Periodontitis is a chronic inflammation of the tooth-supporting apparatus — that is, the gums, the bone and the connective tissue that anchor the tooth in the jaw. Untreated, periodontitis leads to progressive bone loss and can loosen teeth, up to tooth loss.¹
Periodontitis is one of the most common chronic diseases worldwide and the main cause of tooth loss in adults. It usually develops gradually and painlessly — which is why it is often recognized only late.¹,²
Important: periodontitis is not the same as gingivitis
Gingivitis (gum inflammation) affects only the gums and is fully reversible. With periodontitis, the bone is involved too — lost bone usually does not grow back. That is why early recognition and treatment are crucial.
2. Symptoms
Periodontitis causes no pain for a long time — that is what makes it so insidious. Watch out for the following signs:
Bleeding gums — when brushing, when flossing or spontaneously; the most common early sign
Reddened, swollen gums
Gum recession — the teeth appear longer
Bad breath (halitosis) — from the bacteria in the periodontal pockets
Periodontal pockets — the gap between tooth and gum deepens
Loose teeth — a late sign; already means advanced bone loss
Tooth migration — teeth shift, gaps appear
Pus formation at the gum
Bleeding gums are not normal
Even if it doesn't hurt — regular bleeding gums should be evaluated at the dental practice.
3. Causes and risk factors
Bacterial biofilm (plaque): the main cause. Bacteria form a film on the tooth surfaces and beneath the gumline. If the plaque is not removed regularly, inflammation develops.¹
Tartar: hardened plaque. Can no longer be removed by brushing — it has to be removed professionally.
Smoking: the strongest modifiable risk factor. Smokers have a markedly higher risk of periodontitis, the disease runs more severely and responds less well to treatment. Bleeding gums can be masked by smoking.¹
Diabetes:diabetes and periodontitis influence each other: diabetes increases the risk of periodontitis, and periodontitis can worsen blood sugar control.¹
Genetics: a familial predisposition plays a role — some people are more susceptible despite good oral hygiene.
Stress: can weaken the immune system and worsen oral hygiene.
Periodontal Screening Index (PSI): a quick examination with a special probe that can be carried out at every dental check-up. It measures the depth of the periodontal pockets and the tendency to bleed.
Periodontal status: when periodontitis is suspected: detailed measurement of pocket depths at six sites per tooth, assessment of bone loss, bleeding, tooth mobility.
X-ray: shows the bone loss. Single-tooth images or a panoramic X-ray.
New classification (2018): periodontitis is classified by stage (I–IV, severity) and grade (A–C, rate of progression). This classification determines the treatment concept.¹
Periodontitis treatment follows a stepwise concept in line with the current S3 guideline (DG PARO/DGZMK, 2021).¹
Step 1Removing the cause & oral hygiene
Professional dental cleaning — removal of plaque and tartar
Individual oral hygiene instruction and motivation — the most important building block; without good home oral hygiene, any treatment is unsuccessful in the long run
Address risk factors: stopping smoking, optimizing diabetes control
Step 2Subgingival instrumentation
The core procedure of periodontitis treatment: the root surfaces are cleaned beneath the gumline with special instruments (hand or ultrasonic instruments) to remove bacteria and tartar from the periodontal pockets. The procedure is usually carried out under local anaesthesia and is generally well tolerated.¹
Step 3Surgical therapy
With deep residual pockets that do not respond sufficiently to step 2, surgical procedures can be considered:
Flap surgery — access to the bone
Regenerative procedures — bone build-up with biomaterials
Resective procedures
Antibiotics only in certain situations
Systemic antibiotics are usually used only as a supplement (e.g. with an aggressive course or in young people with generalized periodontitis). They are not a substitute for the mechanical cleaning.¹
6. Follow-up (UPT)
Supportive periodontal therapy (in Germany "UPT") is the decisive long-term building block. Without regular follow-up, periodontitis usually deteriorates again.¹
Regular check-up appointments at the dental practice — usually every three to six months, depending on severity
Professional dental cleaning and re-cleaning of the periodontal pockets
Review and re-motivation of home oral hygiene
Covered by statutory health insurance since July 2021
Since July 2021, supportive periodontal therapy (UPT) has been a benefit of statutory health insurance in Germany. It requires a prior application to the health insurer by the dental practice.
