Gum Disease Treatment

• Gingivitis is reversible; in periodontitis the aim is to stop bone loss from progressing
• The plan is based on a periodontal examination and gum pocket measurements
• Cleaning, scaling and root planing and, if needed, surgery proceed step by step
• Regular maintenance appointments after treatment help the result last

In short: Gum treatment aims to eliminate inflammation caused by plaque and tartar and to stop the loss of the bone and fibres that hold the tooth. In the early stage professional cleaning and home care may be enough; in an advanced stage, scaling and root planing and in some cases surgery are performed. Because lost bone does not come back on its own, it is important to be examined at the first sign.

What is it? Gingivitis and periodontitis

The layer of bacteria that builds up around the tooth (plaque) gradually hardens into tartar. This build-up starts inflammation in the gum. If the inflammation is limited to the gum, it is called gingivitis: the gum becomes red and swollen and bleeds easily, but the bone holding the tooth is intact, and with cleaning and regular care the condition improves. When the inflammation progresses towards the fibres and bone surrounding the tooth, periodontitis appears; deep pockets form between the tooth and the gum, bone is lost, and the lost bone does not return on its own. At this stage the aim of treatment is not to regain the loss but to stop progression.

Symptoms and risk factors

Bleeding when brushing or flossing is usually the first sign. If you have any of the following findings, an examination is needed:

• Redness, swelling and spontaneous bleeding of the gums
• Bad breath that does not go away; most persistent bad breath originates in the mouth
• Receding gums, teeth that look longer, sensitivity to cold and heat
• Spaces opening between teeth, loose teeth, an abscess or discharge around the gum

At the top of the risk factors are inadequate plaque control and tartar. Smoking both worsens the disease and markedly reduces the response to treatment; it can also mask bleeding, the most obvious sign of inflammation. Diabetes and gum disease affect each other in both directions: high blood sugar weakens the tissue's resistance to bacteria and its healing, while untreated gum inflammation can make blood sugar control more difficult. Hormonal changes, some medicines and vitamin C deficiency also make the gum more sensitive. Causes of gum recession include hard, horizontal brushing, clenching, thin gum tissue and periodontitis.

Treatment steps

1. Periodontal examination: Gum pockets are measured, bleeding and tooth mobility are assessed, and the necessary X-rays are taken; general medical history, medicines and conditions such as diabetes are recorded.
2. Professional cleaning: Tartar and plaque are removed with ultrasonic tips and hand instruments, and the home care method is worked on together. Ultrasonic tips do not thin healthy enamel; the feeling of spaces and the sensitivity seen after cleaning mostly come from what the tartar was covering becoming visible.
3. Scaling and root planing (curettage): In areas with deep pockets, under local anaesthesia, tartar and inflamed tissue under the gum are cleaned from the root surface.
4. Re-evaluation: After a few weeks the pockets and bleeding are measured again. If healing is sufficient, you move on to the maintenance stage.
5. Surgery (if needed): For deep pockets that do not close with cleaning, procedures such as flap surgery, and for gum recession a gum graft, come into consideration. A graft does not regenerate the receded tissue on its own; it tries to cover the exposed root surface.
6. Maintenance appointments: In people with a history of periodontitis, check-up and cleaning intervals are planned more frequently, so that a return of inflammation is caught early.

When should you be examined?

If bleeding does not decrease within a few days, or if the gums are receding or the teeth feel loose, you should be examined rather than wait. Because gum disease often causes no pain, patients do not come in on their own; the problem is noticed only when bone loss has progressed. Untreated periodontitis can affect not only oral health but also general health matters such as diabetes control and cardiovascular health. A check-up every six months therefore gives a chance of early detection.

The aesthetic appearance of the gum (showing too much when smiling or an irregular margin line) is a separate matter, and reshaping is planned only when the gums are healthy; on this, you can look at the smile design page.

Home care

The lasting effect of treatment depends largely on what is done at home. Brush twice a day for about two minutes with a soft-bristled brush, using a technique that does not harm the gum; hard, horizontal movements cause gum recession. Clean between the teeth daily with floss or an interdental brush. Do not avoid cleaning a bleeding area; bleeding generally decreases as the bacterial layer is removed. Quitting or reducing smoking is one of the steps that markedly improve the response to treatment. Your check-up interval is decided together with you according to the condition of your gums.

Relationship with implants

Gum health is also the foundation of implant treatment. An implant does not decay, but the gum and bone around it can become inflamed just as with natural teeth; this is called peri-implantitis and, if left untreated, leads to bone loss around the implant. In a mouth with active gum disease, this disease is brought under control before an implant is planned, and regular professional care is continued after the implant as well.

Visit plan for patients from abroad

A picture at the level of gingivitis and the initial stage can usually be completed with a short visit. Where scaling and root planing and a re-evaluation are needed, planning is done according to the interval required for healing; maintenance appointments can be continued with your dentist in your own country. Sharing your existing X-rays and a list of the medicines you use before the examination makes the plan easier. Details: process for international patients.

Frequently asked questions

The information on this site is for general guidance only; diagnosis and treatment require an examination by a dentist.