Periodontal Disease

Gingivitis or Periodontitis?

Every case of periodontitis started as gingivitis, but not every case of gingivitis becomes periodontitis. The difference is whether the inflammation has reached the bone. Our guide to gum disease covers the early signs and causes; this one is about what happens once the bone is involved, and what we do about it.

Below the Gum Line

Healthy gum is attached to the tooth just below the visible edge, with a shallow groove around it. When plaque sits in that groove for long enough, the body's response to the bacteria, as much as the bacteria themselves, starts to break down the attachment. The gum peels away to form a pocket, plaque and tartar spread down into it where no brush can reach, and the bone beneath is slowly lost. Deeper pockets shelter more bacteria, so the process feeds itself. Because there's little pain, it can go on for years unnoticed, until teeth loosen or drift and gaps appear between them. By then a lot of support has gone, which is why we check pockets at every visit rather than waiting for symptoms.

Who Is Most at Risk?

• Smokers. Smoking is the single biggest risk factor. It reduces blood flow to the gums, which hides bleeding, slows healing and makes treatment less effective
• People with diabetes, especially when blood sugar isn't well controlled. Gum disease in turn makes diabetes harder to control
• People with a family history of gum disease or early tooth loss
• Anyone who struggles to clean between their teeth, including around crowded teeth, bridges and braces
• People under long-term stress, or with conditions and medicines that affect the immune system

None of these means you'll definitely get periodontitis, and having none of them doesn't rule it out. Regular gum checks are the only way to know.

How Is It Diagnosed?

We measure the depth of the pocket around each tooth with a fine probe, note where the gums bleed, and check whether any teeth are loose. X-rays show how much bone remains around each root. From that we stage and grade the disease using the British Society of Periodontology system. The stage, 1 to 4, describes how much support has been lost, from early to severe. The grade, A to C, describes how fast it's progressing for your age, and whether smoking or diabetes is likely to be driving it. Together they tell us how intensive treatment needs to be and how often you'll need maintenance afterwards. We explain your stage and grade to you, and record them so we can see at each re-assessment whether things are stable.

How Is It Treated?

• Step 1: cleaning advice tailored to your mouth, removing plaque and tartar above the gum line, and controlling risk factors such as smoking and diabetes. Without this, deeper treatment doesn't hold
• Step 2: deep cleaning below the gum line, usually in four stages, one for each quarter of the mouth, under local anaesthetic. Fine instruments remove the tartar and bacteria from the root surfaces inside each pocket, so the gum can heal back against the tooth. £100 per stage, or £90 for dental plan members²
• Re-assessment a few months later, re-measuring every pocket to see where the gums have healed
• Step 3: for any pockets that haven't responded, repeating the deep cleaning in that area. In some advanced cases we refer you to a periodontist, a dentist who has trained further in gum treatment, for gum surgery
• Maintenance: regular hygiene visits, often every three months, to keep it stable

What to Expect After Each Stage

The area is numb during treatment, so you feel pressure and scraping rather than pain. Afterwards, your gums may be tender for a day or two and ordinary painkillers are enough. As the swelling goes down over the following weeks, the gums tighten and often shrink back slightly, so teeth can look a little longer and small gaps may appear between them near the gum. That's healing, not damage, though exposed root surfaces can be sensitive to cold for a while; a sensitive toothpaste helps. Keep cleaning the treated area gently from the first day, as that's what keeps the pockets from refilling with plaque.

Can It Be Cured?

Periodontitis can't be cured, because the bone and attachment that have been lost don't grow back. But it can be stabilised and kept under control for life, with treatment, good home care and regular maintenance, and most people keep their teeth for many years as a result. The most common reason it comes back is missed maintenance visits. Some advanced cases, or cases that don't respond to deep cleaning, are referred to a periodontist elsewhere for further treatment, such as gum surgery. We'll tell you honestly at your re-assessment if that's the right route for you.

Keeping It Stable for Life

Maintenance is where periodontal treatment succeeds or fails. Every three months, your dental therapist checks the pockets, removes any new deposits below the gum line and polishes with Airflow, so the bacteria never get re-established. Between visits, brush twice a day angled into the gum line and clean between your teeth every day with the interdental brush sizes we've shown you. If you smoke, stopping is the single most useful thing you can do for your gums. Plan B, at £40.16 a month, includes four hygiene visits a year with Airflow and two examinations, so the visits that keep your gums stable are already paid for.

Questions

This guide is general information, not a diagnosis. A dentist needs to examine you to say what is right for your teeth.