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Periodontitis is an infectious and inflammatory disease that gradually destroys the periodontium, meaning all the tissues that support the tooth: the gums, bone, and ligaments. Managed through periodontics, the dental specialty dedicated to the gums, it is easier to treat when detected early. Treatment follows a clear process: clean below the gumline, control the infection, and then stabilize the condition over time. Here is how it works, step by step, and when to seek care.
Key points to remember
- Periodontics is the specialty that treats the periodontium (gums, bone, and ligaments); periodontitis is the disease that progressively destroys it.
- The first warning sign is gums that bleed during brushing, often accompanied by bad breath or the beginnings of gum recession.
- The main cause is the buildup of dental plaque and tartar below the gumline, worsened by smoking and diabetes.
- Treatment begins with scaling followed by root planing (cleaning the roots below the gumline); advanced cases may require surgery or laser treatment.
- If left untreated, periodontitis can lead to tooth loss: only a dentist or periodontist can diagnose it and oversee treatment.
- Prevention relies on thorough brushing, daily interdental cleaning, and regular checkups.
Periodontics or periodontitis: what are we talking about?
Periodontics (or periodontology) is the branch of dentistry that deals with the periodontium, the tissues that support the teeth. Periodontitis, on the other hand, is the disease: a bacterial infection that inflames the gums and then affects the bone and ligaments. It is an advanced stage of gum disease, much more serious than simple gingivitis. To fully understand this gum disease, from its causes to its prevention, consult our definitive guide to periodontitis.
It generally starts with gingivitis: the gums become red and bleed, but nothing has been destroyed yet. If plaque and tartar build up below the gumline, the inflammation spreads to the deeper tissues and becomes periodontitis. At this stage, bone loss is irreversible: the disease can be stopped, but what has been destroyed cannot spontaneously grow back. This is why receding gums should be addressed quickly.
Periodontics, periodontology, periodontist: who does what?
The terms are similar, and periodontics and periodontology are often used as synonyms. In practice, periodontics (or periodontology) refers to the same discipline: the dental specialty devoted to the periodontium, the tissues that hold the tooth in place. The distinction is mainly one of usage, with periodontics being the more common term for patients.
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Periodontology
The specialty that prevents, diagnoses and treats diseases of the periodontium: gingivitis, periodontitis and gum recession.
The dentist
They perform most periodontal treatments: assessment, scaling, root planing and maintenance follow-up.
The periodontist
A dentist specifically trained in periodontology, to whom patients are referred for complex cases, surgery and grafts.
What are the symptoms of periodontitis?
Periodontitis is silent and painless for a long time, making it all the more insidious. However, certain signs should prompt you to consult a dentist without delay.
Red and swollen gums
Healthy gums are pale pink and firm. Red, smooth and swollen gums indicate active inflammation.
Bleeding
Blood when brushing or biting into firm food is never normal: it is the earliest and most common sign.
Persistent bad breath
Persistent bad breath and a bad taste in the mouth often accompany infection of the gum pockets.
Gum recession
The gums recede, making the teeth appear longer, and the exposed tooth necks become sensitive to hot and cold.
Periodontal pockets
The gum pulls away from the tooth and forms a deep space where bacteria proliferate, measured by the dentist during probing.
Loose teeth
In advanced stages, bone loss causes the teeth to become loose; they may shift, become spaced apart or even fall out.
What are the causes and risk factors?
The direct cause of periodontitis is bacterial: dental plaque, the sticky film that constantly builds up on the teeth, mineralizes into tartar and infiltrates beneath the gums. Insufficient brushing is therefore the primary contributing factor. However, several factors accelerate the disease and worsen its severity.
- Smoking: the leading preventable risk factor, it reduces blood flow to the gums, masks bleeding and decreases treatment effectiveness.
- Diabetes: poorly controlled diabetes promotes inflammation; the relationship is reciprocal, as periodontitis itself disrupts blood sugar levels.
- Genetic predisposition: with the same level of hygiene, some people develop more aggressive forms.
- Hormonal changes: pregnancy, puberty and menopause weaken the gums.
- Stress, certain medications and an unbalanced diet: they weaken local defenses and promote inflammation.
How is periodontitis treated?
The treatment aims to free the teeth and gums from inflammation and prevent further deterioration. It progresses from least invasive to most invasive: it begins with deep cleaning, followed by reassessment, and surgery is only considered if the pockets persist. Here is the usual process.
- Assessment and diagnosis. The practitioner measures pocket depth (periodontal probing), assesses bleeding and mobility, and takes X-rays to evaluate bone loss.
- Scaling and cleaning. Visible plaque and tartar are removed from above the gumline, and the patient is taught appropriate oral hygiene techniques.
- Root planing. The core of so-called “closed” treatment: under local anesthesia, the dentist cleans and smooths the roots beneath the gumline using curettes, ultrasonic instruments or a laser to prevent bacteria from attaching again.
- Antibiotics if necessary. In severe or aggressive forms, an oral antibiotic or one applied locally in the pocket may complement the cleaning.
