Periodontitis is the leading cause of tooth loss in adults. Most adults are affected to some degree: 91% of those 79 years of age and older have some degree of periodontal disease.


  • Chronic plaque exposure causes inflammation which leads to:
    • Destruction of periodontal ligament
    • Loss of supporting bone
    • Tooth loosening and loss
  • The body's host response to the bacteria, magnifying or suppressing the inflammatory response, helps determine the manifestation and progression of the disease.
  • Smoking, diabetes, HIV, pregnancy, and poor oral hygiene can all contribute to the development of periodontitis

Preventive Measures & Treatment

  • Encourage good oral hygiene and regular dental visits.
  • Recommend cessation of tobacco and other irritants, such as cannabis.
  • Make a dental referral for deep root scaling.
  • Prescribe oral antibiotics and topical solutions such as chlorhexidine.
    • Caution: Chlorhexidine may stain teeth yellow to brown, alter taste temporarily, increase deposition of calculus (tartar), and the taste may be unpalatable.

Advanced Periodontal Disease



Novak MJ. Classification of diseases and conditions affecting the periodontium. In: Clinical Periodontology. M.G. Newman, H. H Takei, F. A. Carranza Eds. Philadelphia: W.B. Saunders. 2002.

Bergstrom J. Tobacco smoking and chronic destructive periodontal disease. Odontology 2004; 92(1):1-8.

Johnson GK, Hill M. Cigarette smoking and the periodontal patient. J Periodontol 2004; 75(2):196-209.

Murray W, et al. Cannabis Smoking and Periodontal Disease Among Young Adults, JAMA 2008; 299(5):525-531.

Eberhard J, Jepsen S, Jervøe-Storm PM, et al. Full-mouth disinfection for the treatment of adult chronic periodontitis. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004622. DOI: 10.1002/ accessed at

Gonsalves WC, Wrightson AS, Henry RG. Common oral conditions in older persons. Am Fam Physician 2008; 78:845-852.