What is worse gum pockets or gum recession

Periodontal disease: causes and symptoms

Periodontitis is an inflammation of the teeth supporting structures (or the tooth bed). It usually arises from a "simple" inflammation of the gums (gingivitis), but goes beyond that and affects not only the gums but also the other components of the gums. At an advanced stage, it can damage the jawbone and the tooth can lose its hold in the jawbone. It loosens and may need to be pulled.

Periodontitis is caused by bacterial plaque. In addition, it is likely that a hereditary predisposition to an increased inflammatory reaction of the immune system is a decisive factor in the development of the inflammation. It is also promoted by risk factors such as smoking, stress, diabetes and hormonal changes.

Symptoms of periodontal disease include frequent bleeding gums, red, swollen gums, and an unpleasant taste in the mouth. However, often none of the mentioned symptoms or pain occurs. As a result, periodontal disease is often not noticed for a long time.

The aim of treatment is to stop the inflammation, preserve affected teeth, and prevent it from spreading to other teeth.

What is Periodontal Disease?

Periodontitis is an inflammation of the tooth holding apparatus (also tooth bed or parodontium in technical terms) and is caused by bacteria in plaque.

The holding device gives the tooth a secure hold in the jaw and consists of:

  • the gums (gingiva)
  • the dental cement (the outer layer of the tooth root)
  • the periodontal membrane (periodontium) with elastic connective tissue fibers and
  • the jawbone (alveolar bone).

In contrast to a simple inflammation of the gums, periodontitis also affects the deeper parts of the periodontium. Later on, the jawbone can be damaged. The tooth can lose its hold and is at risk, although it may be completely healthy itself.

In addition, according to the current state of science, it is considered certain that periodontitis can trigger or worsen cardiovascular diseases and diabetes and even have a negative impact on pregnancies. Bacteria and their metabolic products can enter the bloodstream through the mouth and spread throughout the body.

Periodontitis can occur in single, multiple teeth next to each other or in almost all teeth. Furthermore, a distinction is made between different forms of inflammation.

Periodontal Disease or Periodontal Disease?

Periodontitis is often referred to as periodontal disease. However, there are two different problems. While periodontal disease is an inflammatory bacterial disease, the term periodontal disease refers to non-inflammatory receding gums. This usually occurs from middle age and can be hereditary. Today, however, the term gum recession (s) is preferably used instead of the term periodontal disease.

More information on Gum Recession (s) - Causes of Periodontal Disease

The cause of periodontitis as well as "simple" inflammation of the gums is bacteria in plaque.

Certain types of bacteria are responsible for both diseases. There are around ten types of periodontitis, including the bacterium Aggregatibacter actinomycetemcomitans.

However, because these types of bacteria are present in a large number of people without periodontitis developing, it is likely that a hereditary predisposition to an increased inflammatory reaction of the immune system also plays an important role in the development.

The main starting point for inflammation is the gumline. In this area, the gums lie against the tooth and form a small groove, the so-called sulcus. Bacterial plaque accumulate more easily in this area than in other places and can stay there permanently if they are not carefully removed every day.

Inflammation itself is a defense reaction by the body against bacteria and the toxins they produce. The immune system is activated and causes, among other things, the following processes:

The gums are supplied with more blood and are warmed up. It now looks darker and more reddish (healthy gums appear light pink).

To fight the bacterial infection, the body's own inflammatory cells (lymphocytes, etc.) migrate into the gums. This often leads to swelling and pain. Furthermore, the cell tissue is damaged, which means that inflamed gums are softer than healthy ones at this point.

Simple inflammation of the gums occurs relatively frequently and is usually easy to treat or goes away on its own after a few days. However, if the triggering inflammatory stimuli (bacteria in the coverings) are present for a long time, the inflammation will persist.

In the further course of the process, deeper areas of the holding apparatus are damaged in addition to the gums. The connection between tooth and gum is lost. The small furrow creates a deeper gap, a so-called gingival pocket. Periodontitis has developed from the initial inflammation of the gums.

