Periodontitis: see what it is, what causes and treatments


What is periodontitis?

Periodontitis, popularly known as pyorrhea, is an infectious and bacterial periodontal disease. It is an oral pathology that affects half of adults, that is, at this very moment, about 50% of adults have some periodontal problem, be it mild, medium or high grade.

This disease is the progressive stage of gingivitis , which in turn is gingival inflammation. The difference between both is that periodontitis has extended to the supporting tissues of the teeth, such as bone and the periodontal ligament. It evolves from tartar, which in turn originates from the storage of plaque.

The consequences of periodontitis go beyond facial aesthetics. Periodontitis is a common but serious disease that can lead to tooth loss due to bone fragility caused in the jaw.

How does tartar accumulate in the gums?

There is a mixture of proteins and other components that quietly inhabit our mouth. Naturally, they form a viscous layer between the tooth and gum, known as acquired film. The harmful bacteria that implant themselves there take advantage of its convenience and start to feed on the remains of food that accumulate there.

The storage of remains attracts new bacteria and stimulates the reproduction of those that are already present, causing the proliferation to become greater. Up to this stage, proper brushing can put an end to the problem, but after 12 hours without brushing your teeth, this tartar begins to mineralize (harden), and only the dentist will be able to extract it.

When the tartar is mineralized, it begins to attack the gums, which inflame. During this period, the gums begin to show high sensitivity, inflammation, swelling and among others. We call this stage gingivitis , the precursor to periodontitis.

Types of periodontitis

Because it is a common disease, there are several variants. Among the most recurring are:

Chronic periodontitis

This type of periodontics is the most common and recurrent in adults. It arises from the non-treatment of gingivitis, and can progress gradually. Its main characteristic is the loss of the alveolar bone (which fixes the tooth), mainly in the horizontal direction.

It can be generalized or localized. Generalized is when it affects more than 30% of the teeth and localized when it affects only one or less than 30%. Its severity is assessed under the degree of progression achieved, being light from 1 to 2 mm, moderate from 3 to 4 mm and severe from 5 mm.

Aggressive periodontitis

Aggressive periodontitis is the rarest of the types found. It is rapidly progressing and is recurrent among adolescents and young adults, causing periodontal pockets and loss of support vertically. This derivation is hereditary and is associated with virulent (highly aggressive) bacteria.

Necrotizing ulcerative periodontitis

To say that this type of periodontitis is serious would be an understatement. Necrotizing ulcerative periodontitis has rapid action and compromises the bone and alveolar ligament.

Its main characteristics are the virulent bacteria that are present in cases of smokers, people with HIV , frequent consumers of alcoholic beverages, among others.

Acute apical periodontitis

Acute apical periodontitis directly affects the alveolar bone. It is usually triggered due to traumatic factors (accidents, blows, etc.). Other causes can be dental treatments done improperly and the passage of bacteria from the inside to the outside of the tooth.

Juvenile periodontitis

Juvenile periodontitis is genetically motivated, most of the time, hereditary. It occurs between 11 and 13 years, but in rare cases it can occur during puberty and 30 years. Its main features are non- gingival inflammation , low bacterial plaque and tartar.

Causes of periodontitis

Among the causes of periodontitis are:


The main cause of periodontitis is gingivitis. It is the factor to be taken into consideration to avoid periodontal diseases, because, if left untreated, it can progress and lead to tooth loss.

The process that causes gingivitis to become periodontitis varies from case to case, however, the first step is always the accumulation of tartar.

The tartar that accumulates in the mouth has no association with that of Greek mythology, but it can be just as bad. It is the plaque (dental biofilm) hardened on the surface of the teeth or on the gums, and is due to the remains of food that lodge there.

Genetic predisposition

Having a genetic predisposition does not mean that the individual will actually develop the disease, but that his immune system is more susceptible to the microorganisms that cause the problem.

Genetic predisposition periodontitis is frequently reported in young people over 15 years of age.

Inadequate brushing

Not carrying out tooth brushing, or doing it inappropriately, is a big step forward for bacteria that want to dominate your mouth.


There is still no study that effectively confirms that periodontitis is transmissible orally. However, studies suggest that the disease-causing bacteria can be transmitted through saliva, especially among people who are genetically susceptible to periodontitis. Despite this, it is enough to have good oral hygiene that the disease is easily avoided.

Groups of risk

Those most likely to develop the disease are:

  • Carriers of diabetes;
  • Smokers;
  • Individuals who have poor oral hygiene;
  • People genetically susceptible to bacteria;
  • HIV / AIDS carriers;
  • Pregnant women;
  • Teenagers;
  • Malnourished;
  • People in the treatment of cancer;
  • Depressants;
  • Anyone with diseases that influence the immune system.

Understand the relationship between the groups below and periodontitis.


