Periodontal Therapy

How it progresses

It begins as gingivitis — inflamed gums that bleed when brushed. At this stage it is fully reversible with a professional cleaning and better home care. Bleeding gums are not normal and should not be dismissed as a sign of brushing too hard.

Left alone, the inflammation moves below the gumline and starts destroying the bone that holds the teeth. This is periodontitis, and the bone that is lost does not come back. Pockets form between gum and tooth, bacteria accumulate where no toothbrush can reach, and the process accelerates.

The cruelty of it is that this can proceed for years without pain. Many patients first notice a problem when a tooth becomes loose — at which point a great deal of support has already been lost.

Treatment

The foundation of treatment is scaling and root planing, sometimes called a deep cleaning. Under local anesthetic, plaque and tartar are removed from the root surfaces below the gumline and the roots are smoothed so the gum tissue can reattach. It is usually done in two visits, one side of the mouth at a time.

Most patients are surprised at how manageable it is. There is some soreness for a day or two and the teeth may feel more sensitive for a few weeks as inflammation resolves.

After the initial treatment, maintenance visits every three to four months are what actually determine the outcome. Periodontal disease is a chronic condition — it is controlled rather than cured, and the interval between cleanings is the single most important factor in keeping it stable. Patients who return to six-month intervals frequently relapse.

Where pockets remain deep after initial therapy, or where bone loss is advanced, we may recommend referral to a periodontist for surgical treatment or grafting.

Why this matters beyond your mouth

Periodontal disease is associated with cardiovascular disease, poorly controlled diabetes, respiratory infection, and other systemic conditions. The relationship runs in both directions with diabetes in particular: uncontrolled blood sugar worsens gum disease, and active gum disease makes blood sugar harder to control.

The evidence on causation continues to develop and we would not overstate it. What is not in dispute is that chronic inflammation in the mouth is not confined to the mouth, and that treating it is worthwhile on general health grounds as well as dental ones.