Gum Disease Treatment

What Gum Disease Is

Plaque bacteria at the gumline cause inflammation. In gingivitis, the gum is inflamed but the bone is intact; it is fully reversible. In periodontitis, the inflammation has destroyed some of the bone and the fibers that attach the gum to the tooth, creating a pocket that harbors more bacteria. Left alone it progresses, usually without pain, until teeth loosen.

That plaque is the cause was settled by experiment. Löe, Theilade and Jensen published the study that established it in 1965, in the Journal of Periodontology: healthy volunteers who stopped all cleaning developed gingivitis as plaque accumulated, and their gums returned to health once cleaning resumed. Sixty years on, that experiment is still the reason treatment starts by removing the deposits rather than by treating the symptom.

The CDC reports that periodontitis affects roughly four in ten American adults over 30 and most adults over 65, and that periodontitis and tooth decay are the two leading causes of tooth loss in adults. It is also linked to diabetes control, heart disease, and pregnancy outcomes. The primary surveillance data behind that figure is the same: Eke and colleagues reported in 2018, from full-mouth examinations in the National Health and Nutrition Examination Survey for 2009 to 2014, that an estimated 42 percent of dentate US adults aged 30 and over had periodontitis and 7.8 percent had severe periodontitis. Gum disease and your health.

How We Diagnose It

A full periodontal exam measures pocket depth at six points on every tooth, bleeding, recession, mobility, and furcation involvement (bone loss between the roots of a molar). Digital X-rays and, when needed, a cone-beam CT (a 3D X-ray) show the bone. You see the numbers and the pictures, and you get a written diagnosis with the stage and grade of disease, the same system your dentist uses. That staging and grading system comes from the 2017 World Workshop convened by the American Academy of Periodontology and the European Federation of Periodontology.

Treatment, by Stage

Sedation is available for the surgical steps below; the sedation page describes the nitrous, oral, and IV options.

Non-surgical treatment. Scaling and root planing removes plaque and tartar from the root surfaces below the gum, under local anesthetic, usually over one or two visits. Six to eight weeks later we re-measure. Many patients need nothing more than maintenance after this; the American Academy of Periodontology notes that many patients do not require additional treatment after scaling and root planing.

Pocket reduction surgery. When pockets remain deep, the gum is gently folded back so the roots and bone can be cleaned directly and the bone reshaped where needed, then closed so the gum fits snugly. This makes the area cleanable, which is what keeps disease from returning.

Regeneration. Where bone has been lost in a shape that allows it, bone graft material, a membrane, and growth factors are placed to regrow bone and attachment. The American Academy of Periodontology describes these regenerative procedures as using membranes, bone grafts, or tissue-stimulating proteins to encourage the body’s own ability to regenerate lost bone and tissue. Where it works, this is the treatment that can change a tooth’s long-term prognosis rather than hold it steady, and the cone-beam CT shows where it will work.

Extraction and replacement. A tooth that cannot be saved is removed with the socket preserved, and replaced with an implant when appropriate. Dental implants.

Maintenance. After treatment, periodontal maintenance every three to four months, alternating with your dentist. This is not optional; treated periodontitis stays treated only with maintenance. Lindhe and Nyman followed 61 patients treated for extremely advanced periodontal disease for 14 years on a three-to-six-month recall and found that probing depths, attachment levels, and bone height held steady in most patients and sites over that period, with significant recurrence confined to 43 surfaces in 15 people.

Recovery

Scaling and root planing: sensitivity to cold for a week or two, otherwise normal activity. Surgery: two to three days of swelling and soreness, a week of soft food and no brushing of the treated area, sutures out at one to two weeks. Full written instructions go home with you.

Cost and Insurance

Non-surgical treatment is usually covered in part by dental insurance; surgical treatment often is too. You receive a written estimate by stage so treatment can be sequenced across benefit years if that helps. Insurance and financing.