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By James T. Ubertalli, DMD

Periodontitis (pyorrhea) is a severe form of gingivitis in which the inflammation of the gums extends to the supporting structures of the tooth.

  • Plaque and tartar build up between the teeth and gums and then spread to the bone under the teeth.

  • The gums swell and bleed, the breath smells bad, and teeth become loose.

  • Doctors take x-rays and measure the depth of pockets in the gums to determine how severe periodontitis is.

  • Repeated professional cleanings and sometimes dental surgery and antibiotics are needed.

Periodontitis is one of the main causes of tooth loss in adults and is the main cause of tooth loss in older people. Infection erodes (wears away) the bone that holds the teeth in place. The erosion weakens the attachments and loosens the teeth. An affected tooth may eventually fall out or need to be pulled (extracted).


Most periodontitis is the result of a long-term accumulation of plaque and tartar on the teeth and the gums. Pockets form between the teeth and gums and extend downward between the root of the tooth and the underlying bone. These pockets collect plaque in an oxygen-free environment, which promotes the growth of aggressive forms of bacteria. The plaque and bacteria cause chronic inflammation that damages the tissue and bone that hold teeth in place. If the disease continues, eventually so much bone is lost that the tooth may become painfully loose. Tooth loss typically starts in a person's 40s.

Did You Know...

  • Periodontitis is the main cause of tooth loss in older people.

Periodontitis: From Plaque to Tooth Loss

Healthy gums and bone hold the tooth firmly in place.

Plaque buildup irritates the gums, and they become inflamed (gingivitis). In time, the gums pull away from the tooth, creating a pocket that fills with more plaque.

The pockets get deeper, and the plaque hardens into tartar. More plaque accumulates on top.

Tartar moves down to the root of the tooth and eventually destroys the bone supporting the tooth. Without this support, the tooth loosens and falls out.

The rate at which periodontitis develops differs considerably, even among people with similar amounts of tartar. Such differences occur because each person's plaque contains different types and numbers of bacteria, and periodontitis is partly caused by the person's unique immune system response to bacteria in the plaque. Periodontitis may cause bursts of destructive activity that lasts for months followed by periods when the disease apparently causes no further damage.

Many diseases and disorders, including diabetes (especially type 1), Down syndrome, Crohn’s disease, leukopenia, and AIDS, can predispose a person to periodontitis. In people with AIDS, periodontitis progresses quickly.

Symptoms and Diagnosis

The early symptoms of periodontitis are tender, swollen, bleeding, and red gums and bad breath (halitosis―see Bad Breath). To diagnose periodontitis, dentists measure the depth of the pockets in the gums with a thin probe and take x-rays to see how much bone has been lost. As more and more bone is lost, the teeth loosen and shift position, and chewing becomes painful. Frequently, the front teeth tilt outward. Periodontitis usually does not cause pain unless an infection forms in a pocket, the teeth loosen enough to move while chewing, or the person has HIV-associated periodontitis.


Unlike gingivitis, which usually disappears with good oral hygiene (daily brushing and flossing), periodontitis requires repeat professional care. People using good oral hygiene can clean only 1/12 inch (2 to 3 millimeters) below the gum line. However, dentists can clean pockets up to 1/5 inch (4 to 5 millimeters) deep using scaling and root planing, which thoroughly remove tartar and the diseased root surface. For pockets ¼ inch (5 millimeters) deep or more, surgery is often required. Dentists or periodontists may access the tooth below the gum line by surgically opening a flap of gum tissue (periodontal flap surgery). They thoroughly clean the teeth and correct bone defects (sometimes by bone grafting) under the flap and then sew the flap back in place. Dentists or periodontists may also remove part of the infected and separated gum (a gingivectomy) so that the rest of the gum can reattach tightly to the teeth and people can then remove the plaque at home.

Dentists may prescribe antibiotics (such as amoxicillin or metronidazole), especially if an abscess has developed. Dentists may also insert antibiotic-impregnated materials (filaments or gels) into deep gum pockets, so that high concentrations of the drug can reach the diseased area. Periodontal abscesses cause a burst of bone destruction, but immediate treatment with surgery and antibiotics may allow much of the damaged bone to quickly grow back. If the mouth is sore after surgery, a chlorhexidine mouth rinse used for 1 minute twice a day may be temporarily substituted for brushing and flossing.

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* This is the Consumer Version. *