Periodontitis: Causes, Symptoms, & Treatment Options

Periodontitis is a severe gum disease that starts as inflammation in the gums. It can quickly worsen to cause a variety of oral health problems, including tooth loss, if left untreated.

Oral hygiene is the best preventative care to keep periodontitis and its symptoms at bay. Those same steps ensure strong teeth and healthy gum tissue long-term. Let’s take a look at early signs of periodontitis and how to treat the disease once it’s set in.

What is periodontitis?

Periodontitis is a chronic inflammation of the gums caused by too much bacteria on the teeth and along the gum line. It may begin as gingivitis, a highly treatable form of early gum disease, but early interventions are necessary to prevent worsening symptoms.

What are the 3 types of periodontitis? The 3 types of periodontitis are necrotizing periodontitis, periodontitis as a direct manifestation of systemic disease, and most commonly, periodontitis.

Necrotizing periodontitis is an acute infection caused by an overgrowth of bacterial plaque in the immuno-compromised. This form of periodontitis can quickly become quite serious. Oral sores, painful, bleeding gingiva (gums), and swollen lymph nodes in the neck are common markers.

Periodontitis as a direct manifestation of systemic disease is directly related to a primary diagnosis. This includes conditions that affect the immune system like leukemia and genetic disorders that put patients at a higher risk for the disease.

General forms of periodontitis are most common, and can affect children and adults of all ages. Periodontitis may begin as gingivitis then progress to early, moderate, and advanced stages of the disease. The more severe the periodontist, the more difficult it can be to treat.

Periodontitis vs. Gingivitis

Gingivitis is a very common, mild form of gum inflammation caused by plaque buildup on your teeth and along the gum line. This is an early stage of periodontitis, and is completely treatable with a visit to your dental hygienist and a deep cleaning.

The most common sign of gingivitis is bleeding gums. Periodontitis is the more serious condition that progresses from a case of untreated gingivitis.


What are some potential causes of periodontitis? Potential causes of periodontitis are most commonly linked to poor oral hygiene.

An inconsistent oral care routine can cause a buildup of bacteria and plaque in your mouth. If left untreated, that plaque can harden into tartar, or calculus. This makes your teeth more difficult to clean, but more significantly allows bacteria to grow below your gum line.

Bacteria allowed to fester beneath the gum line can lead to more severe forms of periodontitis and a variety of health complications. At that point, this form of gum disease is much more difficult to treat.

Risk Factors

Certain habits or existing conditions put you at a higher risk of periodontitis. Those include:

  • Smoking or chewing tobacco
  • Type 2 diabetes
  • Chronic stress
  • Conditions affecting immune system health, e.g. AIDS and leukemia
  • Genetic disorders or a family history of gum disease
  • Poor nutrition
  • Dental cavitations and tooth extractions
  • Medications that affect saliva production and cause dry mouth
  • Hormonal changes in women, particularly during menopause and pregnancy
  • Conditions caused by inflammation, e.g. heart disease

Signs & Symptoms of Periodontitis

Signs and symptoms of periodontitis depend on the severity of the disease. Noticeable symptoms typically include:

  • Red or discolored gums
  • Swollen gums
  • Bleeding gums, especially after brushing or flossing
  • Noticeable pink on your toothbrush or blood in the sink
  • Infection or pus along the gum line
  • Painful abscesses
  • Tooth sensitivity
  • Painful chewing
  • Bad breath
  • Loose teeth or new gaps between the teeth
  • Bone loss around the teeth and jaws
  • Gum recession
  • Changes in dental structure
  • Changes in the fit of your dental devices


Periodontitis is diagnosed during a dental exam following a complete medical history. Your dentist may measure any periodontal pockets, or spaces between your gums and teeth filled with plaque and tartar, with a dental probe.

In more severe cases, you may be referred to a a periodontist, an expert in gum disease, for X-rays or more intensive treatment. An X-ray is the best way to see whether the disease has progressed to the jaw bone or tooth structure.

Treatment Options

Periodontal treatments depend on how far the disease has progressed. The first course of action is a professional cleaning from your dentist, dental hygienist, or a gum disease specialist. In early stages of periodontitis, a professional cleaning may curb the progression of the disease.

If your dentist or periodontist doesn’t see much progress on your tooth surfaces following a cleaning, they may recommend additional non-surgical or surgical options.

Non-Surgical Treatments

Less severe forms of periodontitis may respond well to non-surgical treatments.

