What Is the Disease of the Periodontium?

The periodontium is the group of tissues that surround, attach and support each tooth. It includes the gingiva (gums), periodontal ligament, cementum and alveolar bone. Together, these structures hold the teeth in the jaw while allowing them to withstand the forces produced during biting and chewing.

Diseases affecting these supporting tissues are known as periodontal diseases. The most familiar are gingivitis and periodontitis. Gingivitis causes inflammation of the gums without loss of the tooth’s supporting attachment, whereas periodontitis involves destruction of the deeper tissues and bone supporting the teeth.

Periodontal disease is very common and can sometimes progress with surprisingly few symptoms. Early diagnosis, effective plaque control and appropriate periodontal treatment can help stabilise the condition and preserve natural teeth.

What Makes Up the Periodontium?

The periodontium consists of four main structures, each with a different role:

• Gingiva: The gum tissue surrounding the teeth. Healthy gingiva forms a protective seal around each tooth.
• Periodontal ligament: A specialised network of fibres connecting the tooth root to the surrounding alveolar bone. It also helps absorb and transmit chewing forces.
• Cementum: A mineralised layer covering the surface of the tooth root to which periodontal ligament fibres attach.
• Alveolar bone: The part of the upper and lower jaws that forms the sockets supporting the teeth.

Periodontitis can progressively damage these supporting tissues, which is why advanced disease may eventually result in tooth mobility and tooth loss.

What Is a Disease of the Periodontium?

A disease of the periodontium is any condition affecting the tissues supporting the teeth. In everyday dentistry, the term usually refers to gingivitis or periodontitis, although there are other, less common periodontal conditions.

Periodontitis is now understood as a multifactorial chronic inflammatory disease associated with an altered plaque biofilm and the body’s immune-inflammatory response. It is therefore more complicated than simply describing it as a bacterial infection.

Dental plaque is central to the disease process, but factors such as smoking, diabetes and individual susceptibility can significantly influence whether disease develops and how quickly it progresses.

What Is Gingivitis?

Gingivitis is inflammation of the gums without destruction of the deeper periodontal attachment or supporting bone.

Common signs include:

• Bleeding when brushing or cleaning between the teeth
• Red or swollen gums
• Gum tenderness
• Increased plaque around the gumline
• Bad breath in some people

Gingivitis is generally reversible when plaque is effectively controlled. This usually involves improving brushing and interdental cleaning together with professional care from a dental hygienist where needed.

Not every person with gingivitis will develop periodontitis, but persistent inflammation should not simply be ignored.

What Is Periodontitis?

Periodontitis occurs when the inflammatory disease process affects the deeper supporting structures around the teeth, resulting in loss of periodontal attachment and supporting alveolar bone.

As attachment is lost, spaces known as periodontal pockets can develop between the tooth and gum. These deeper areas can harbour plaque biofilm and become increasingly difficult to clean without professional treatment.

Possible consequences include:

• Loss of bone supporting the teeth
• Gum recession
• Deep periodontal pockets
• Changes in tooth position
• Increasing tooth mobility
• Eventually, tooth loss in severe untreated disease

Unlike gingivitis, the attachment and bone loss caused by periodontitis does not simply return to normal once inflammation settles. However, modern periodontal treatment can often stabilise the disease, and regenerative procedures may restore some lost support in carefully selected defects.

What Are the Stages of Periodontitis?

Modern periodontal classification no longer simply divides gum disease into mild, moderate and advanced disease. Periodontitis is described using a staging and grading system.

Stage I Periodontitis

Stage I represents relatively early periodontal destruction. Bone and attachment loss are limited, and the disease is usually less complex to manage.

Stage II Periodontitis

Stage II represents established periodontitis with greater attachment and bone loss but without the more complex features associated with severe disease.

Stage III Periodontitis

Stage III involves severe periodontal destruction and an increased risk of tooth loss. Deep pockets, significant bone loss and involvement of more complicated areas around the roots may be present.

Stage IV Periodontitis

Stage IV represents very severe disease in which periodontal destruction may be accompanied by functional problems such as tooth mobility, migration, loss of teeth or difficulty maintaining a stable bite and chewing function. Treatment may require multidisciplinary dental care.

What Do Periodontal Grades A, B and C Mean?

In addition to staging the severity and complexity of periodontitis, dentists may also assign a grade that estimates how rapidly the disease is progressing and considers important risk factors.

• Grade A: Evidence suggests a relatively slow rate of progression.
• Grade B: Evidence suggests a moderate rate of progression.
• Grade C: Evidence suggests a more rapid rate of progression.

