What Causes Periodontal Disease?

Treatment of Periodontal Disease Marielaina Perrone DDS

What causes periodontal disease?

Periodontal disease progresses in stages across different forms. The beginning stage of periodontal disease is Gingivitis. Gingivitis is reversible with timely and proper treatment. If diagnosed and treated before progression, there will be no long-term effects. If it were to advance to the next stage, periodontitis, there would be long-term effects on your smile. These effects can include recession of gum tissue and loss of bone surrounding your teeth. Below we will discuss the causes of periodontal disease and how to bring it under control for good dental health.

What Causes Periodontal Disease?

Bacteria and Plaque are the main culprits. Periodontal disease is a chronic dental infection of the periodontal tissues immediately surrounding our teeth. This disease can result in the breakdown of the tissue and bone loss surrounding your teeth. Periodontal disease starts when bacteria and Plaque form a sticky film on the surface of your teeth. This film is an irritant to the surrounding tissues and causes inflammation of the periodontal tissues. Periodontal disease progress and become more advanced with time without proper dental intervention. Periodontal disease is the primary cause of tooth loss in adults. According to the Centers For Disease Control, it is estimated that approximately 65 million American adults have some form of periodontitis. For seniors aged 65 and older, rates increase to over 70%.

Bacteria That Causes Periodontal Disease

Periodontal disease and tooth decay are triggered by various types of oral bacteria and are considered separate and distinct oral diseases. However, they can work together to break down our teeth and gingival tissues if left untreated. Swollen and receding gums allow exposure to the more vulnerable areas (root areas). This exposure will lead to an increased incidence of tooth decay. On the flip side, in patients with extensive tooth decay, the broken down teeth allow for food trap areas that keep periodontal tissue chronically inflamed.

Periodontal Disease – Stages


The earliest stage of periodontal disease. Gingivitis is the inflammation of the periodontal tissues surrounding the teeth. Gingivitis is the mildest and earliest form of periodontal disease. It is completely reversible with professional dental care and the development of an excellent at-home dental hygiene regimen. Symptoms of Gingivitis include red, swollen gum tissue with inflammation and bleeding upon brushing, flossing, or even just eating. Often these symptoms go unnoticed by patients.

Bad breath may be another sign of the presence of periodontal disease. Unfortunately, there are only a few signs at this stage, and most are painless. These silent, painless symptoms are what make the periodontal disease so common. It is quiet until it is not. Periodontal disease does not typically break its “silence” until the fourth and final stage.

Early symptoms to watch out for include:

  • Chronic bad breath.
  • Swelling and redness of the gums.
  • Bleeding upon brushing or flossing.

Maintaining good overall dental hygiene and regular professional examinations can treat and reverse Gingivitis. Treatment can stop it from progressing further.

This is a crucial period for the patient. Gingivitis can be reversed (since the bone and connective tissue that hold the teeth in place have not yet been adversely affected) at this point. This is if it is recognized, diagnosed, and treated adequately by a dentist.

Gingivitis is commonly noted during puberty, pregnancy (also called pregnancy gingivitis), menopause, and times of high stress. Poor dental hygiene is typically the #1 cause, followed by medications and certain systemic medical conditions (like diabetes).


If treatment is not begun, the next phase is early periodontitis. Once this stage begins, the disease can be more challenging to control. In early periodontitis, the bone surrounding the teeth is now being affected. The bacteria will invade between the tooth and gums, causing connective fiber separation. The result is a periodontal pocket. Standard pocket depth should be about 3mm without the presence of inflammation.

These pockets will now read 4-5mm in depth and can get filled with bacteria, plaque, and food. This will begin to break down the bone below the gum line. Simple at-home dental hygiene maintenance will no longer be the only answer to bring your oral tissues back to health. Periodontitis signs include the following:

-increased redness or swelling of the gums 

-chronic bad breath

-bleeding upon brushing or flossing

-pocket depths between four and five millimeters.