- Periodontal surgery. If deep pockets remain, a procedure can clean inaccessible areas and, if necessary, regenerate the bone with a graft.
- Periodontal maintenance. Regular follow-up, often every three months at first, stabilizes the results over the long term.
Non-surgical treatment: scaling and root planing
Subgingival cleaning is the key to the initial phase. It involves removing bacterial plaque and tartar from beneath the gumline, around the necks of the teeth and on exposed roots. This is known as “closed” periodontal treatment because the gum is not opened: the dentist cleans the pockets under local anesthesia using fine instruments (curettes and scalers), an ultrasonic device or a laser, then smooths the root surfaces. A professional dental cleaning often completes this step, with polishing and fluoride treatment.
A basic treatment is often enough to stop the inflammation. In severe cases, antibiotic therapy may be added, either in tablet form or as a local application (gel or ointment) directly into the pocket. A bacteriological test can sometimes help identify the most suitable antibiotic.
Surgical treatment
It becomes necessary when the pockets remain deep despite root planing, or when the disease has already caused extensive damage. It combines deep cleaning and, if necessary, tissue regeneration.
- The practitioner opens the pocket through a small incision under local anesthesia to access the infected areas.
- It cleans the exposed roots and removes diseased tissue, then sutures the area so that the gum can reattach to the tooth.
- When the bone is severely damaged, a bone graft (taken from the patient or sourced from a tissue bank) can improve the existing structure; however, complete regeneration remains impossible.
The benefits of laser treatment in periodontics
More and more dental practices offer laser treatment as a supplement to root planing. In periodontics, it is primarily used to disinfect pockets, reduce the bacterial load and promote tissue healing. Its advantage: a procedure that is often more comfortable, with less bleeding after the session.
However, the laser does not replace mechanical root cleaning, which remains the foundation of treatment. It is used as a supplement, when indicated by the practitioner, and its cost is generally added to that of root planing. To date, no study supports presenting it as a standalone treatment for periodontitis.
Follow-up: why periodontal maintenance is essential
Periodontitis is a chronic disease: once stabilized, it requires long-term monitoring. When the gums have receded, the necks and roots, lacking protective enamel, become more susceptible to cavities. Structured follow-up, known as periodontal maintenance, prevents relapses.
This follow-up combines impeccable daily hygiene, check-up visits and regular professional cleaning, sometimes several times a year. Appointments, often every three months at first, make it possible to check the condition of the pockets and monitor risk factors such as smoking and diabetes.
How much does periodontal treatment cost, and is it reimbursed?
The cost of periodontal treatment varies greatly depending on the stage of the disease and the number of sessions required. The key point to understand: only part of this care is covered by the French Health Insurance system, making the estimate and supplemental health insurance decisive.
- Scaling is reimbursed by the French Health Insurance system based on an agreed fee: it is the periodontal treatment with the highest level of coverage.
- Root planing and pocket treatment are, in most cases, not reimbursed by the basic health insurance scheme and require an estimate.
- Periodontal surgery and grafts represent the most expensive item and are most often covered only by supplemental health insurance, if covered at all.
How can periodontitis be prevented every day?
The best weapon against periodontitis remains thorough oral hygiene, which prevents plaque from settling below the gum line. Three steps form the foundation of prevention.
- Thorough brushing twice a day. The goal is to clean every surface of the teeth, including along the gum line, without irritating it. Learning how to brush your teeth properly makes all the difference.
- Daily interdental cleaning. Interdental brushes, dental floss or a water flosser remove plaque where a toothbrush cannot reach, between the teeth and below the gum line.
- Regular dental visits. A professional cleaning and check-up can detect the disease before it progresses.
For brushing that is both effective and gentle on weakened gums, our Y-Brush sonic toothbrush cleans both arches simultaneously thanks to its filaments, already angled correctly: ten seconds per arch are enough, without pressing or scrubbing too hard. In addition, a water flosser helps rinse the spaces between the teeth and the gum line, a valuable benefit when the gums have receded.
Can periodontitis be treated with home remedies?
Salt-water mouth rinses, tea tree essential oil, baking soda or aloe vera gel: home remedies are widely discussed when it comes to gums. They may soothe mild inflammation and support daily hygiene, but they do not treat periodontitis.
The reason is simple: no home remedy reaches tartar lodged below the gum line or disinfects deep pockets, which are the source of the infection. Delaying a dental visit while relying on these tips allows the disease to progress and the bone to deteriorate. Natural remedies can complement oral hygiene, but never replace professional root cleaning.
When should you see a dentist or periodontist?
You should see a dentist as soon as the first signs appear: bleeding, swollen, or receding gums, persistent bad breath, loose teeth, or teeth that appear to be getting longer. The earlier treatment begins, the simpler it is and the more likely the teeth are to be preserved. Dentists treat most cases of periodontitis; they refer patients to a periodontist, a gum specialist, for complex or advanced cases.
