PERIODONTOLOGY
Periodontitis
Periodontitis is an inflammatory disease of the tooth-supporting tissues. Without early diagnosis, it leads to progressive bone destruction and can result in tooth loss.
Schedule an initial consultation →Key points
Periodontitis is a bacterial infection that progressively destroys the tissues supporting the teeth — gum, periodontal ligament and alveolar bone. It often progresses without pain, which delays diagnosis.
At the 47VH practice in Nice, we perform a comprehensive periodontal assessment from the first consultation to establish an accurate diagnosis and define a treatment strategy tailored to each clinical situation.
What is periodontitis?
Periodontitis is an infectious and inflammatory disease that affects the periodontium—the set of tissues that support the teeth.
In most cases, it develops from untreated gingivitis. Two main stages are distinguished:
Gingivitis
First stage of periodontal disease. The gums become red, swollen, and bleed during brushing. At this stage, the damage is reversible. If gingivitis is not treated, it may progress to deeper involvement of the supporting tissues.
Periodontitis
Advanced stage in which the infection spreads beneath the gumline. Bacteria cause progressive destruction of the alveolar bone and periodontal ligament. Periodontal pockets form between the gum and the tooth root. Without treatment, teeth may shift and eventually be lost.
How can you tell if you have periodontitis?
The periodontitis is difficult to detect on your own, as it often progresses without pain. Only a clinical examination by a periodontist can diagnose it with certainty, through periodontal probing and radiological analysis.
That is why we recommend a consultation at the first signs — or preventively, especially in the presence of risk factors.
How does periodontitis begin?
Periodontitis generally begins with untreated gingivitis.
The early signs are often subtle: red or swollen gums, bleeding during brushing, slight bad breath. This progression frequently occurs without visible signs, making the disease difficult to identify on your own.
Most patients discover their periodontitis at age 40 or 50, when bone destruction is already advanced. A periodontist can detect the early signs much sooner, during a simple clinical examination.
What are the signs of periodontitis?
Over time, several changes may appear:
- more frequent gum bleeding, sometimes spontaneous
- persistent bad breath
- shift in tooth position
- teeth that appear longer due to gingival recession
- occasional pain
Tobacco masks the signs. In smokers, gingival vasoconstriction reduces bleeding. The disease progresses silently, often more severely, without visible signs that alert the patient.
What causes periodontitis?
Periodontitis results from the accumulation of bacterial plaque and calculus on the teeth and under the gumline.
A healthy mouth harbors more than 700 bacterial species, most of them harmless. When plaque control is insufficient, pathogenic bacteria proliferate, triggering an inflammatory response that progressively destroys the supporting tissues.
Calculus — formed by the mineralization of plaque — creates an ideal surface for subgingival bacterial colonization. It cannot be removed by brushing alone.
How does periodontitis progress?
When bacterial plaque accumulates without being removed, it mineralizes and forms calculus . This calculus promotes bacterial progression toward the roots.
Inflammation progressively disrupts the attachment between the gum and the root, forming a periodontal pocket. This space becomes an ideal environment for pathogenic bacteria, which release toxins and further stimulate the inflammatory response.
The severity and speed of progression depend on three factors:
- the quantity and type of bacteria present
- the strength of the individual's defense mechanisms
- the presence of associated risk factors
Which factors favor the onset and progression of periodontitis?
Several factors can weaken the body's defenses and accelerate disease progression:
- Tobacco — the main modifiable risk factor. It impairs the local immune response and masks gingival signs.
- Diabetes — diabetic patients have a high risk of severe periodontitis. The relationship is bidirectional: periodontitis worsens glycemic control.
- Systemic diseases — cardiovascular diseases, rheumatoid arthritis, immune disorders (leukemia, HIV) worsen the periodontal response.
- Genetics — some patients develop severe periodontitis despite rigorous hygiene.
- Stress — reduces immune defenses and promotes disease progression.
- Bruxism — excessive occlusal forces accelerate the destruction of periodontal tissues.
- Diet — a diet deficient in essential nutrients weakens the immune system and its ability to fight infection.
Certain medications — antihypertensives, vasodilators, and immunosuppressants can alter the gingival response.
What are the consequences of periodontitis?
Periodontitis is the leading cause of tooth loss in adults.
