What are the symptoms of periodontitis?
In the early stage it hardly hurts at all, so it is often found late. If two or three of the following symptoms occur together, I suspect periodontitis.
- Bleeding when you brush or floss
- The gums are red and swollen, or feel puffy whenever you are tired
- Bad breath has become worse than before
- The teeth look longer and gaps have formed between them
- A tooth feels loose or lifted when you chew
The stage where there is inflammation only in the gums and the bone is fine is called gingivitis, and the stage where bone has started to break down is called periodontitis. Gingivitis returns to normal with good care, but bone lost to periodontitis mostly does not come back. So the goal of treatment is “to stop it from breaking down further.”
What causes periodontitis?
The direct cause is the bacterial film on the teeth (plaque) and the tartar it hardens into. When tartar works its way below the gumline, a toothbrush cannot reach it, inflammation continues there, and the bone breaks down.
Even with the same tartar, some factors make it get worse faster. Smoking is the biggest risk factor, and it also hides gum bleeding, which delays detection. Uncontrolled diabetes, family history, and teeth grinding or clenching also speed up progression.
In what order is periodontitis treated?
We start with the lightest treatment, look at the response, and then decide the next step.
| Step | What is done | Health insurance |
|---|---|---|
| Scaling | Removing tartar above the gumline | Once a year for ages 19 and over; covered separately as part of gum treatment |
| Root planing | Under anesthesia, scraping out tartar below the gumline and smoothing the root surfaces | Covered |
| Periodontal curettage | Removing inflamed tissue on the inner side of the gums | Covered |
| Gum surgery | Opening the gums to remove deep tartar and inflammation | Mostly covered (depends on materials) |
| Maintenance treatment | Checkups and cleaning every 3–6 months | Covered |
Root planing is usually done over several visits, dividing the mouth into 2–4 sections. Whether scaling alone is enough or gum treatment is needed is explained separately in Is scaling enough, or do I need gum treatment too?, and pain after treatment in why it hurts after gum treatment.
Can loose teeth be saved?
It depends on whether the looseness is caused by inflammation or by there being almost no bone left. With teeth that are loose because of inflammation, the looseness quite often decreases after treatment as the gums firm up.
- When we can try to save the tooth: when at least half the root length is still supported by bone, smoking and blood sugar are under control, and you can keep up with care
- When we consider extraction: when the bone has broken down to near the root tip, or when inflammation keeps coming back and threatens the bone of the neighboring teeth
Dragging it out too long can lose the surrounding bone as well, which can mean a larger bone graft later when getting an implant. It is realistic to weigh how long the tooth can be kept together with the cost.
How do I care for my gums after periodontitis treatment?
Maintenance is more important than treatment. Periodontitis progresses again if care stops.
- Get maintenance treatment every 3–6 months. The interval is set according to the condition of your gums.
- Clean between your teeth every day with an interdental brush. How to choose a size that fits the gaps formed after treatment is in how to use an interdental brush.
- Quit smoking, and if you have diabetes, control your blood sugar.
How we handle it at Wonjin Dental
I look at the overall bone height on a panoramic X-ray and check the gum depth for each tooth, and first sort out which teeth to save. Scaling, root planing, periodontal curettage, and periodontal follow-up care are done under Korean National Health Insurance. For teeth that truly cannot be saved, I explain why, and plan to follow on with a bridge or an implant for the gap (₩300,000–₩800,000 based on Osstem at Wonjin Dental, bone graft separate).
Frequently asked questions
Is periodontitis contagious?
Gum disease bacteria can be passed through saliva, but being exposed does not immediately mean you get periodontitis. Each person’s level of care and the body’s response play a bigger role in whether it develops. Still, it is best to avoid the habit of feeding children food from your own mouth.
Can gum medicine or supplements cure periodontitis?
Medicines and supplements cannot remove tartar below the gumline, so they cannot treat periodontitis. Antibiotics are sometimes used to support treatment when inflammation is severe, but they are a supporting measure. Removing the tartar comes first.
Is periodontitis related to other diseases?
Periodontitis and diabetes are known to worsen each other, and there is research showing that treating the gums also helps blood sugar control. A link with cardiovascular disease has also been reported. If you have diabetes, set a shorter interval between checkups.