Whatever is bad can always get worse. So, once again, we have the depression group in the risk group . They are more susceptible to periodontitis, as some antidepressants cause low saliva production.

Saliva is in our mouth for much more than humidifying food, it is also composed of substances that act to protect the mouth against bacteria and viruses.

People in cancer treatment

As the treatment of cancer employs procedures such as chemotherapy and radiography, they end up minimizing the individual’s immune capacity. When this occurs, the person becomes more likely to get gingivitis, which in turn can turn into periodontitis.

Therefore, it is essential that the patient undergoing treatment for cancer also takes care of his oral health , as this may affect his physical health as a whole.

Periodontitis and genetically susceptible people

Within periodontal medicine, there are two sides: those who believe in susceptibility genes and those who do not.

Despite the personal beliefs of some periodontists (specialists in the tissues that surround the teeth), studies have shown that about 30% of the world population is six times more vulnerable to periodontitis, even if they have healthy oral hygiene habits.

Another factor that causes disagreement is the inheritance of periodontics. However, it makes sense that the parents’ periodontal genes are passed on to their children, so if the parents had periodontics, the children have twice the chance of having the same problem.

In addition to genetics, other risk factors may be:

  • Malocclusion;
  • Tartarus;
  • Absence of restorations;
  • Low saliva production;
  • Continued use of cigarettes and alcohol;
  • Exposure to heavy metals (lead and bismuth, for example).

Periodontitis and diabetes

Not all diabetics will experience this problem. So much so that an individual with controlled diabetes can keep their gums healthy and avoid periodontitis without any hindrance.

The type of diabetes, the age of the individual, the level of hyperglycemia and abnormalities in the response of the immune system are just some of the factors that can determine whether or not the diabetic will be affected by periodontitis.

The relationship between both diseases is a bridge, that is, what passes to one side also passes to the other. Diabetes increases a person’s chances of developing periodontitis, and periodontitis, in turn, influences insulin sensitivity.

Studies also reveal that diabetics are more susceptible to losing teeth.

Periodontitis and pregnancy

No, gingival bleeding should not be treated as part of everyday life, especially for pregnant women! Due to hormonal changes, it is possible that bleeding occurs in the gums of the pregnant woman.

These bleeds are a sign of gingivitis. Even if the pregnant woman has an adequate toothbrushing, she will be subject to develop periodontitis, because her immune system is more weakened, which promotes the proliferation of bacteria.

As soon as the problem is identified, it is necessary for the pregnant woman to go to the dentist as soon as possible, because if the condition worsens, it can bring complications for the mother and baby, with premature delivery being an example of the seriousness of the situation.


Commonly reported symptoms are:

  • Canker sores;
  • Tartarus;
  • Bad breath;
  • Bleeding during brushing and flossing;
  • Gums receding, giving the impression of longer teeth;
  • Tooth mobility (soft teeth);
  • Sour taste in the mouth;
  • Smooth and shiny gum texture;
  • Changes in the bite;
  • Redness in the gums;
  • I put it between the gum and the tooth;
  • Abscesses around the tooth.

How is periodontitis diagnosed?

The person responsible for diagnosing periodontitis is a dentist or periodontist. Because they do not know what problem is causing their discomfort, many people go to the dentist. However, when he sees that it is a periodontal case, he sends the individual to the periodontist, the specialist in the case.

It is only possible to carry out the diagnosis by determining the state of the disease’s damage and its cause. Generally, the tests performed to diagnose periodontitis are:

Clinical examination

This examination is divided into two axes, the initial (anamnesis) and the posterior axis (physical examination). Anamnesis is performed in three steps. The first aims to find out the main reason for the individual’s discomfort. The main complaints are bad breath and bleeding.

The second step is marked by the history of the current disease (HDA), which asks how long ago the symptoms appeared and how they started.

The third step is to learn about the histories of other diseases, such as diabetes, HIV, among others.

Physical exam

The physical examination intraorally detects the signs of periodontitis. The steps the individual will go through are:

Visual inspection

The dentist or periodontist visually examines the gums. The purpose of this step is to find out whether the gum has normal characteristics or not.

Aspects that characterize a healthy gum are pink or brownish color, absence of plaque or visible bleeding and texture due to dermal interdigitations.


To assess more effectively, the doctor in charge will need to touch the gum. In cases of periodontal pockets, the individual may experience pain or mild discomfort. Blood or exudate, an inflammatory fluid produced when damage to tissues and blood vessels, can come out of this pouch.

Radiographic examination

On the radiograph, it is not possible to see the periodontal pockets. So, only with the radiographic examination, it is not possible to make the diagnosis. However, he is asked to know the proportion of bone loss that the patient has already suffered.

Is periodontitis curable?

Periodontitis is incurable, but it has effective treatment, if it has not reached a very advanced degree.

