Periodontitis Munich — Diagnosis, Treatment & Prevention | Dr. Dickel

Periodontitis is a chronic inflammatory infectious disease of the periodontium, triggered by bacterial biofilms (plaque) below the gum line. The term is often colloquially equated with "bleeding gums" — but that is an oversimplification. Periodontitis systematically destroys the entire tooth-supporting apparatus: the gingiva, periodontal ligament, alveolar bone, and the fibers that anchor the tooth in the bone.

The numbers speak clearly: periodontitis is the most common cause of tooth loss in adults — even ahead of tooth decay. More than 50% of all adults over 40 in Germany are affected by periodontitis requiring treatment, and many are not even aware of it. This is because the disease progresses painlessly and insidiously for a long time, until tooth loss threatens.

The distinction between gingivitis and periodontitis is crucial: gingivitis (gum inflammation) affects only the gingival tissue and is completely reversible with consistent treatment and improved oral hygiene. However, once the inflammation has spread to the alveolar bone and bone loss has occurred, we are dealing with periodontitis — a condition that is treatable and controllable, but cannot be completely reversed.

The insidious aspect: most patients only notice the disease at an advanced stage because pain is absent for a long time. Regular check-ups are therefore essential. At our dental practice in Munich-Oberföhring, we perform a Periodontal Screening Index (PSI) at every recall appointment — the simplest and fastest method to detect periodontitis at an early stage.

If you suspect you may be affected, do not hesitate: call us at 089 95760618 or book an appointment online. Early detection is the most effective weapon against periodontitis.

Periodontitis develops gradually — but there are warning signs you can recognise yourself. The following self-check helps you assess whether you should schedule a dental appointment. Please note: this check does not replace a dental examination. Only probing depth measurements and an X-ray can reliably diagnose periodontitis.

Check which of the following symptoms apply to you:

• Bleeding gums when brushing or eating — Healthy gums do not bleed. Even occasional bleeding is not a "normal state" but an alarm signal for inflammation.
• Reddened, swollen gums — Healthy gums are light pink to salmon-coloured and firmly attached. Redness and swelling indicate active inflammation.
• Gum recession — your teeth look longer than before — When tooth necks become exposed, it is a sign that the gums are receding. This may indicate periodontitis or aggressive tooth brushing.
• Persistent bad breath (halitosis) — Bacteria in deep periodontal pockets produce sulphur compounds responsible for chronic bad breath. If bad breath does not disappear despite good oral hygiene, periodontitis should be ruled out.
• Sensitive tooth necks — Exposed tooth necks often react painfully to cold, hot or sweet foods and drinks. This symptom arises when the gums have receded due to inflammation.
• Loose teeth or tooth migration — If teeth feel as though they are wobbling, or their position has changed, the periodontium is already significantly damaged. This is an urgent warning signal.
• Pus formation between tooth and gum — Visible pus or an unpleasant taste in the mouth (especially in the morning) can indicate a periodontal abscess — an acute finding that requires immediate treatment.
• Changed bite — teeth no longer fit together properly — If your bite has changed or dental restorations (bridges, crowns) suddenly fit differently, tooth migration due to periodontitis may be the cause.

Your assessment:

1–2 symptoms: Possible gingivitis or early periodontitis. A dental check-up is advisable.

3 or more symptoms: The probability of periodontitis requiring treatment is high. Make an appointment promptly by calling 089 95760618. The earlier we treat, the better your prognosis and the more tooth structure can be preserved.

At our practice in Munich-Oberföhring, we carry out comprehensive periodontal diagnostics: probing depth measurements at all 6 measurement points per tooth, digital X-rays, bleeding indices and assessment of the oral microbiome. This examination forms the basis for an individualised treatment plan.

Periodontitis is not a uniform disease — it progresses through different degrees of severity, from reversible inflammation to severe bone loss. Understanding the stages helps you assess the urgency of treatment. The decisive rule is: the earlier detected, the better the prognosis.

Stage 0: Gingivitis — The Precursor

Gingivitis is an inflammation of the gingiva that has not yet caused bone or tissue loss. The gums are reddened, swollen and bleed when brushing. Periodontal pocket depths are not increased (≤3 mm). The key point: gingivitis is completely reversible. A professional dental cleaning combined with consistent home oral hygiene is sufficient to fully resolve the inflammation. This stage should be understood as a wake-up call — acting now prevents periodontitis.

Stage I: Mild Periodontitis

In the first stage of periodontitis, the inflammation spreads to the deeper structures. Early bone loss occurs and periodontal pocket depths deepen to 3–4 mm. This stage is often still nearly painless — patients may only notice occasional gum bleeding. X-rays show first signs of bone resorption at the tooth roots. With consistent anti-infective therapy (closed subgingival scaling and root planing), the disease can be very well controlled at this stage and the prognosis is excellent.

Stage II: Moderate Periodontitis

In moderate periodontitis, bone loss has reached a moderate extent. Periodontal pockets deepen to 4–5 mm, the gums recede and tooth necks become visible. Patients now notice more pronounced bad breath, sensitive tooth necks and possibly early tooth loosening. Treatment is more demanding — often several sessions of subgingival scaling are required. At this stage, regular supportive periodontal therapy (SPT) after treatment is particularly important to prevent recurrence.

