What is periodontal disease?

Periodontitis is one of the most common infections i USA and Europe. It is a chronic disease, were there is an active and an inactive phase. At first and if there is no pain the bone will break done. Later the teeth will loosen and hurt. Futhermore the disease can cause bad breath and change the look of the smile. The goal with treatment is to keep the teeth and replace missing teeth fx with implants. 

If plaque is not removed, it will cause the gums to bleed, a condition called gingivitis. Unremoved plaque can devolop into a hard substance called calculus (tartar). As plaque and calculus build up, the gum and bone anchoring the teeth in the jaw will be destroyed – this is irreversible. Eventually, there will not be enough gum and bone remaining to hold the tooth in place, and the tooth will need to be removed.

Periodontal means “around the tooth”. Periodontal disease is a bacterial gum infection that destroys the attachment fibers and supporting bone that hold your teeth in your mouth. It can affect all people at any age.

The main cause is plaque that forms daily (a sticky film on teeth). It contains bacteria, by-products of bacteria, and salvia. Bacteria use sugar (carbohydrates) to grow and produce acid that attacks the enamel and cause cavities. Plaque can be reduced by daily brushing and flossing.
If plaque is not removed, minerals in saliva combine with plaque at the tooth surface and harden into rough mineral deposits, calculus (tartar, hard build-up). Calculus will develop in less than two days both over and under the gum-line and bacteria will stick to it. Toothbrush and floss can’t remove calculus. It can only be removed with special instruments at the dental office. If it is not removed periodontal disease will occur.

Bacteria produce toxins (poisons) that irritate the gum, cause infection, start the inflammatory process and destroy the bone and fibers around the tooth. The body’s immune system response sometimes over-reacts leading to further bone damage.
The gum draws back from the tooth (creates a pocket) and allows more bacteria to enter. If untreated the pocket gets deeper, the bone is destroyed, the teeth loosen and need removal. In addition these bacteria and the inflammation process can travel throughout the body. Research has linked periodontal diseases to preterm, low birth weight babies, cardiovascular disease and diabetes. Often, this destructive process has mild or undetected symptoms.

Contributors to development of periodontal disease

Bacteria, impacted food between teeth, tobacco, alcohol, improper use of dental floss or toothpicks, badly aligned teeth, poorly fitting fillings/crowns/bridges/partial dentures, grinding teeth, nutritional deficiency, reduced immune system, pregnancy, medications and systemic diseases.

The stages og periodontal disease
Normal, healthy gums and bone (Source: ADA)
Gingivitis – Irritated gums (Source: ADA)






Periodontitis – Loss of tissue and bone (Source: ADA)
Advanced periodontitis – Servere damage to supporting ligament and bone (Source: ADA)






Normal, healthy teeth are anchored to the bone and gum by fibers. There is a normal but narrow space around each tooth known as the sulcus (around 1-3 mm).

Gingivitis: The mildest form – The early stage – Bacterial deposits build up on the tooth surface causing irritation to the gum and periodontal ligament fibers. Gums become red, swollen and bleed easily. There is usually little or no discomfort. Gingivitis is reversible with professional treatment and optimal home oral care. Pockets are about 1-4 mm.

Mild Periodontitis: When gingivitis is untreated, the breakdown of supporting bone and tissue proceeds, the space around the tooth deepens. The sulcus is now called a pocket. The depth of the pocket is measured carefully, and provides information as to the stage of the disease. (“Mild” 1-2 mm loss of attaching fibers and bone – called Clinical Attachment Loss – Usually seen with 5 mm pockets).

Moderate to advanced Periodontitis: The plaque and its byproducts attack further, causing more of the fibers and bone support to be lost. The tooth might loosen, and the root may become exposed and sensitive. Unless treated, the tooth may fall out or need to be removed. (“Moderate” 3-4 mm or “Advanced” 5 mm or higher Clinical Attachment Loss – Usually seen with 6 mm pockets or higher).

Normal, healthy teeth (Source: Tandlægeforeningen)
Gingivitis – The mildest form (Source: Tandlægeforeningen)
Advanced Periodontitis





Periodontal disease can be seen localized to one or few teeth or generalized on several or all teeth.

Source: Tandlægeforeningen
Source: Tandlægeforeningen
Symptoms of periodontal disease

Usually Periodontal Infection is painless until it reaches more advanced stages. Possible warning signs can be :

  • Gums bleed easily, are red, swollen or tender (when you brush or floss).
  • Gums have pulled away from the teeth (receding gums, teeth look longer)
  • Pus between the teeth and gums when the gums are pressed
  • Persistent bad breath or bad taste
  • Pain when chewing
  • Teeth are loose, separating or protruding (spaces between teeth)
  • Change in your bite or in the fit of partial dentures
  • Teeth are sensitive to hot and cold
Reasons for Gum pain
  • Toothbrush trauma
  • Food trauma (e.g. spicy, hot, food fragment)
  • Gum disease
  • Mouth ulcer (various types)
  • Herpes Simplex
  • Abscess
  • Tooth erupting
  • Impacted tooth
  • Cyst
  • Oral cancer
  • Various other conditions

Read about the treatment here:  Periodontal treatment

Read more about gum and bone problems around implants here: Periimplantitis