Smoking and suboptimally controlled diabetes are particularly important factors when assessing periodontal risk.

What Causes Periodontal Disease?

The development of plaque-induced periodontal disease begins with dental plaque collecting around the teeth and gumline. If plaque is not adequately disrupted, inflammation can develop.

However, the severity of periodontitis is influenced by more than the quantity of plaque alone. Important risk and modifying factors include:

• Smoking: One of the most important modifiable risk factors for periodontitis and tooth loss
• Diabetes: Particularly when blood glucose is not well controlled
• Genetic susceptibility: Some people appear more susceptible than others
• Previous periodontal disease: A history of periodontitis increases the need for long-term monitoring
• Plaque-retentive areas: Certain restorations, tooth positions or deposits of calculus can make effective cleaning more difficult
• Some medications and medical conditions: These can affect the gums or the body’s response to plaque

If you smoke, stopping is one of the most valuable things you can do for both periodontal and general health. Read more about smoking and oral health.

Does Pregnancy Cause Periodontal Disease?

Pregnancy does not automatically cause periodontitis, but hormonal changes can alter the way gum tissues respond to plaque. This can make gingival inflammation and bleeding more noticeable during pregnancy.

Good plaque control and professional dental care therefore remain particularly important. Read more about looking after your teeth and gums during pregnancy.

What Are the Symptoms of Periodontal Disease?

Possible warning signs include:

• Bleeding gums
• Red, swollen or tender gums
• Persistent bad breath or an unpleasant taste
• Receding gums
• Teeth appearing longer
• Spaces developing between teeth
• Loose or moving teeth
• Pus around a tooth or gum
• Changes in the position of teeth
• Discomfort when chewing in some cases

Can You Have Periodontitis Without Knowing?

Yes. Periodontitis can develop without significant toothache, particularly during its earlier stages.

Some people first become aware of the problem because their gums bleed or recede, while others are diagnosed during a routine dental examination.

This is one reason regular periodontal screening matters even when your teeth feel completely comfortable.

Do Bleeding Gums Always Mean Periodontitis?

No. Bleeding gums commonly indicate gingival inflammation, but they do not automatically mean that supporting bone has been lost.

Your dentist needs to assess the gums and periodontal support to distinguish gingivitis from periodontitis.

Bleeding should nevertheless not be considered normal or ignored. If your gums regularly bleed when brushing or cleaning between the teeth, arrange an assessment with a dentist or dental hygienist.

How Is Periodontal Disease Diagnosed?

Periodontal assessment involves more than simply looking at the colour of the gums.

In UK dental practice, a Basic Periodontal Examination (BPE) is commonly used as a screening tool. The mouth is assessed using a periodontal probe to identify areas that may need further investigation.

Importantly, the BPE is a screening tool rather than a diagnosis by itself.

If signs of periodontitis are identified, a more detailed periodontal assessment may include:

• Measuring periodontal pocket depths around each tooth
• Recording bleeding on probing
• Assessing gum recession and clinical attachment loss
• Checking tooth mobility
• Assessing areas where the roots of multi-rooted teeth divide
• Dental X-rays to assess the pattern and extent of bone loss
• Reviewing smoking, diabetes and other risk factors

Your dentist can then establish the diagnosis and determine whether treatment can be managed within routine dental care or whether specialist periodontal treatment would be beneficial.

How Is Gingivitis Treated?

The main aim is to reduce plaque and establish effective daily oral hygiene.

Treatment may involve:

• Improving brushing technique
• Daily cleaning between the teeth using appropriately sized interdental brushes or floss
• Professional removal of plaque and calculus
• Managing factors that make plaque control difficult
• Stopping smoking

A hygiene appointment at Glow Dental can include professional cleaning together with personalised advice on cleaning between the teeth and maintaining healthier gums at home.

How Is Periodontitis Treated?

Modern periodontal treatment is generally delivered in stages. The exact treatment plan depends on the severity of disease, individual risk factors and how the tissues respond.

Step 1: Improving Plaque Control and Managing Risk Factors

Successful periodontal treatment depends heavily on effective daily plaque removal. Your dental team will help you improve brushing and interdental cleaning and address important risk factors such as smoking and diabetes.

Step 2: Cleaning Below the Gumline

If deeper periodontal pockets are present, professional subgingival instrumentation may be required to remove deposits and disrupt plaque biofilm from the root surfaces beneath the gumline.