Without treatment, bone destruction progresses, teeth shift and fall out or require extraction. Patients may also develop periodontal abscesses, changes in bite, and significant gingival recession.
Beyond the oral sphere, uncontrolled periodontitis is associated with several systemic conditions:
- worsening of glycemic imbalance in diabetic patients
- increased cardiovascular risk (coronary artery disease, stroke)
- obstetric complications (premature birth, low birth weight)
- pulmonary diseases through inhalation of oral bacteria
- increased risk of erectile dysfunction
How to treat periodontitis?
The goal of treatment is to eliminate pathogenic bacteria, control inflammation, and stabilize the supporting tissues.
Non‑surgical periodontal treatment
First systematic step. We perform subgingival scaling, a root planing and personalized reinforcement of hygiene techniques. When hygiene is mastered and inflammation decreases, the gums firm up, bleeding reduces, and the depth of periodontal pockets diminishes.
Surgical periodontal treatment
In advanced cases, periodontal surgery allows access to deep root surfaces, removal of residual calculus, reduction of persistent pockets, and regeneration of destroyed tissues. Gum grafts may complement treatment to cover exposed roots. Other approaches—such as orthodontic treatment or replacement of missing teeth with dental implants—may be integrated into the overall treatment plan.
Periodontal maintenance
After the active treatment phase, we implement a structured and personalized follow-up program, generally every three to four months. These visits help control inflammation, remove deposits in hard-to-reach areas, and prevent disease recurrence.
Periodontitis is a chronic disease. Treatment allows it to be stabilized, while maintenance enables long-term control.
Bibliographic References
- Tonetti M.S. et al. — Staging and grading of periodontitis: framework and proposal of a new classification and case definition. J Periodontol, 2018. PubMed PMID 29926952
- Papapanou P.N. et al. — Periodontitis: consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol, 2018. PubMed PMID 29926951
- Sanz M. et al. — Treatment of stage I–III periodontitis: the EFP S3 level clinical practice guideline. J Clin Periodontol, 2020. PubMed PMID 32383274
- Chapple I.L.C. et al. — Interaction of lifestyle, behaviour or systemic diseases with dental caries and periodontal diseases: consensus report of group 2 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol, 2017. PubMed PMID 28266114
- Tonoyan L, Mounier C, Fassy J, Leymarie S, Mouraret S, Monneyron P, Vincent-Bugnas S, Mari B, Doglio A.— Unveiling the etiopathogenic role of Epstein-Barr virus in periodontitis. J Dent Res, 2025. PubMed PMID 39876607
FAQ
Is periodontitis painful?
Not necessarily — this is precisely what makes its diagnosis delayed.
The disease often progresses without pain for years. Early signs — bleeding, bad breath, swollen gums — are frequently overlooked. Pain usually appears at an advanced stage, particularly in cases of periodontal abscess.
Is periodontitis contagious?
The bacteria responsible can be transmitted through saliva, particularly between partners or between parents and children.
This does not mean that the disease is systematically transmitted; its development also depends on individual susceptibility, risk factors, and the quality of oral hygiene.
Can periodontitis come back after treatment?
Yes — periodontitis can recur if maintenance is interrupted or if risk factors are not properly controlled.
Smoking and diabetes are the two main risk factors to control. This is why we implement a structured maintenance program after every active treatment phase.
Do you need a referral from your dentist to see a periodontist?
No — you can contact us directly, without a prescription or referral letter.
After the consultation, we systematically send a report to your referring practitioner to ensure continuity of care.
At what age can periodontitis develop?
Periodontitis can begin during adolescence in certain aggressive forms, but it most commonly develops between the ages of 30 and 50.
The earlier the diagnosis, the more limited the bone loss and the more effective the treatment.
Can periodontitis be permanently cured?
Periodontitis is a chronic disease: it cannot be cured in the strict sense, but it can be stabilized.
Properly conducted treatment allows the arrest of bone loss and control of the infection. Regular periodontal maintenance is then essential to prevent recurrence and preserve long-term results.
Are periodontitis treatments reimbursed by social security?
Since April 2021, non-surgical periodontal treatment has been partially reimbursed, but only for patients with diabetes.
Surgical procedures remain the patient’s responsibility, although your private insurance may provide partial coverage depending on the terms of your policy.