To put it more comprehensively: periodontitis is caused by the tartar bacteria, as already mentioned here. However, it is chronic. This means that the person may be without the signs of the disease, but he does not leave his body completely. Therefore, treatment for life is necessary.

What is the treatment for periodontitis?

The best treatment for periodontitis is prevention, except in those who, even with prevention, suffer from the disease.

The good news is that there are treatments that can relieve or ease the pain of those who are going through the drama of periodontitis. Being separated into surgical and non-surgical groups, we have:


Reduction of the periodontal pocket

In this surgery, the periodontist lifts the periodontal pouch and exposes the dental roots. The goal is to perform a more effective cleaning of the affected area. After cleaning, the gingiva is sutured to its proper size and place.

Soft tissue grafts

In some cases of periodontitis, the gums overgrow and cover the teeth. In others, it retracts and exposes the tooth root. When this gingival tissue is lost due to retraction, it may be necessary to reinforce the area surgically.

In the procedure, the affected tissue is opened and then the soft tissue graft is inserted, this graft can be from another part of the patient’s mouth, donated, or synthetic.

Bone graft

When periodontitis affects the tooth root horizontally, periodontists perform a procedure called bone graft, that is, the transfer of a bone to another place, in order to supply the damage caused in the jaw.

The graft bone can be the individual’s own, synthetic or even obtained through donation. The purpose of surgery is to help prevent tooth loss, as well as serving as a basis for the natural growth of bone layers.

Guided tissue regeneration

To promote the natural growth of the bone that has been affected, the dentist inserts a tissue between the tooth and the existing bone. The biocompatible material that was inserted there prevents foreign bodies from entering the operated area. This means that the bone will be able to grow back naturally.

Application of enamel matrix derivatives

Dental enamel is what protects you from bacteria, helps your development and stimulates the growth of healthy bone. For people with periodontitis, this enamel has low or no production. Then, a special gel is applied to diseased teeth that need these capabilities.

Crown increase

This surgery is a restorative procedure, it can (and is) used for aesthetic purposes. However, it is also very useful to prevent the formation of periodontal pockets.

The dental surgeon makes small incisions around the gums to remove their excesses, and in some cases the bone that surrounds the roots of the teeth is also reshaped.



Cleaning is the first process that most people with periodontitis will go through. Because the gums are sensitive, it is very likely that the process will be painful, especially if it is without anesthesia or with very calcified tartar.

However, the process is extremely important, as cleaning removes tartar and bacteria that cause gum irritability.

Root scraping and straightening

Root smoothing (scaling of the tooth root) is responsible for preventing the accumulation of new bacterial toxins and tartar.


Each case has a different specification, but many dentists often recommend antibiotics . Their function is to eliminate or prevent the growth of bacteria.

Among the commonly indicated are:

  • Ciflogex;
  • Amoxicillin ;
  • Clindamycin hydrochloride .


NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Living together

There are two ways to live with periodontitis: with and without professional treatment.

Without proper treatment, living with periodontitis can become quite a challenge. What happens is that the high cost of treatment and the inefficiency of the Unified Health System leads many Brazilians to live with the disease without treating it efficiently.

Once diagnosed, periodontitis needs immediate treatment. Removing the tartar or, in advanced cases, the affected teeth, is the first step towards resuming oral health.

Attending and following the guidelines of the periodontist is what makes the difference between professional treatment and attempted home treatment. After all, when the focus of the disease is removed, along with the correct treatment, signs of periodontitis may be non-existent .

Some tips for living with periodontitis are:

Avoid trauma and irritating foods

In addition to attending the periodontist at least every 3 months, performing proper brushing and avoiding excess tobacco and alcohol, it is necessary to avoid trauma to the gums.

With traumas, we mean everything that may irritate you. For example: Eat popcorn and do not brush your teeth for at least 1 hour after consumption.

Foods like popcorn and peanuts tend to irritate the gums, whether or not they are free of periodontitis. However, when the individual already has periodontal problems, his gums need twice as much care, as he has twice as much sensitivity.

In the case of these foods, they are not completely crushed, leaving large pieces between the gums and the teeth. With friction, the gums can suffer small cracks and start to bleed and become inflamed. An hour is the maximum time to brush your teeth after consuming this type of food, but the ideal is immediate brushing.


Another thing that should be added to the routine is the use of non-alcoholic mouthwashes. Some alcohol rinses kill benign bacteria in the mouth, that is, antibodies that fight against aggressive bacteria. The ideal is to consult the dentist or your periodontist, he will know how to indicate the mouthwash indicated for your use.


Periodontitis, in itself, is already a complication of gingivitis, but the human body does not tire of surprising us and the case can get even worse. Understand:

Cardiovascular diseases

In cardiovascular patients, the situation is even more serious. Recent studies have shown that periodontitis is associated with the development of cardiovascular diseases. So, if the person with cardiovascular disease develops periodontitis, their chances of dying increase substantially.

