Gum Disease Treatment

THE TWO STAGES

Gingivitis is inflammation of the gum only. The gum becomes red, swollen and bleeds easily, particularly when brushing. Nothing has yet been lost. With thorough professional cleaning and good home care, gingivitis resolves completely and the gum returns to health.

Periodontitis is what gingivitis becomes if the inflammation continues. The inflammation spreads beneath the gum, the attachment between gum and tooth breaks down, and the bone supporting the tooth begins to be lost.

The crucial difference is that bone does not grow back on its own. Periodontitis can be stopped, and the mouth can be made healthy and comfortable again, but the support already lost is not recovered. Treatment is about halting the process and keeping what is there.

 

THE SIGNS WORTH NOTICING

Bleeding gums when you brush or floss. This is the earliest and most reliable sign. Healthy gums do not bleed, and bleeding should never be dismissed as normal.

Red, swollen or tender gums, rather than firm and pale pink.

Persistent bad breath or a bad taste that does not go away with brushing.

Gums that have receded, so teeth look longer than they used to.

Spaces opening up between teeth that were previously in contact.

Teeth that feel loose, or that have moved or changed the way they bite together.

Pus at the gum line, or recurring gum abscesses.

Pain is notably absent from most of that list. Periodontitis is usually painless until it is advanced, which is exactly why it is so often found late.

 

WHAT MAKES IT MORE LIKELY

Plaque left in place is the underlying cause in every case. Everything else makes the response to it worse.

Smoking is the most significant modifiable risk factor. It also masks the main warning sign, because smokers' gums bleed less, so the disease progresses more quietly.

Diabetes, particularly when not well controlled. The relationship runs both ways: gum disease is harder to control with poor blood sugar, and gum inflammation makes blood sugar harder to control.

Genetics. Susceptibility differs significantly between people, which is why two people with similar habits can have very different gums.

Stress, certain medications, hormonal changes including pregnancy, and anything that causes a dry mouth.

Crowded or crooked teeth, simply because they are harder to clean properly.

 

HOW IT IS DIAGNOSED

Gum disease is diagnosed by measurement, not by appearance alone.

A small probe is used to measure the depth of the space between gum and tooth at several points around each tooth. In health that space is shallow. Where the attachment has been lost, the probe goes deeper — and the pattern of those measurements, recorded as a chart, is the record of your gum health.

X-rays show the level of the bone, which is the other half of the picture, and allow progress to be compared over time.

This examination is the basis for everything that follows, and it is repeated to measure whether treatment is working.

 

NON-SURGICAL TREATMENT

This is the first-line treatment for almost everyone, and for most patients it is the only treatment needed.

The deposits are removed from the root surfaces below the gum line, thoroughly, under local anaesthetic where needed. The procedure is variously called scaling and root surface debridement, root planing or deep cleaning. It is considerably more thorough than a routine clean, and it is often carried out over more than one appointment.

The aim is to remove what the gum is reacting to, so the inflammation settles and the gum reattaches more tightly to the root.

Alongside it, home care is addressed in detail, because treatment below the gum does not succeed if plaque continues to accumulate above it. Smoking is discussed for the same reason.

Treatment is then reassessed, usually after a few weeks, by repeating the measurements. Most patients improve substantially at this stage.

 

WHEN SURGICAL TREATMENT IS CONSIDERED

Where deep pockets remain after non-surgical treatment, and particularly where their shape means they cannot be cleaned, surgery may be considered.

Flap surgery involves lifting the gum away from the tooth to give direct access to the root surfaces and the bone, cleaning thoroughly under vision, and repositioning the gum so that it fits more closely afterwards.

Regenerative procedures aim to encourage some regrowth of bone in specific kinds of defect, using graft materials, membranes or biological agents. They are suitable only for certain shapes of bone loss, not for generalised loss.

Surgery is a second step, not a first one, and it is only offered where the first step has been completed and home care is reliable.

 

AFTER TREATMENT: THE PART THAT DECIDES THE OUTCOME

Gum disease is a chronic condition. It is controlled rather than cured, and it returns if the conditions that caused it return.

Patients who have had periodontitis are placed on a maintenance programme — professional cleaning and re-measurement at intervals set by their own risk, often every three to four months rather than every six. This is not an upsell; it is the single best-established factor in whether the result of treatment holds over the following years.

Between appointments, daily cleaning between the teeth matters as much as brushing. A toothbrush cleans roughly three of the five surfaces of a tooth. Gum disease begins on the other two.

 

WHAT TO EXPECT DURING AND AFTER

Non-surgical treatment is done under local anaesthetic where needed, so it should not be painful at the time.

Afterwards the gums are often tender for a few days and the teeth may be sensitive to cold for a few weeks. This generally settles.

As the inflammation resolves, swollen gum shrinks back to its true level. This means some patients notice their gums have receded slightly, their teeth look a little longer, or spaces have appeared between teeth. This is the swelling going down, not the treatment causing damage, but it is worth being told beforehand rather than discovering it.

Teeth that were loose because of inflammation often feel firmer. Teeth that were loose because of bone loss generally do not become firm again.

 

GUM DISEASE AND GENERAL HEALTH

Gum disease has been studied alongside a number of general health conditions, including diabetes, cardiovascular disease and adverse outcomes in pregnancy.

The clearest and best-established of these is the two-way relationship with diabetes. For the others, an association has been observed in research, but an association is not the same as one thing causing the other, and the evidence does not currently support telling patients that treating their gums will prevent those conditions.

What can be said plainly is that chronic inflammation in the mouth is not a good thing to leave untreated, and that gum health and general health tend to travel together.

 

QUESTIONS PATIENTS ASK

My gums bleed when I brush. Is that normal? No. It is the most common early sign of gum disease and it is worth having looked at.

 

Is gum disease painful? Usually not until it is advanced, which is why it is so often found late.

 

Can gum disease be cured? Gingivitis can be completely reversed. Periodontitis can be stopped and controlled, but bone already lost does not return.

 

Will I lose my teeth? Not necessarily, and most patients who are treated and maintained do not. The outcome depends on how much support has already been lost, how well the disease responds, and how consistently it is maintained afterwards.

 

Is deep cleaning painful? It is carried out under local anaesthetic where needed. Tenderness and sensitivity for a short period afterwards are common.

 

Why do I need appointments every three months when others go every six? Because the interval is set by risk, not by convention. Patients who have had periodontitis need closer monitoring to keep it stable.

 

Does smoking really make that much difference? Yes. It is the most significant factor within a patient's control, both in how the disease progresses and in how well treatment works.

 

Can I have implants if I have had gum disease? In many cases yes, but the gum disease must be treated and stable first, and maintenance afterwards is particularly important.

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