fluoride toothpaste
    • At least 2 times per day
  • Flossing teeth 1 time per day
  • Not using tobacco
  • Regular dental visits


Mouth Healthy—American Dental Association 

Perio—American Academy of Periodontology 


Canadian Dental Association 

Public Health Agency of Canada 


Gingivitis and periodontitis in adults and adolescents. EBSCO DynaMed website. Available at: Accessed July 30, 2021.

Johnson TM. Smoking and periodontal disease. US Army Med Dep J. 2017;(3-17):67-70.

Periodontal (gum) disease: cause, symptoms, and treatment. National Institute of Dental and Craniofacial Research website. Available at: Accessed July 30, 2021.

Treatments. American Academy of Periodontology website. Available at: Accessed July 30, 2021.

Revision Information

  • Reviewer: EBSCO Medical Review Board Dan Ostrovsky, MD
  • Review Date: 07/2021
  • Update Date: 07/30/2021