This treatment is sometimes called deep cleaning, periodontal debridement or scaling and root surface instrumentation. Local anaesthetic may be used to keep treatment comfortable.

Step 3: Reassessment

After the tissues have had time to respond, the periodontal condition is reassessed. Pocket depths, bleeding and plaque control can be measured again to identify areas that have stabilised and any sites that still require further treatment.

Step 4: Further or Surgical Periodontal Treatment

Where deep periodontal pockets remain despite good plaque control and non-surgical therapy, a periodontist may recommend additional treatment.

Depending on the individual defect, options can include periodontal surgery to gain better access to root surfaces or regenerative procedures designed to rebuild some of the supporting tissues around selected teeth.

Soft-tissue grafting may also be used for certain types of gum recession, although gum recession and periodontitis are not exactly the same condition.

Are Antibiotics Used to Treat Periodontitis?

Antibiotics are not routinely required for most cases of periodontitis.

The foundation of treatment is effective plaque control, risk-factor management and professional mechanical cleaning of the affected root surfaces.

Systemic antibiotics may be considered in specific circumstances, such as selected highly susceptible patients or particular clinical situations, but they should not be seen as a substitute for periodontal treatment.

Can Mouthwash Cure Periodontal Disease?

No. An antimicrobial mouthwash can sometimes be useful as an adjunct for selected patients, but it cannot remove established calculus or clean deep periodontal pockets by itself.

Mechanical plaque removal through brushing and cleaning between the teeth remains fundamental.

Mouthwash should also not normally be used immediately after brushing with fluoride toothpaste because this can wash away the concentrated fluoride left on the teeth.

Can Periodontitis Be Reversed?

There is an important difference between gingivitis and periodontitis.

Gingivitis can usually be reversed when plaque-induced inflammation is brought under control because there has been no periodontal attachment or bone loss.

With periodontitis, previously lost attachment and bone do not simply grow back once inflammation settles. The main objective of treatment is therefore to control the disease, stabilise the remaining support and prevent further destruction.

Some specialised regenerative procedures can rebuild periodontal tissues in selected types of defects, but this is not possible around every affected tooth.

Can Periodontitis Be Cured Permanently?

Periodontitis can often be successfully treated and brought into a stable state, but patients who have developed the disease remain at increased risk of recurrence.

For this reason, treatment does not finish when the initial deep cleaning is completed. Long-term supportive periodontal care is an important part of maintaining the result.

How Often Should You See a Hygienist If You Have Periodontitis?

There is no single interval that is right for everyone.

After periodontal treatment, supportive-care appointments are commonly scheduled approximately every three to six months, although the interval should be tailored to your disease history, plaque control, smoking status, diabetes and current periodontal stability.

This is different from simply telling every patient to attend every six months. Your dentist, hygienist or periodontist should recommend a personalised maintenance interval.

How Does Periodontal Disease Affect General Health?

Periodontitis is a chronic inflammatory disease and has been extensively studied in relation to wider health. However, it is important to distinguish an association from proof that periodontal disease directly causes another condition.

Periodontitis and Diabetes

The relationship between periodontitis and diabetes is particularly well established and appears to be bidirectional.

People with poorly controlled diabetes have a greater risk of developing severe periodontitis and may respond less favourably to treatment. Periodontitis is also associated with poorer glycaemic control, and successful periodontal treatment can produce a modest improvement in HbA1c in people with diabetes.

If you have diabetes, maintaining good periodontal health should form part of your overall healthcare.

Periodontitis and Cardiovascular Disease

Research has found a consistent association between periodontitis and cardiovascular diseases such as coronary heart disease and stroke.

However, this does not mean that gum disease can simply be described as a direct cause of heart attacks or strokes. The conditions share several important risk factors, including smoking, age, diabetes and inflammatory pathways.

Periodontal treatment is important for oral health, but it should not be presented as a proven treatment for preventing cardiovascular disease.

Periodontal Disease and Pregnancy

Periodontitis has also been associated in some studies with adverse pregnancy outcomes such as preterm birth, low birth weight and pre-eclampsia. However, whether this relationship is directly causal remains uncertain.

What is clear is that maintaining good oral and periodontal health during pregnancy is beneficial, and periodontal treatment can be performed safely when clinically required. Read more about dental care during pregnancy.

Is Periodontal Disease Contagious?

Periodontitis is not normally regarded as a contagious disease in the same way as a cold or flu.

Oral bacteria can be exchanged between people through saliva, but developing periodontitis depends on a complex combination of plaque biofilm, the individual’s immune-inflammatory response and risk factors such as smoking and diabetes.

