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Periodontitis or pyorrhea: causes, symptoms, treatment and periodontal charting

13 January · 4 minutes

Periodontitis is a disease that, if not treated in time, can be quite harmful. Understanding this gum disease and how to prevent and treat it are essential to maintaining good oral health.

What is periodontitis?

For those wondering what periodontal disease is, periodontitis, commonly known as "pyorrhea", is a gum disease that affects the periodontal ligament and bone, causing the teeth to lose their attachment. Although the mobility of the tooth isn’t always affected initially, it worsens over time and tends to be an issue in cases of advanced periodontal disease.

Patients can stop the deterioration with treatment in early periodontitis but, unlike gingivitis, it is not reversible. The degree in which the tooth has become detached from the bone can not be reversed. This is why periodontal disease must be treated as soon as possible, if not, you can lose teeth in the most advanced stages.

Periodontitis Stages

Periodontal disease progresses in stages. There are different periodontal classifications depending on their level of aggressiveness. The severity of the diagnosis should be determined by your periodontist based on the loss of periodontal attachment (separation of the gum from the tooth) that has occurred. Additionally, it’s important to remember that periodontitis is a recurrent disease, so a follow-up is necessary after treatment.

Dentist showing and explaining a dental x-ray to a patient.

Early or mild periodontitis

Mild or early stage periodontitis can be measured by a loss of periodontal attachment that falls between 1-2 mm. It is the first stage of pyorrhea and, is therefore, the least aggressive stage.

Moderate periodontitis

Moderate periodontal gum disease displays a loss of bone level of between 3 and 4 mm. In this intermediate stage there may already be some tooth mobility which should be noted in the periodontal disease diagram.

Severe or advanced periodontitis

Severe periodontitis is the latest stage of periodontal disease. In this case, your periodontist will be able to detect more than 5 mm of lost attachment with a periodontal probe. If the case of periodontal disease is very advanced, the patient can have considerable tooth mobility and may even lose teeth.

What causes periodontitis

The list of periodontal disease causes is made up of several factors:

  • To start, the accumulation of microbial plaque or dental tartar due to poor brushing is one of the most frequent periodontitis causes.
  • Additional causes of periodontal disease consist of a variety of bad habits such as smoking, having a poor diet, and stress. These are risk factors that can trigger or aggravate periodontitis.
  • Genetics are also a determining factor in the development of this disease.
  • Lastly, systemic diseases such as Diabetes with poor glucose control can also trigger periodontal gum disease.

Periodontitis symptoms

The signs and symptoms of periodontal disease may vary. The gums can become inflamed, bleed, or change in color (turning bright red, dark red, or even purple). Other symptoms of periodontal disease or pyorrhea are:

  • Pain when chewing
  • Bad breath
  • Tooth mobility
  • Drainage from periodontal abscesses
  •  Receding gums
  • Increased interdental spaces
A patient feeling discomfort from oral pain or sensitivity. 

How to treat periodontitis

The first step in periodontitis treatment is performing a periodontal study. Using a periodontal probe, the level of gum recession is assessed and noted in the periodontal disease diagram. This recession is caused by the formation of periodontal pockets in which bacteria accumulate and cause periodontal abscesses. Before determining a specific treatment for periodontal disease or pyorrhea, the specialist will also perform X-rays to assess the loss of dental bone.

Then your dentist will proceed by performing an oral cleaning to remove accumulated bacteria. This cleaning is done by scaling and root planing, which is also referred to as periodontal or gingival curettage. A prescription for antibiotics may also be necessary to finish eliminating the bacteria that may have accumulated in the periodontal abscesses. If periodontitis is very advanced, it can be necessary to resort to surgical treatments for periodontal disease such as soft tissue or bone grafting, among others.

A dental professional explaining a periodontal chart to a patient.

Periodontal care

In order to maintain good periodontal health, you should go to the dentist every 4 or 6 months for a check-up and, if necessary, perform a maintenance gingival curettage. As we have mentioned, you should also maintain good oral hygiene by brushing and flossing after meals. A generally clean mouth is the key to successful periodontal care.

How to prevent periodontal disease

Maintaining good oral hygiene is essential to the prevention of periodontal gum disease. Immediately after each meal, you should brush and use dental floss or an interproximal brush in the case of larger interdental spaces. Keeping the periodontal pockets free of harmful bacteria is of the utmost importance, so in addition to daily dental hygiene, it is recommended to visit the dentist for a professional cleaning at least once a year. Furthermore, to prevent periodontal disease, you should avoid habits that are bad for your health such as smoking, poor diet, and stress.

Orthodontic treatment in periodontal patients

Having good periodontal health is vital to the success of any orthodontic treatment. Although periodontal disease and braces or aligners are not incompatible, all orthodontic treatments cause the teeth to move, and if due to periodontal disease the teeth are not firmly attached to the bones, it could lead to complications.

An orthodontist checking and fitting aligners to a patient.

Periodontitis, periodontal charting, and invisible orthodontics at Impress

Orthodontic treatment in periodontally compromised patients can be a complicated issue. Thus, at Impress, if during the first visit we detect that the patient suffers from or is susceptible to periodontal disease, we advise periodontal charting. This is one of the most common pretreatments among our patients, it includes a periodontal chart and periodontal disease diagram.

This chart should be administered by a periodontist who, with a periodontal probe, will record the attachment loss of each tooth on each of its faces. In periodontal charting, the professional uses the data collected to determine if the patient is suited for an orthodontic treatment.

At Impress we ensure that each patient starts their invisible orthodontic treatment with the best possible oral health. We have the latest medical technology, the best professionals, and in some of our clinics, we get help from experienced periodontists who can best detect and treat periodontitis.

So if you want to improve your oral health and change your smile, get in touch with us here at Impress. We‚Äôll inform you about our prices, orthodontic treatments, and pre-treatments available at your nearest Impress clinic. You can make an appointment through our website, by phone or WhatsApp at +44 20 3808 1072, or by sending an email to

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Frequently asked questions about periodontitis

How do I know if I have periodontitis?

Not sure how to know if you have periodontitis? Visit a specialist. There, they will perform the appropriate tests and give you further treatment instructions in the case you suffer from periodontal disease.

Gingivitis vs periodontitis - what’s the difference?

Although both are periodontal gum diseases, the main difference between gingivitis and periodontitis is that in gingivitis there is inflammation and bleeding of the gums but no recession or bone loss, which is the case with periodontitis.

Can periodontitis be cured?

Yes, periodontitis has a cure. But before treating it, you should go to your dentist to perform a periodontal report so they can determine the stage of progression. It should be noted, however, that periodontal disease can be stopped, but not reversed.

Is periodontal disease contagious?

Yes, periodontitis can be spread from one person to another. Since the cause of periodontitis is the accumulation of pathogenic bacteria in the periodontal pockets, that bacteria can migrate when it comes into contact with the oral cavity of another person.

I have periodontal disease, can I get braces or aligners?

Yes, patients with periodontitis are eligible to receive orthodontic treatment but it’s always at the discretion of the periodontist to decide if it is viable or not. If so, the patient’s follow-ups should be more detailed and frequent both in the orthodontic clinic and by the periodontist.

Is periodontitis reversible?

No, periodontitis is not a reversible disease. With the correct periodontal treatment, its progress can be slowed, but the lost bone can not be recovered.


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