7. Periodontitis and general health
Periodontitis is not just a problem of the mouth. The chronic inflammation can affect the whole body.¹
Diabetes — mutual worsening; treating periodontitis can improve blood sugar control
Cardiovascular disease — periodontitis is associated with an increased risk of heart attack and stroke
Rheumatism — a connection with rheumatoid arthritis is increasingly being discussed
Respiratory diseases — bacteria from the mouth can promote lung infections
8. Everyday life and prevention
Brushing: thoroughly at least twice a day — electric toothbrushes can improve cleaning. Don't press too hard.
Interdental spaces: clean daily — with interdental brushes (first choice) or dental floss. That is where most plaque forms.
Regular check-ups: at least once a year for a dental check-up — don't forget the PSI screening.
Professional dental cleaning: regularly (usually once or twice a year, more often with periodontitis).
Stopping smoking: the most effective single measure for improving oral health in smokers.
Controlling diabetes: good blood sugar control improves oral health, and vice versa.
How brite helps you with periodontitis
UPT every three to six months, supplementary antibiotics only for a short time, a chlorhexidine mouthwash after the subgingival instrumentation — periodontitis treatment is a marathon, not a sprint. brite helps you keep the routine going over the years.
Medication reminder — a supplementary antibiotic course after step 2, a time-limited chlorhexidine rinse, tablets with systemic accompaniment: brite reminds you on time so that nothing is forgotten or stopped too early. Set up a reminder
Interaction check — antibiotics (e.g. amoxicillin + metronidazole for aggressive periodontitis) plus the pill (can impair the contraceptive effect)? Plus blood thinners? Plus thyroid hormones? brite shows the critical combinations. Check now
Health history — document UPT appointments, bleeding gums, HbA1c with accompanying diabetes and your oral hygiene routine over time. At your next dental appointment, be able to show the real course — what works and what doesn't. Track your history
Digital medication plan — all your medications clearly laid out for dentistry and your family doctor. Some agents (e.g. bisphosphonates, anticoagulants, immunosuppressants) are especially important to know about before dental surgical procedures. Go to medication plan
No. Regular bleeding gums are usually a sign of gum inflammation (gingivitis) or periodontitis and should be evaluated by a dentist. Healthy gums do not bleed when brushing.
Periodontitis can usually be stopped but not fully cured — lost bone mostly does not grow back (exception: regenerative procedures in certain situations). That is why early detection is so important. With consistent treatment and follow-up, the disease can be controlled over the long term.¹
Yes — in Germany, systematic periodontitis treatment (steps 1 and 2) and, since July 2021, also supportive periodontal therapy (UPT) are benefits of statutory health insurance. It requires a prior application to the health insurer by the dental practice.
Gingivitis is gum inflammation without bone loss — fully reversible. Periodontitis also affects the bone — the bone loss usually cannot be reversed. Gingivitis can progress to periodontitis if it is not treated.
With periodontitis, usually every three to six months (UPT). The intervals are set individually — depending on severity and response to treatment. The follow-up is the decisive long-term building block.¹
For most people yes — interdental brushes usually clean the spaces between the teeth more effectively than dental floss. The size has to be adjusted individually. Dental floss can be useful with very narrow spaces.
Yes — periodontitis and diabetes influence each other. Diabetes increases the risk of periodontitis, and periodontitis can worsen blood sugar control. Treating the periodontitis can improve the HbA1c.¹
Mouthwashes (e.g. with chlorhexidine) can be used as a supplement but do not replace mechanical cleaning (brushing, interdental brushes). Chlorhexidine should usually not be used continuously (discolouration, taste changes).
Medical disclaimer: This article is for general information and does not replace dental advice, diagnosis or treatment. Periodontitis usually requires professional treatment and regular follow-up at the dental practice. Last updated: April 2026.