This process continues: the gum pockets can no longer be completely cleaned during daily oral care because the toothbrush and dental floss do not reach into them. Bacteria, plaque and bacterial breakdown products continue to accumulate. Deeper pockets and even greater tissue damage develop.

In addition to these actual triggers of periodontal disease, there are several risk factors that promote the development and progression of the inflammation. These include:

  • Smoke
  • stress
  • Alcohol consumption
  • Nutritional deficiencies (e.g. lack of vitamin C and other antioxidant substances)
  • Sensitivity of the gums during pregnancy (pregnancy gingivitis)
  • Diseases that weaken the immune system (diabetes, herpes, etc.)
  • Hormonal factors like puberty and the menstrual cycle
  • Certain medications

Symptoms of periodontal disease

At the beginning as well as in the further course of periodontitis there is often no pain or other clear symptoms. Therefore, the inflammation goes unnoticed by many patients for a long time.

Frequent bleeding gums, an unpleasant taste in the mouth, bad breath, and loosening of the teeth are possible signs of periodontal disease. Other symptoms of periodontitis and simple inflammation of the gums (gingivitis) can include reddened, swollen and sensitive gums. Pain when biting open and "dull" pain in the jawbone can occur, but they do not always have to be signs of (already advanced) periodontitis.

Symptoms are generally less pronounced in smokers. As a result, there is a greater risk that the chronic inflammation will not be noticed.

Diagnosis of periodontal disease

Noticeable symptoms of periodontal disease such as reddened gums can often be seen with the naked eye after a dental examination.

In some cases, however, the gums appear healthy despite the presence of periodontal disease. The most important examination method is therefore the so-called probing: With the help of a probe - a fine hand instrument with a millimeter scale and rounded tip - the presence and depth of gingival pockets can be determined. The probe is guided at several points between the tooth and the gum and the depth of any pocket is read on the scale.

If values ​​of more than about 3 to 4 mm are found, this indicates periodontitis. If bleeding occurs during probing or if pus emerges from the affected area, a simple inflammation of the gums or periodontal disease may be responsible.

Determination of certain parameters (indices)

In order to describe the state of health of the tooth supporting apparatus and determine the need for treatment, various parameters can also be determined if necessary.

Periodontal Screening Index (PSI)

Here the gum pocket depth is measured at fixed measuring points in the immediate vicinity of the tooth. The examination results in a so-called “code” from 0 to 4. A value of 0 means that the gums and the gums are healthy. Values ​​3 and 4 indicate moderate and severe periodontitis, respectively, which requires treatment.

Sulcus Bleeding Index (SBI)

Inflamed gums react to careful touching with a probe through (slight) bleeding. With the help of the Sulcus Bleeding Index (SBI), the bleeding tendency of the gums is described and divided into 6 levels. In addition, the swelling and reddening of the gums is assessed.

Papillary Bleeding Index (PBI)

With this index value, the occurrence of bleeding in the area of ​​the interdental papilla (gums in the interdental space) is measured and divided into five levels from 0 to 4.


Any bone damage or a regression of the jawbone ridge and, in some cases, the formation of gingival pockets can be recognized by individual x-ray images or overview images of the entire dentition. Therefore, the examination is often supplemented by the X-ray.

Other diagnostic methods

  • Measurement of tooth mobility
  • Periodontitis risk test (genetic test)

Treatment of periodontal disease

As a rule, periodontitis can be stopped with systematic treatment. Your goal is to preserve the affected tooth or teeth in the long term. This includes preventing the inflammation from spreading to deeper areas of the tooth support system and reducing the depth of the gingival pockets that have formed.

In general, bacterial deposits, deposits in the gum pockets and possibly damaged gum tissue are removed during the treatment.

Therapy can include several steps, depending on the degree of inflammation. The “open”, that is to say surgical, treatment is only required, for example, in the case of more advanced periodontitis. Additional measures are also available for supplementary treatment.

