Periodontitis is a form of gum disease that affects the tissues surrounding the teeth. Mild and moderate periodontitis can affect up to 50% of the adult population over the age of 30 in the US, while the severe form is less common.

The inflammation starts at the gum line as gingivitis; it can progress to the deeper structures of the gum if not treated, affecting the underlying bone. Ultimately, bone destruction in periodontitis can become so extensive that teeth can become loose and eventually fall out.

Besides the effects on oral health, periodontitis can spread inflammation products, bacteria or their toxic products to other parts of the body. Studies have shown that this disease can make heart problems, diabetes, respiratory problems and even Alzheimer’s disease worse. It can also affect pregnancy, with the potential to lead to early birth of low weight babies.



Periodontitis is a silent disease in most cases. Signs and symptoms are typically mild, including the following:

  • Bleeding when brushing and flossing or spontaneous (less noticeable in smokers)
  • Loose teeth, changes in the positioning of the teeth
  • Pain when chewing, discomfort around the teeth
  • Red and swollen gums
  • Bad breath
  • Gum recession



The primary cause of periodontitis is bacteria. There are certain types of bacteria in the mouth that can be harmful to the gums. However, not everyone who has these bacteria will develop the disease, indicating that other risk factors play an important role. Smoking, low socioeconomic status, diabetes and stress increase the risk for gum disease.



One condition that can aggravate gum disease is the bite. Bite problems, such as crowding, tilted, rotated, crooked and misaligned teeth can make them more prone to gum disease and accelerate bone loss.

Just as tilted beams make a poor foundation for a building, misaligned teeth have a poor bone structure around them, which is not so strong to withstand the chewing pressure. This can lead to more severe bone loss when the bad bite is combined with periodontitis.

Furthermore, bite problems make cleaning difficult due to a lack of space and the presence of unreachable places for the toothbrush and dental floss. If bacteria are not removed properly, they buildup and trigger inflammation in the gums, thus making periodontitis worse.



The best tool to prevent gum diseases is good daily oral hygiene with appropriate tooth brushing and flossing, which should remove the majority of bacterial deposits.

In most people with gum disease, due to the silent nature of the condition, it is only discovered in severe stages, when the damage is big enough to cause tooth loss. Thus, regular dental check-ups are essential for prevention.

As inflammation in the gums progresses, it causes separation between gums and teeth, called pockets. When pockets are formed, bacteria move deeper and start multiplying. Bacterial deposits can become calcified and form tartar above and below the gum line. The condition can progress undisturbed until supporting bone is destroyed. Most forms of periodontitis are slow progressing; however, it can present phases of quick destruction, especially when the immune system is compromised.

In order to estimate the severity of periodontitis, the dentist measures the depth of the pockets around the teeth. The deeper, the more severe. Initial treatment always involves deep cleaning, usually called scaling and root planning, to remove all bacterial deposits from pockets and other areas in the mouth. Depending of the treatment response, further cleaning and/or gum surgery can be necessary. In severe cases, the dentist can choose to combine cleaning with antibiotics.



Correcting bite problems through orthodontic treatment is essential to prevent oral health problems. Adequate cleaning is better achieved when teeth are straight and in good alignment in relation to each other and the jawbones.

Even if bite problems were not present before the development of gum disease, they can develop because of the shifting of teeth due to the bone loss associated with periodontitis. Thus, after deep cleaning, orthodontic treatment can be necessary to correct bite issues and tooth positioning in order to improve the condition of the gums, facilitate cleaning and provide better foundations for the roots in the jawbone, so they can better absorb the biting pressure.

Orthodontic treatment in adults has become easier and more convenient with clear aligner therapy. This involves the use of thin plastic devices, which provide gentle forces to shift teeth and change the bite. These aligner are removable and discrete, reasons why they are preferred by most adults.

Ask your dentist about the health of your gums and the state of your bite in order to maintain oral and general health.