  • Scaling: Dental scaling is the removal of plaque below the gumline using manual tools or laser dentistry. The use of lasers is a more precise way to target both hard and soft tissues affected by gum disease.
  • Root planing: Root planing is similar to scaling, but the focus is on the roots of your teeth just below the gum line. Your dentist uses a tool to expose your tooth roots and chip away at tartar buildup in those areas.
  • Ozone dental treatments: Ozone treatments use ozone gas, ozonated water, or ozonated oil to target harmful bacteria in the mouth and break down plaque. The method is safe and effective, with the added benefit of reducing tooth sensitivity.
  • Antibiotics: Your dentist may prescribe a course of antibiotics to treat an ongoing infection. Antiobiotics may be taken orally, applied as a gel to the affected teeth and gums, used as a mouthwash, or as a combination of all of these methods.

Surgical Treatments

Your dentist may recommend surgical treatments in more severe cases of periodontitis:

  • Flap surgery: In this procedure, your health care provider or periodontist makes incisions along the gum line to lift back segments of gum tissue. This allows them to reach the tooth roots for scaling and root planing.
  • Bone grafting: Patients with more severe forms of gum disease may require bone grafts to support progressive bone loss. These grafts allow for new regrowth and help maintain existing tooth structure.
  • Tissue grafts: Soft tissue or gum grafts may be necessary if too much of your tooth roots are left exposed by gum recession. The grafts are often taken from the roof of your mouth for a more natural appearance, but a tissue bank may also be used.
  • Guided tissue regeneration: This procedure allows for the regrowth of bone lost due to bacterial infection. Your dentist does this by placing a piece of biocompatible membrane between the bone and your tooth.
  • Platelet-rich plasma (PRP): PRP shows promise may be an effective way to help your body regenerate bone and tissue lost to periodontitis Your provider uses injections of platelet-rich plasma from your own blood to stimulate growth in affected areas.
  • Pinhole Surgical Technique: This alternative to gum grafting involves pinholes in gum tissue adjacent to the affected areas. Your provider can then loosen the surrounding gums to cover recesses. This method allows for faster healing and a more natural smile.


If left untreated, chronic periodontitis can cause tooth loss, tooth rot, receding gums, and exposure of the root surfaces of your tooth. More severe complications may occur if the bacteria find their way into your bloodstream and the infection spreads.

That can put you at a higher risk for health conditions like cardiovascular disease and respiratory conditions like pneumonia and chronic obstructive pulmonary disease. It can also worsen existing conditions like diabetes, particularly in the elderly.

In pregnant women, periodontitis can contribute to adverse outcomes like reduced birth weight or premature birth.


Can periodontitis be cured? Periodontitis cannot be completely cured, but it can be managed. Following the appropriate course of treatment, regular home oral care and professional cleanings can go a long way in preventing recurrences of periodontitis.

If you notice signs of early stages of gum disease and gingivitis, a visit to your dental provider could reduce your risk of developing more severe forms of periodontitis. It’s important that you take any early advice seriously to reduce your risk of serious complications down the line.

How to Prevent Periodontal Disease

The best way to prevent periodontal disease is to follow a good oral hygiene routine.

  • Brush your teeth twice per day. Use a natural toothpaste like Revitin, the world’s first prebiotic toothpaste for a healthy oral microbiome, instead of fluoride.
  • Use dental floss daily. Flossing is your best defense against harmful bacteria that settle at the gum line. It’s also an easy way to spot early signs of gingivitis. If you notice any bleeding during your flossing routine, that’s an early sign of gum disease.
  • Don’t smoke or chew tobacco. Smokers have an 80% higher risk of developing periodontal disease over those who have quit or never smoked. Smoking also reduces the success rate of periodontal treatments in more advanced cases.
  • Maintain a healthy diet. Foods that reduce inflammation and give your body an antioxidant boost are good for your oral health. Green tea is particularly powerful with proven effects for a more balanced oral microbiome.
  • Try home remedies. Salt water rinses, natural mouthwashes, and topical turmeric gels are all remedies for gingivitis, an early form of periodontal disease. These methods are no replacement for a biological dentist, but they could reduce your risk of further disease.
  • Keep regular dental visits. See your dentist twice a year for dental cleanings and checkups. Increase your frequency if you need periodontal maintenance or you’re in a high-risk category for gum disease.

When to See a Dentist

If you notice early signs of gingivitis or are high-risk for developing periodontal disease, it’s important that you have a dentist you trust for both treatment and regular oral maintenance.

At Rejuvenation Dentistry, we support our New York patients with less invasive approaches to dental health. If you’re ready to see what we can do for chronic oral inflammation, early gum disease, and periodontitis, schedule an appointment today.

To learn more about our practice and our approach to oral health, check out The Mouth-Body Connection, a book from the founder of our practice, Dr. Gerry Curatola. The explores how oral health impacts overall health.


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Dr. Gerry Curatola is a renowned biologic restorative dentist with more than 40 years of clinical practice experience.

He studied neuroscience at Colgate University and attended dental school at the New York University (NYU) College of Dentistry where he now serves as Adjunct Clinical Associate Professor in the Department of Cariology and Comprehensive Care.