The treatment steps:

1. Hygiene phase (initial phase)

In the case of inflammation in the initial stage, improved oral hygiene for the patient and one or more professional tooth cleanings [LINK] at individually defined intervals are usually sufficient. Soft (bacterial) deposits and deposits are removed from the tooth surfaces and on the gumline. The polishing and fluoridation of the tooth surfaces follow.

After this phase, the depth of the gingival pockets and the degree of inflammation usually decrease. Any subsequent treatment will also be more effective.

This pretreatment is carried out once or repeated as required. The aim is to significantly reduce the number of bacteria in the diseased areas.

2. Closed treatment (closed curettage)

If the periodontitis is not very advanced and the depth of the pockets is shallow, a so-called closed treatment can be used.

Bacterial plaque, tartar and other deposits above and below the gum line are removed manually with fine hand instruments (scaler and curette), if necessary with ultrasound instruments. In addition, the root and tooth neck surfaces are smoothed. If necessary, the gums are lifted a little away from the neck of the tooth.

3. Open treatment (open curettage)

For gingival pockets from a depth of about 5 to 6 mm and when the above-mentioned closed treatment has not led to the desired success, a so-called open treatment can be carried out. This procedure is also known as "flap surgery".

A part of the tooth root in the area of ​​the pocket is exposed through a small incision in the gum to make the diseased areas more accessible. The tooth neck and root areas are cleaned, smoothed and diseased gum tissue is removed. Then the gums are placed on the tooth and, if necessary, closed with the help of a fine suture.

The aim of the treatment is, among other things, the best possible reattachment of the gums to the tooth (attachment) and the reduction of the gum pocket depth.

Complementary measures:

Antibacterial therapy

If necessary, periodontal therapy can be supplemented with the use of antibacterial agents. These are placed in the gum pockets using a gel, for example.

The aim is to remove the bacteria that cause periodontal disease from the gingival pockets and the oral cavity. It can be used as a supplement if the periodontitis is particularly pronounced.

Ultrasound assisted treatment

Depending on the individual findings, bacterial plaque and hard deposits on the surfaces of the tooth necks and roots can be removed either additionally or exclusively with ultrasound devices. These have fine working tips that vibrate with more than 16,000 oscillations per minute and gently remove the bacterial coverings and deposits on the root surfaces.

Periodontal Risk Tests

In some cases it can be useful to determine the types of bacteria present in gingival pockets using a microbiological test. In the case of more stubborn inflammation, for example, the result is used to kill the bacteria with targeted antibacterial therapy.
Reconstruction of the tooth support system (regenerative therapy)

Advanced periodontitis can damage deeper-lying tooth retaining tissue such as the periodontal membrane surrounding the tooth root and the jawbone and thus loosen the affected tooth in its tooth socket. In order to stabilize it again, the tooth support system can often be rebuilt with regenerative measures.

Lost jawbones can be replenished with an appropriate bone structure, "soft" tooth retaining tissue through regenerative measures such as controlled tissue regeneration.

Bone formation through guided bone regeneration (GBR)

This is similar to the bone structure in implantology. The missing jaw bone substance is filled with the body's own bone or substitute material and covered with a membrane. The membrane prevents gums from growing in from the surface and enclosing the tooth like connective tissue. The slower growing fibers can form under the membrane in the periodontal membrane, which are important for a "healthy" periodontium. The membrane is automatically broken down by the body, it is not necessary to remove it.

The inserted bone substance stimulates the body to form new bone. This gradually replaces the inserted material. Usually a mixture of the body's own bone and substitute material is used.

Guided tissue regeneration (GTR)

Recent developments make it possible to specifically promote the build-up of the "soft" tooth retaining tissue (elastic fibers in the periodontal membrane, etc.). For this purpose, the properties of special growth enzymes ("enamel matrix proteins") are used, which play a role in tooth development in the womb.

These are applied to the damaged areas of the tooth support system using a gel and covered with a collagen membrane, as is the case with bone regeneration. The enzymes stimulate the formation of new tooth retaining tissue.