Stage III/IV: Severe Periodontitis

In the severe stage, bone loss is far advanced. Periodontal pockets of 6 mm and deeper are typical, teeth loosen considerably, tooth migration and bite changes occur. Without treatment, tooth loss is imminent. At this stage, closed therapy alone is often insufficient — surgical interventions (flap surgery) or regenerative procedures may be required. For patients with severe bone loss, we also offer bone regeneration with state-of-the-art biomaterials to restore lost structures and create the foundation for implants.

The most important conclusion: every stage is treatable — but acting early avoids complex and costly interventions. If you recognise any of the described stages in yourself, make an appointment today by calling 089 95760618.

Periodontitis treatment follows a clear, scientifically grounded step-by-step protocol. The goal: halt inflammation, eliminate bacterial load, stabilise the periodontium and prevent recurrence through lifelong aftercare. At our practice in Munich-Oberföhring, we work in accordance with the current guidelines of the German Society of Periodontology (DGParo) and the European Federation of Periodontology (EFP).

1. Periodontal Charting — The Diagnosis

   Everything begins with thorough diagnostics. The Periodontal Screening Index (PSI) provides an initial overview. As part of the detailed periodontal chart, we measure probing depths at 6 measurement points per tooth, record bleeding on probing (BOP), tooth mobility grades and furcation involvement. We supplement this with a digital X-ray to assess bone loss. This charting forms the basis for diagnosis, treatment planning and subsequent monitoring.

2. Pre-treatment — Inflammation Reduction and Oral Hygiene Instruction

   Prior to the actual periodontitis therapy, we carry out a professional dental cleaning (prophylaxis) and remove supra- and subgingival calculus deposits. Equally important: we instruct you in optimal home oral hygiene — brushing technique, selection of the right interdental brushes and the use of supplementary aids. Optimised oral hygiene is a prerequisite for the success of any periodontitis therapy.

3. Closed Periodontal Therapy (Anti-infective Therapy) — The Core of Treatment

   The anti-infective therapy (AIT), also known as subgingival scaling and root planing, is the cornerstone of treatment. Under local anaesthesia, bacterial biofilm, calculus and infected root cementum are removed from the periodontal pockets using ultrasonic instruments and hand instruments (Gracey curettes). Treatment is carried out quadrant by quadrant over several sessions. Smoothing of the root surface makes it more difficult for bacteria to recolonise.

4. Re-evaluation — Assessment of Outcomes after 6–8 Weeks

   Approximately 6–8 weeks after the AIT, the re-evaluation takes place: we re-measure all probing depths and document the healing. Bleeding indices and pocket reduction show how successful the therapy was. For most patients, closed therapy is sufficient to stabilise the disease.

5. Surgical Therapy if Required — When Closed Therapy is Insufficient

   In the case of persistent pockets exceeding 5–6 mm or unfavourable tooth anatomy, surgical therapy may be necessary. Flap surgery (access flap) provides direct access to deeper root and bone areas. Regenerative procedures such as enamel matrix proteins (Emdogain) or guided tissue regeneration (GTR) with bone substitutes can, in selected cases, partially restore lost bone and periodontal attachment. For further information, visit our periodontology page.

6. Supportive Periodontal Therapy (SPT) — Lifelong Aftercare

   SPT is not optional but a necessity: periodontitis is a chronic disease that recurs without regular aftercare. As part of SPT, we carry out an individual prophylaxis and check-up 2–4 times per year — depending on your risk profile and treatment outcome. Statutory health insurance covers SPT for 2 years following systematic periodontitis therapy.

Periodontitis is in many cases preventable — at least in its severe forms. Gingivitis, the precursor, is completely reversible. Those who act early and practise consistent prevention can prevent gum inflammation from developing into periodontitis. These measures have the greatest effect:

1. Interdental Cleaning — The Absolutely Decisive Factor

A toothbrush alone cleans only approximately 60% of tooth surfaces. The interdental spaces — where periodontitis most frequently begins — remain uncleaned. Interdental brushes are more effective for most patients than dental floss because they remove more plaque and are easier to handle. Use the smallest size that still feels resistance. Once a day in the evening before brushing is sufficient — but daily is essential.

2. Professional Dental Cleaning — Regular and Consistent

Bacterial biofilm that is not removed for a longer period mineralises into calculus — which can no longer be removed at home. Regular professional dental cleaning (prophylaxis) at our practice removes calculus, staining and stubborn deposits in areas that cannot be reached at home. The recommended interval: 1–2 times per year for healthy patients, more frequently for patients with elevated risk or following periodontitis treatment.

3. Smoking Cessation — The Single Greatest Risk Factor

Smoking is the most significant modifiable risk factor for periodontitis. Even after just one year without smoking, the periodontitis prognosis improves considerably. Those who stop smoking reduce their periodontitis risk to the level of non-smokers — an enormous benefit for oral health and general health.

4. Diabetes Management

Patients with diabetes should consistently control their blood sugar — not only for their general health, but also to minimise the risk of periodontitis. The bidirectional association means: better blood sugar control protects the gums, and healthy gums facilitate blood sugar control.

5. Stress Reduction

Chronic stress increases the level of inflammation in the body and weakens the immune system. Stress management techniques — exercise, meditation, adequate sleep — contribute indirectly to oral health.

6. Regular Dental Check-ups

The Periodontal Screening Index (PSI) should be carried out every 2 years — for GKV patients from age 18, this is covered as a statutory benefit. This allows us to detect early signs of periodontitis before bone loss occurs.

The most important message: gingivitis is reversible — act before it becomes periodontitis. If you notice that your gums are bleeding or receding, do not hesitate and book an appointment by calling 089 95760618.