Advanced Periodontitis 

This is where the actual destruction occurs. A minimum of 50% of bone support is lost. Teeth will begin to become mobile and shift if this has not already happened. Scaling and root planings and possibly surgical intervention are necessary to salvage your smile. 

These deeper cleanings may occur using a periodontal microscope (Perioscope), grafting of gum tissue or bone, placement of growth factors (Emdogain), periodontal antibiotic regimen (Periostat), placement of antibiotics directly into pockets (Arestin), open periodontal flap surgery, and, if all else fails even removal of teeth.

Options For Treatment

Fortunately, the beginning stages of periodontal disease are easily treated. Maintaining a good, at-home hygiene program (including brushing, flossing, and antibacterial mouthwash) is imperative.

Seeing your dentist as recommended is also important to halt the development of Gingivitis in its tracks. Falling short of the above steps will allow the periodontal disease to advance unchecked, leading to loss of teeth and possibly systemic health issues.

Treatment For Periodontal Disease Can Include The Following:

  • Pocket Reduction SurgeryA surgical procedure to reduce the depth of the periodontal pockets around your teeth. This will give you an increased ability to keep the areas clean at home. The surgery consists of tiny incisions in your gum tissues so that a section of gingival tissue can be lifted back, exposing the roots for better visual and more effective teeth cleaning.
  • Because periodontitis often leads to bone loss, your dentist may recontour the supporting bone tissue before the gum tissue closes back up. This periodontal surgery can take anywhere from 1-3 hours and is typically performed using local anesthesia.
  • -Periodontal Tissue Grafts. Gum tissues are often lost due to gum disease. When the gums recede, your teeth will begin to appear longer than normal as exposure to root surfaces occurs. You may need to have damaged tissue replaced for esthetic as well as functional reasons. Root surfaces are not protected by enamel. These exposed roots can cause extreme tooth sensitivity.
  • This gum tissue grafting procedure can help reduce further gum recession, protect exposed roots and give your teeth a more esthetic lift.
  • Bone graft. The use of bone grafts helps prevent tooth loss by increasing the support structure around your teeth. It also serves as a scaffold for natural bone regrowth.
  • Antibiotics and Antibacterial Medications – These medications will help heal and remove harmful bacteria from in and around our teeth. These include:
  • -Peridex – Prescription antibacterial rinse.
  • -Periostat – Oral antibiotic.
  • Arestin – Antibiotic placed directly into the periodontal pocket to help aid in healing.
  • Chlorhexidine – A prescription antibacterial mouthwash. Chlorhexidine is used for bacteria control when treating gum disease and following surgery. Patients are given instructions to use it as they would a regular mouthwash.
  • -Guided Tissue Regeneration. This periodontal procedure helps to regrow destroyed bone. Your dentist will place a special piece of biocompatible fabric between the existing bone and your tooth.
  • The biocompatible material prevents unwanted tissue from entering the healing area, creating a stable environment allowing bone to grow. The goal is to regenerate periodontal tissue and repair defects that have resulted from the development of periodontitis.
  • -Enamel Matrix Derivative Application. Another technique involves the application of a specialized gel to a diseased tooth root. This gel contains the same proteins found in developing tooth enamel and stimulates the growth of healthy bone and tissue. An example of this is the use of emdogain.


Periodontal disease, if left untreated, can cause aggressive destruction of your smile. Regular dental visits can help prevent periodontal disease from developing. A good way of looking at this is that it is far cheaper and less painful to go to your dentist every six months than it is to wait for periodontal disease to develop and chase after a healthy smile. Visit your dentist regularly for a happy, healthy smile.

Contact Marielaina Perrone DDS at (702) 458-2929 to schedule a no-cost cosmetic consultation appointment if you are ready for a smile makeover. We cannot wait to help you with your smile makeover to create the smile of your dreams in Summerlin, Henderson, and Las Vegas, NV.