Follow-up care for periodontal disease

Periodontitis is not completely curable, but it can usually be brought to a standstill. This requires intensive follow-up care after the actual periodontal treatment. It can stop the inflammation from progressing and contributes to the long-term preservation of the teeth.

Dental care in the form of regular checks and professional tooth cleaning are of great importance. In this way, possible progression of the disease is recognized at an early stage and timely intervention is made possible. X-rays are taken if necessary and are used to assess the condition of the gums and jawbones.

In addition to dental aftercare, thorough oral and dental hygiene at home is important.

Prevention of periodontal disease

Periodontitis can be prevented with a number of in-house and dental measures.

1. Careful oral care

The most important thing you can do to prevent periodontal disease is to take good care of your mouth.

The more thoroughly bacterial plaque is removed, the fewer bacteria can permanently stick to the tooth surfaces and the gumline, the origin of periodontitis, and lead to inflammation. Places that are difficult to access, such as the spaces between the teeth, are particularly at risk and can be reached more easily with additional aids such as dental floss and interdental brushes.

Even if periodontitis has already been diagnosed, you can prevent further spreading with your own careful care and regular check-ups.

2. Regular checkups

Patients often go unnoticed about periodontitis because symptoms such as bleeding gums or pain do not always appear or are ambiguous.Therefore, the recommended six-monthly check-ups are very important.

Teeth and gums are thoroughly examined. If there are any first signs of periodontitis, measures such as professional tooth cleaning and optimized oral care can often prevent the inflammation from spreading in this early phase.

The earlier gum inflammation and the early stages of periodontal disease are detected, the easier these measures can be.

3. Professional tooth cleaning

In general, professional tooth cleaning (PZR) is recommended at regular intervals. This removes bacterial deposits and hard deposits such as tartar on the tooth surfaces and in the spaces between the teeth. At the same time, it reduces the number of bacteria in the entire mouth and the risk of inflammation. The teeth are then polished and smoothed and remineralized with a fluoride gel or varnish.

If your teeth and gums are healthy, we recommend about two professional tooth cleanings a year. In patients with periodontitis, shorter intervals are useful. These are individually tailored to each patient.

4. Limit smoking as far as possible or give up completely

Smoking leads to poor blood circulation in the gums and changes the oral flora. It is therefore a significant risk factor for diseases of the periodontium and all forms of inflammation.

Quitting smoking lowers the risk of developing periodontal disease and can prevent further progression if the inflammation is already present. Treatment is also made easier.

5. Follow symptoms carefully and have them clarified

Symptoms that indicate periodontal disease should be taken seriously and clarified by a dental check-up.

6. Periodontal risk tests (genetic tests)

With the help of genetic tests, it can be examined whether a patient has a hereditary (genetic) predisposition and thus an increased risk of developing periodontitis.

The results of the test can be used to tailor the preventive care individually to the patient, for example with more frequent check-ups, gum pocket measurements and professional tooth cleaning.

Frequently asked questions - FAQ:

Do I know for myself whether I have periodontitis?

Signs of periodontitis can include frequent bleeding gums, red, swollen gums, an unpleasant taste in the mouth and bad breath, loosening of the teeth and pain when biting open. However, these symptoms do not always appear or are not always clear. Most affected patients therefore fail to recognize periodontitis. The best way to clearly identify periodontal disease is to have a dental exam.

What do I have to pay attention to after the treatment?

Periodontitis is a chronic inflammation. It can be effectively halted with careful treatment, but after that, your careful oral hygiene and intensive dental follow-up care with regular checkups and professional teeth cleaning are essential.

Is periodontal disease the same as periodontal disease?

No, periodontitis (or "gum inflammation") is an inflammatory disease of the periodontium. The term periodontal disease describes a non-inflammatory regression of the gums. One possible cause for this is a hereditary predisposition. Too much pressure when brushing your teeth or too hard and worn toothbrushes usually intensify this receding gums.