Periodontitis is a chronic inflammation of the tooth-supporting tissues — 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 all the way to tooth loss.¹
Periodontitis is one of the most common chronic conditions worldwide and the leading cause of tooth loss in adults. It typically develops slowly and painlessly — which is why it is often only recognised late.¹,²
Important: periodontitis is not the same as gingivitis
Gingivitis (gum inflammation) only affects the gums and is fully reversible. In periodontitis, the bone is also involved — lost bone typically does not grow back. Early detection and treatment are therefore essential.
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
Red, swollen gums
Receding gums — teeth appear longer
Bad breath (halitosis) — caused by bacteria in the gum pockets
Gum pockets — the space between tooth and gum deepens
Loose teeth — a late sign; means advanced bone loss
Tooth migration — teeth shift, gaps appear
Pus formation at the gum line
Bleeding gums are not normal
Even if it doesn't hurt — regular bleeding gums should be checked by a dental professional.
3. Causes and risk factors
Bacterial biofilm (plaque): the main cause. Bacteria form a film on the tooth surfaces and below the gum line. If plaque is not removed regularly, inflammation develops.¹
Calculus (tartar): hardened plaque. Can no longer be removed by brushing — must be removed professionally.
Smoking: the strongest modifiable risk factor. Smokers have a substantially higher risk of periodontitis, the disease runs more severely and treatment responds less well. Bleeding gums can be masked by smoking.¹
Diabetes: diabetes and periodontitis affect each other: diabetes increases the risk of periodontitis, and periodontitis can worsen blood glucose control.¹
Genetics: familial predisposition plays a role — some people are more susceptible despite good oral hygiene.
Stress: can weaken the immune system and worsen oral hygiene routines.
Basic Periodontal Examination (BPE / PSI): a quick examination with a special probe at every dental check-up. Measures pocket depth and tendency to bleed.
Full periodontal charting: when periodontitis is suspected: detailed measurement of pocket depths at six sites per tooth, assessment of bone loss, bleeding, tooth mobility.
X-rays: show bone loss. Periapical or panoramic radiographs.
2018 classification: periodontitis is classified by stage (I–IV, severity) and grade (A–C, rate of progression). This classification determines the treatment approach.¹
5. Treatment
Periodontitis treatment follows a stepwise concept in line with the EFP S3 Clinical Practice Guideline.¹
Step 1Cause control & oral hygiene
Professional cleaning — removal of plaque and calculus
Individual oral hygiene instruction and motivation — the most important component; without good home oral hygiene, any treatment is unsuccessful long-term
Address risk factors: stop smoking, optimise diabetes control
Step 2Subgingival instrumentation
The core procedure of periodontitis treatment: the root surfaces below the gum line are cleaned with special instruments (hand or ultrasonic instruments) to remove bacteria and calculus from the gum pockets. The procedure is typically performed under local anaesthetic and is generally well tolerated.¹
Step 3Surgical therapy
For deep residual pockets that do not respond sufficiently to step 2, surgical procedures may be considered:
Flap surgery — access to the bone
Regenerative procedures — bone augmentation with biomaterials
Resective procedures
Antibiotics only in specific situations
Systemic antibiotics are typically used only as an adjunct (e.g. with aggressive courses or in younger patients with generalised periodontitis). They are not a replacement for mechanical cleaning.¹
6. Aftercare (supportive periodontal therapy)
Supportive periodontal therapy (SPT) is the key long-term component. Without regular aftercare, periodontitis typically recurs.¹
Regular check-ups at the dental practice — typically every three to six months, depending on severity
Professional cleaning and re-cleaning of gum pockets
Review and re-motivation of home oral hygiene
7. Periodontitis and general health
Periodontitis is not just a problem of the mouth. The chronic inflammation can affect the whole body.¹
Diabetes — mutually worsening; treating periodontitis can improve blood glucose control
Cardiovascular disease — periodontitis is associated with an increased risk of heart attack and stroke
Rheumatoid arthritis — connections are increasingly being discussed
Respiratory conditions — bacteria from the mouth can promote lung infections
8. Daily life and prevention
Brushing: at least twice a day thoroughly — electric toothbrushes can improve cleaning. Don't press too hard.
Interdental cleaning: daily — with interdental brushes (first choice) or floss. Most plaque forms there.
Regular check-ups: at least once a year for a dental check-up — don't forget the basic periodontal screening.
Professional cleaning: regularly (typically once or twice a year, more often with periodontitis).
Stop smoking: the most effective single measure for improving oral health in smokers.
Diabetes control: good blood glucose control improves oral health and vice versa.
How brite helps you with periodontitis
SPT every three to six months, adjunctive antibiotics short term only, chlorhexidine mouth rinse after subgingival instrumentation — periodontitis treatment is a marathon, not a sprint. brite helps maintain the routine over years.
Intake reminder — an adjunctive antibiotic course after step 2, a time-limited chlorhexidine rinse, tablets when systemic support is needed: brite reminds you on time so nothing is forgotten or stopped too early.
Drug interaction check — antibiotics (e.g. amoxicillin + metronidazole for aggressive periodontitis) plus the pill (can affect contraceptive reliability)? Plus blood thinners? Plus thyroid medication? brite shows the critical combinations.
Health journal — track SPT appointments, bleeding gums, HbA1c if diabetes is involved, and the oral hygiene routine over time. At the next dental appointment, show the real picture — what's working and what's not.
Digital medication plan — all medications clearly organised for dental and general practice. Some agents (e.g. bisphosphonates, anticoagulants, immunosuppressants) are particularly important to know about before dental surgical procedures.
No. Regular bleeding gums are typically a sign of gum inflammation (gingivitis) or periodontitis and should be assessed by a dental professional. Healthy gums do not bleed when brushing.
Periodontitis can typically be stopped but not fully cured — lost bone usually does not grow back (exception: regenerative procedures in certain situations). Early detection is therefore essential. With consistent treatment and aftercare, the condition can be controlled long-term.¹
Gingivitis is gum inflammation without bone loss — fully reversible. Periodontitis also involves the bone — bone loss is typically not reversible. Gingivitis can progress to periodontitis if left untreated.
For periodontitis, typically every three to six months (supportive periodontal therapy). Intervals are set individually — depending on severity and response to treatment. Aftercare is the key long-term component.¹
For most people yes — interdental brushes typically clean the spaces between teeth more effectively than floss. The size must be individually fitted. Floss can be useful for very tight spaces.
Yes — periodontitis and diabetes affect each other. Diabetes increases the risk of periodontitis, and periodontitis can worsen blood glucose control. Treatment of periodontitis can improve HbA1c.¹
Mouthwashes (e.g. with chlorhexidine) can be used as an adjunct but do not replace mechanical cleaning (toothbrushing, interdental brushes). Chlorhexidine should typically not be used long term (staining, taste changes).
Smokers have a substantially higher risk of periodontitis, the disease runs more severely and treatment responds less well. Smoking can also mask bleeding gums, which delays diagnosis. Stopping smoking is the most effective single measure.¹
American Academy of Periodontology (AAP). perio.org
Medical disclaimer: This article is for general information only and does not replace dental advice, diagnosis or treatment. Periodontitis typically requires professional treatment and regular aftercare at a dental practice. Last updated: April 2026.