This is due to inflammatory bacteria and proteins, present in the periodontium region, penetrating the bloodstream, causing damage to the cardiovascular system.

Bacterial endocarditis and pyelonephritis

Other complications are bacterial endocarditis and pyelonephritis. Endocarditis is the inflammation of the membrane that lines the heart, while pyelonephritis is the inflammation of the kidneys.

The result of these diseases is because the kidneys are responsible for filtering the blood, so the bacteria present in the bloodstream end up infecting them. The same occurs with heart valves, which can compromise blood circulation and the functioning of the heart.

Other complications

In addition to these, the most recurrent complications are:

  • Bad breath;
  • Bleeding;
  • Loss of teeth;
  • Inflamed gums;
  • Sensitive gums;
  • Gingival retraction;
  • I put it between the gums.

How to prevent periodontitis?

Among the ways to prevent periodontitis are:

Proper brushing

How many times have you not heard the phrase “Brush your teeth right”? Countless!

However, many still sin when it comes to performing oral hygiene. Using the brush, cream and dental floss correctly makes all the difference when it comes to periodontitis.

Of course, after the disease has contracted and the gums are tender, this ritual is regrettable. This is because, at the time of brushing, the gums tend to bleed and hurt, and the same occurs when flossing. However, it is necessary to continue hygiene properly, otherwise the disease will worsen.

In short: always brush your teeth well after meals and before bed. If you are listed in the risk group, it is ideal to brush after drinking coffees, teas and soft drinks as well. This is due to the high level of corrosivity that these liquids have.

Discover 3 quick but efficient steps for proper brushing:

Step 1

For a thorough brushing, make sure you have the necessary and efficient materials. They are: a toothbrush, toothpaste, dental floss and, for reinforcement, mouthwash.

Dentists recommend using a brush with soft bristles and a small head, so it does not irritate the gums and reaches more difficult places in the mouth. When it comes to toothpaste, you need to talk to your dentist, as only he will know which type of toothpaste is best for your mouth.

Step 2

It is recommended to perform the mouth rinse with water before brushing. Thus, the largest pieces of food will be eliminated even before brushing starts, making smaller pieces more accessible.

The ideal is to perform brushing in circular movements, and in one quadrant (sector) at a time, so that no area will be overlooked. Always start with the teeth of the upper jaw because, if any residue remains, it will be eliminated at the time of brushing the lower jaw. Always remembering that strength is not necessary, but the knowledge of how to brush correctly.

Brush the areas of the upper teeth towards the cheeks and then the lower ones. The pattern of upper first and lower later is repeated in the internal area of ​​the teeth. Leave the chewing part to be brushed last.

Know that, for a more assertive cleaning of the gums, it is necessary to hold the brush at 45 degrees: this angle allows the brush bristles to come into contact with the gingival groove, a free space between the tooth and the gum. It is mainly in the gingival sulcus that plaque, which later becomes tartar, is implanted.

Step 3

Proper brushing lasts at least 3 minutes. After the brushing process has been carried out, it is necessary to use dental floss, respecting the same order in which the brushing was carried out , so that hardly any tooth will be forgotten.

It is advisable that the floss is always used after brushing, so any spare residues will be eliminated. Some dentists defend the use of dental floss before brushing, but this line of thought proves unfeasible, as dental floss alone will not guarantee the removal of all food remains, just as the brush does not do. Therefore, dental floss should be used after brushing .

The correct way to floss is to and fro, as if the tape embraces the tooth, so the remaining plaque will in fact be removed.

Mouthwash serves much more than advertising shows: leaving your breath refreshing is a welcome consequence, but it should not be the main motivator for using the mouthwash.

For patients with periodontitis, its importance is much greater than for healthy consumers, as the rinse has germicidal and bactericidal actions, which helps to eliminate plaque. Remembering that the rinse alone does not solve the problems. It is necessary that its use is combined with good brushing.

Frequent dentist

Don’t be afraid of the dentist, because, like doctors, they just want to help you and are essential to maintaining your health.

Visit the dentist at least twice a year. If you have close relatives with the disease or are a smoker, go to the dentist at least every 3 months.

Avoid smoking

Like everything called addiction, smoking is not legal. Being a smoker and wanting adequate oral health do not match.

Tobacco alters the gum’s immune system, making it more accessible to bacteria, which in turn become more aggressive due to the body’s lack of combat.

Have all your questions been answered? Anything, leave your comment or contact us and we will respond with pleasure!
Tell us what you think of the article, share this text and don’t forget to change your brush every three months, or when you notice bristle wear. In cases of patients with periodontitis, it is recommended to perform the replacement every month.