You therefore do not simply “catch periodontitis” by kissing someone who has gum disease.

Can Periodontal Disease Cause Tooth Loss?

Yes. Severe uncontrolled periodontitis can destroy enough periodontal ligament and supporting bone that teeth become mobile and ultimately cannot be maintained.

However, tooth loss is not inevitable. Early diagnosis and effective periodontal treatment can often preserve teeth that might otherwise be at risk.

Patients with more advanced disease may benefit from assessment by the specialist periodontal team at Glow Dental.

Can Receding Gums Grow Back?

Receded gum tissue generally does not simply grow back to its original position by itself.

The first step is determining why recession has occurred, because possible contributing factors include periodontal disease, tooth position and traumatic brushing.

In selected cases, periodontal soft-tissue grafting can cover an exposed root or increase the amount of gum tissue around a tooth. A periodontist can assess whether this is appropriate.

How Can You Help Prevent Periodontal Disease?

Good periodontal health depends primarily on controlling dental plaque and modifying risk factors where possible.

• Brush thoroughly twice a day with fluoride toothpaste
• Clean between the teeth every day using interdental brushes or floss where appropriate
• Spit after brushing rather than immediately rinsing with water
• Attend dental examinations at the interval recommended for you
• Attend hygiene appointments when advised
• Do not smoke, and seek support with smoking cessation if needed
• Manage diabetes in partnership with your medical team
• Follow the periodontal maintenance programme recommended after treatment

Frequently Asked Questions About Diseases of the Periodontium

What is the most common disease of the periodontium?

Plaque-induced gingivitis and periodontitis are among the most common periodontal conditions. Gingivitis affects the gums without loss of supporting attachment, while periodontitis causes destruction of the deeper tooth-supporting tissues.

What is the difference between gingivitis and periodontitis?

Gingivitis causes inflammation without permanent loss of periodontal attachment or supporting bone and is generally reversible. Periodontitis involves attachment and bone loss and therefore requires long-term disease management.

Can periodontal disease be painless?

Yes. Periodontitis can progress without significant pain, which is why periodontal screening during routine dental examinations is important.

Can periodontitis make teeth loose?

Yes. If enough periodontal ligament and bone support is lost, a tooth can become increasingly mobile. Mobility does not automatically mean the tooth has to be removed, however, and a periodontal assessment is needed to determine its prognosis.

Is bleeding when brushing normal?

Regular gum bleeding is usually a sign of inflammation and should not simply be accepted as normal. If your gums repeatedly bleed, arrange a dental or hygiene assessment.

Can a hygienist treat periodontal disease?

Dental hygienists and therapists play an important role in periodontal care, including oral-hygiene instruction, professional plaque removal and periodontal maintenance. More complex or advanced disease may also require treatment from a dentist or specialist periodontist.

Do antibiotics cure gum disease?

No. Antibiotics alone do not remove plaque biofilm and calculus from periodontal pockets and are not routinely recommended for most periodontitis patients. Effective mechanical cleaning and long-term plaque control remain fundamental.

How do I know whether I need a periodontist?

Your dentist may recommend specialist assessment if you have severe or rapidly progressing disease, complicated periodontal defects, persistent deep pockets despite treatment, significant recession requiring surgery or other factors that make treatment more complex.

Periodontal Treatment at Glow Dental

If you have bleeding gums, gum recession, persistent bad breath, loose teeth or have already been diagnosed with periodontitis, Glow Dental provides specialist periodontics in Battersea for patients who require more advanced gum care.

Routine prevention and maintenance are also available through our dental hygienists, while a dental examination can identify signs of periodontal disease before more obvious symptoms develop.

If anxiety has prevented you from seeking treatment, find out how Glow Dental supports nervous dental patients. New patients can also learn more about joining Glow Dental.

Summary: What Is a Disease of the Periodontium?

A disease of the periodontium affects one or more of the tissues supporting the teeth—the gingiva, periodontal ligament, cementum and alveolar bone. The two most familiar periodontal diseases are gingivitis and periodontitis.

Gingivitis causes reversible inflammation of the gums without loss of supporting tissue. Periodontitis is a deeper chronic inflammatory disease in which periodontal attachment and bone are progressively lost. Modern diagnosis describes periodontitis according to its stage, grade, extent, current stability and relevant risk factors rather than simply calling it mild or advanced gum disease.

With good daily plaque control, professional treatment, management of risk factors and appropriate long-term maintenance, periodontitis can often be successfully stabilised and natural teeth preserved for many years.