Periodontitis is gum inflammation that has extended into the bone supporting the teeth. The bone that is lost does not come back. Treatment stops the process and stabilises what remains — which, if it is caught before too much has gone, means keeping your teeth.
It is the leading cause of tooth loss in adults, and it is almost entirely painless until it is advanced. That combination is what makes it dangerous.
How it progresses
It starts as gingivitis — inflammation at the gum margin. In susceptible people it goes further: the fibres attaching gum to tooth break down, and the bone begins to resorb.
As the attachment is lost, the crevice between gum and tooth deepens into a pocket. Beyond about three millimetres you cannot reach the bottom of a pocket with a toothbrush or floss, so plaque accumulates there undisturbed and hardens into tartar. That drives further inflammation, which deepens the pocket further, which makes it less cleanable still.
The process is self-sustaining, which is why it does not resolve with better brushing once it has started. It also tends to progress in episodes rather than steadily, with periods of activity separated by quiet phases.
The signs
Early on, the only sign may be bleeding — identical to gingivitis. Later:
- Gums receding, teeth looking longer.
- Black triangles appearing between teeth where the gum used to fill the space.
- Persistent bad breath or a bad taste.
- Teeth drifting, gaps opening, or a change in how your teeth meet.
- Loose teeth.
- Sensitivity from exposed root surfaces.
- Occasional swelling or a gum abscess.
- Pus from the gum margin.
Note what is missing from that list: pain. Patients frequently arrive because a tooth has become loose, having had no symptoms that prompted concern for years.
How it is diagnosed
A periodontal assessment measures pocket depths around every tooth and records where bleeding occurs on probing. Radiographs show the bone level directly and, crucially, allow comparison with earlier images — which is what distinguishes historical damage from active disease.
Ask for your pocket depths. Numbers of 4 mm and above indicate pockets; 6 mm and above indicates significant loss. See what is gum disease.
What treatment involves
Non-surgical treatment first
Scaling and root planing — thorough cleaning of the root surfaces below the gum line, under local anaesthetic, usually over several appointments. This removes the deposits driving the inflammation. See scaling and root planing explained.
Alongside it: detailed instruction in cleaning the specific areas that are affected, and addressing the risk factors that are modifiable — smoking above all.
Reassessment
Six to twelve weeks later, the pockets are measured again. Most respond well. Where deeper pockets remain, further treatment is considered.
Surgical treatment where needed
Access surgery allows the root surfaces of deep pockets to be cleaned directly. In selected defects, regenerative techniques can restore some bone. These are used where non-surgical treatment has not achieved stability, not as a first step.
Maintenance, permanently
This is the part that determines the long-term outcome. Professional cleaning at intervals shorter than standard — commonly every three to four months — with pockets remeasured periodically. Patients who complete treatment and then return to six-monthly visits frequently relapse. See periodontal maintenance visits.
What treatment can and cannot do
Can: stop the disease progressing; reduce pocket depths as inflammation resolves and tissue tightens; eliminate bleeding; remove the infection; keep teeth that appeared doomed; in selected cases regenerate some bone.
Cannot: regrow bone generally; reverse recession; restore gum that has been lost between teeth; make the susceptibility go away.
Recession and black triangles that follow successful treatment are not a sign it failed — they are the swelling going down and revealing what was already lost. It is worth being told this beforehand, because patients often find their teeth look worse after treatment that has in fact worked.
The risk factors that decide the outcome
Smoking. The strongest modifiable factor. Smokers respond less well to treatment and lose more teeth. Stopping measurably changes the prognosis, at any stage.
Diabetes control. The relationship runs both ways: poorly controlled diabetes worsens periodontitis, and periodontitis makes glycaemic control harder.
Plaque control at home. Professional treatment cleans the pockets; daily cleaning is what keeps them clean.
Attending maintenance appointments.
See who is at higher risk of gum disease.
If teeth are already loose
Not all loose teeth are lost. Mobility caused by inflammation often improves once the inflammation resolves. Mobility caused by substantial bone loss usually does not, though such teeth can sometimes be retained for years, splinted where appropriate.
Where a tooth genuinely cannot be kept, the periodontal condition must be stabilised before any replacement — an implant placed into an unstable mouth is at high risk of peri-implantitis.
Frequently asked questions
Will I lose my teeth?
Not necessarily. Many patients with moderate periodontitis keep their teeth for life once it is stabilised and maintained.
Is it painful to treat?
Local anaesthetic is used. Gums are often tender and teeth sensitive for a few days afterwards.
Can I have orthodontics or veneers?
Only once the condition is stable, and then with ongoing monitoring.
My previous dentist never mentioned it.
It is frequently under-diagnosed because it is silent. What matters now is the current assessment and a baseline to measure against.
Do antibiotics help?
They are used as an adjunct in certain cases, not as a substitute for removing the deposits mechanically.
Get a full periodontal assessment
Pocket depths and bone levels are measurements, not opinions. See our gum and periodontal care page.
To arrange a consultation at our clinic on Abbas El-Akkad in Nasr City, call +20 101 969 7597 or message us on WhatsApp.
