Periodontitis

Periodontitis is a common chronic inflammatory disease of the supporting tissues of the teeth, caused by a microbial biofilm (dental plaque) and the host immune response. It results in progressive attachment loss and bone destruction around teeth, with gingival recession and pocket formation. It differs from gingivitis, which affects only the gingiva and does not involve attachment loss.

Symptoms may be mild early on and include red, swollen gums that bleed on brushing, persistent bad breath, and, over time, loose teeth or changes in bite. Pain is not always present.

Causes and risk factors include accumulation of dental plaque with pathogenic bacteria and a host response. Risk factors such as smoking, uncontrolled diabetes, aging, genetic susceptibility, immune dysregulation, and poor oral hygiene contribute to disease progression.

Diagnosis and classification rely on clinical findings such as probing depths, clinical attachment loss, gingival recession, and radiographic bone loss. Modern classification uses stages (I–IV) to reflect severity and complexity, and grades (A–C) to indicate progression risk and rate.

Treatment and prognosis begin with initial therapy: scaling and root planing to remove plaque and tartar, improved daily plaque control, and risk-factor modification. More advanced cases may require periodontal surgery (flap procedures, regenerative or resective techniques) and, when indicated, local or systemic antibiotics. Long-term success depends on ongoing maintenance and management of risk factors. Prevention focuses on good oral hygiene, regular dental visits, smoking cessation, and control of systemic conditions.