Definition & Types

A group of diseases affecting the gums and bone supporting the teeth. Includes:

• Gingivitis – reversible inflammation (red, swollen, bleeds easily).
• Periodontitis – advanced form with irreversible bone and soft-tissue damage.

Caused by bacterial plaque biofilm, leading to chronic inflammation and tissue destruction.

Prevalence & Risk

Affects ~40–50% of U.S. adults over age 30, rising to ~60% in those 65+.

Progression: deep gum pockets, receding gums, loose teeth, pus, biting changes, tooth loss.

Signs & Symptoms

Early: red, swollen, tender, bleeding gums, bad breath.

Progression: deep gum pockets, receding gums, loose teeth, pus, biting changes, tooth loss.

Surgical Therapy (Advanced Disease)

Indicated for deeper pockets, insufficient response to SRP, or bone defects. Procedures include:

• Periodontal flap surgery
• Osseous recontouring / guided tissue regeneration
• Gum grafts (for recession or aesthetics)
• Peri-implantitis management
• Regenerative biomaterials (bone grafts, collagen membranes).

Maintenance & Supportive Care

Supportive periodontal therapy every 3–6 months—frequency based on risk/progression.

Continuous monitoring of pocket depth, bleeding, plaque, and radiographic stability.

Patient education: home care, smoking cessation, diabetes control, systemic health integration.

Goals & Outcomes

Eliminate harmful plaque and reduce inflammation.
Arrest disease progression, preserve bone and soft tissue, prevent tooth loss.
Improve oral function, aesthetic appearance, patient comfort, and overall quality of life.
Minimize risk of related systemic conditions (e.g., diabetes, cardiovascular disease).

Summary

Stage: Gingivitis

Treatment FocusImproved home care + professional cleaning
Follow-up: Regular checkups; disease reversal

Stage: Mild–Moderate

Treatment Focus SRP with adjunctive therapy
Follow-up: Re-evaluate; supportive maintenance

Stage: Advanced

Treatment FocusSurgical correction + regenerative therapy
Follow-up: More intensive maintenance schedule

Successful periodontal care requires a blend of professional treatment, rigorous daily oral hygiene, risk-factor modification, and ongoing monitoring. Early detection and intervention can significantly reduce long-term damage and health consequences.

Bad breath (halitosis) can be an unpleasant and embarrassing condition. Many of us may not realize that we have bad breath, but everyone has it from time to time, especially in the morning.

There are various causes that attribute to bad breath, but in healthy people, the major source is microbial deposits on the tongue. Some studies have shown that simply brushing the tongue reduced bad breath by as much as 70 percent.

What causes bad breath?

• Morning time – Saliva flow almost stops during sleep, reducing its cleaning power and allowing bacteria to grow, which results in bad breath.
• Certain foods – Garlic, onions, etc. Foods containing odor-causing compounds enter the blood stream; they are transferred to the lungs, where they are exhaled.
• Poor oral hygiene habits – Food particles remaining in the mouth promote bacterial growth.
• Periodontal (gum) disease – Colonies of bacteria and food debris residing under inflamed gums.
• Dental cavities and improperly fitted dental appliances – May also contribute to bad breath.
• Dry mouth (Xerostomia) – May be caused by certain medications, salivary gland problems, or continuous mouth breathing.
• Tobacco products – Dry the mouth, causing bad breath.
• Dieting – Certain chemicals called ketones are released in the breath as the body burns fat.
• Dehydration, hunger, and missed meals – Drinking water and chewing food increases saliva flow and washes bacteria away.
• Certain medical conditions and illnesses – Diabetes, liver and kidney problems, chronic sinus infections, bronchitis, and pneumonia are several conditions that may contribute to bad breath.

Keeping a record of what you eat may help identify the cause of bad breath. Also, review your current medications, recent surgeries, or illnesses with your dentist.

What can I do to prevent bad breath?

• Practice good oral hygiene – Brush at least twice a day with an ADA approved fluoride toothpaste and toothbrush. Floss daily to remove food debris and plaque from in between the teeth and under the gumline. Brush or use a tongue scraper to clean the tongue and reach the back areas. Replace your toothbrush every 2 to 3 months. If you wear dentures or removable bridges, clean them thoroughly and place them back in your mouth in the morning. See your dentist regularly – Get a check-up and cleaning at least twice a year. If you have or have had periodontal disease, your dentist will recommend more frequent visits.
• Stop smoking/chewing tobacco – Ask your dentist what they recommend to help break the habit.
• Drink water frequently – Water will help keep your mouth moist and wash away bacteria.
• Use mouthwash/rinses – Some over-the-counter products only provide a temporary solution to mask unpleasant mouth odor. Ask your dentist about antiseptic rinses that not only alleviate bad breath but also kill the germs that cause the problem.

In most cases, your dentist can treat the cause of bad breath. If it is determined that your mouth is healthy and bad breath remains persistent, your dentist may refer you to your physician to determine the cause of the odor and an appropriate treatment plan.

Brushing and flossing help control the plaque and bacteria that cause dental disease.

Plaque is a film of food debris, bacteria, and saliva that sticks to the teeth and gums. The bacteria in plaque convert certain food particles into acids that cause tooth decay. Also, if plaque is not removed, it turns into calculus (tartar). If plaque and calculus are not removed, they begin to destroy the gums and bone, causing periodontal (gum) disease.

Plaque formation and growth is continuous and can only be controlled by regular brushing, flossing, and the use of other dental aids.

Toothbrushing – Brush your teeth at least twice a day (especially before going to bed at night) with an ADA approved soft bristle brush and toothpaste.

• Brush at a 45 degree angle to the gums, gently using a small, circular motion, ensuring that you always feel the bristles on the gums.
• Brush the outer, inner, and biting surfaces of each tooth.
• Use the tip of the brush head to clean the inside front teeth.
• Brush your tongue to remove bacteria and to freshen your breath.

Electric toothbrushes are also recommended. They are easy to use and can remove plaque efficiently. Simply place the bristles of the electric brush on your gums and teeth and allow the brush to do its job, several teeth at a time.

Flossing – Daily flossing is the best way to clean between the teeth and under the gumline. Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

• Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
• Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion. Curve the floss into a “C” shape around each tooth and under the gumline. Gently move the floss up and down, cleaning the side of each tooth.
• Floss holders are recommended if you have difficulty using conventional floss.

Rinsing – It is important to rinse your mouth with water after brushing, and also after meals if you are unable to brush. If you are using an over-the-counter product for rinsing, it’s a good idea to consult with your dentist or dental hygienist on its appropriateness for you.