Gum disease treatment, from first signs to healthy gums

What is gum disease?

Gum disease is an infection of the tissues that hold your teeth in place. It starts when plaque, a sticky film of bacteria, builds up along and under the gumline. Your body fights back with inflammation, and over time that inflammation damages the gums and then the bone.

It comes in two broad forms. Gingivitis is inflammation of the gums alone: they turn red, puff up and bleed easily, but the bone is not affected. Periodontitis means the damage has spread below the gums to the fibers and bone that anchor each tooth.

With periodontitis, the gums pull away from the teeth and form pockets. A pocket is the space between the gum and the tooth. Healthy pockets are shallow, usually 1 to 3 millimeters deep, and deeper ones trap bacteria that a toothbrush can't reach.

The difference between the two forms decides what treatment can do. Gingivitis can usually be reversed with a professional cleaning and better daily care at home. Periodontitis can't be reversed, because bone lost to the disease doesn't grow back on its own. It can be controlled, though, with treatment and regular upkeep.

Plaque that stays on the teeth hardens into tartar, and brushing can't remove it. Once tartar forms below the gumline, only a dental professional can clear it away. That is why periodontitis needs treatment in the chair, not just a better brushing routine.

What are the warning signs, and why don't they always hurt?

Common signs include gums that bleed when you brush or floss, and gums that look red or swollen. Gum disease often causes little or no pain until it is advanced. The bacteria and inflammation work slowly, below the gumline, where you can't see or feel the damage.

Healthy gums don't bleed from gentle brushing, so regular bleeding is worth a check even when nothing hurts. Smoking can mask bleeding by narrowing the blood vessels in the gums. If you smoke, your gums may look calm while the disease is active.

Pain tends to show up late. It may come from a gum abscess, a painful swollen spot near a tooth that sometimes drains pus. It may also come from teeth that have loosened enough to hurt when you chew. An abscess needs prompt care.

• Gums that bleed when you brush, floss or eat hard food
• Red, puffy or tender gums
• Bad breath or a bad taste that keeps coming back
• Gums pulling away from the teeth, so the teeth look longer
• Pus between the gums and teeth
• Teeth that feel loose, drift apart or meet differently when you bite
• A partial denture that no longer fits the way it did

Why see a periodontist for gum disease?

A periodontist is a dentist who specializes in the gums and bone that support your teeth. After dental school, periodontists train for three more years in treating gum disease and placing dental implants. General dentists often manage mild cases and refer deeper pockets, bone loss or disease that keeps returning.

A referral doesn't mean your dentist is stepping away. Care is usually shared: the periodontist treats the active disease, and your dentist keeps up your fillings, crowns and checkups. Once your gums are stable, you may alternate cleanings between the two offices.

A periodontal exam measures the gums around every tooth, not just a few spots. That full chart shows where the disease is active and sets a baseline. Later measurements are compared against it, so changes can be spotted early.

What are the steps in gum disease treatment?

Treatment moves in steps, from least to most involved. Most people start with a deep cleaning and then return for a recheck. Further treatment is planned only for the areas that still need it, and maintenance visits protect the result.

The first step is usually scaling and root planing, a deep cleaning below the gumline. It removes tartar and bacteria from the roots and smooths them so the gums can heal. Your gums are numbed first, and the mouth is often treated in sections over two or more visits.

A few weeks to about two months later, your gums are measured again. Many pockets shrink and stop bleeding after the deep cleaning alone. Where pockets stay deep, bacteria can hide beyond the reach of home care, so the next step focuses on those spots.

For pockets that stay deep, periodontal surgery is a common next step. The gum is folded back so the roots can be cleaned in full view, and uneven bone may be smoothed. The gum then heals snugly at a level that is easier to keep clean.

Some patients ask about laser gum treatment, a form of gum surgery that pairs a dental laser with root cleaning. Studies so far haven't shown it to be clearly better than other approaches, so it is one option to weigh rather than a shortcut.

Where bone loss has left a narrow, deep defect beside a tooth, periodontal regeneration may rebuild part of the lost bone and attachment. It uses a bone graft, a thin membrane or proteins that encourage healing. It works for some defect shapes and not others, and it can't restore everything that was lost.

After active treatment, periodontal maintenance visits clean below the gumline and recheck your measurements. The interval is set for you, based on how your gums respond. These visits are how controlled gum disease stays controlled.

What happens if gum disease isn't treated?

Untreated periodontitis tends to get worse. Pockets deepen, more bone is lost, and teeth can loosen, drift apart or need to be removed. The damage is gradual and seldom hurts, which is why it can go unnoticed for years.

It also changes how you eat and how your smile looks. Receding gums can expose roots that ache with cold drinks. Loose or shifting teeth can make chewing uncomfortable and open gaps where food catches.

Gum disease is also associated with other health conditions, including diabetes and heart disease. Researchers are still working out how these links work, and you can read what is known about gum disease and your overall health.

Treatment carries its own, smaller risks. Gums can feel tender for a few days, teeth can be sensitive to cold, and healed gums may sit lower on the teeth. Each treatment page explains these trade-offs in detail.

What affects the cost of gum disease treatment?

Cost depends on how much treatment your gums need, and only an exam can show that. A deep cleaning of two areas costs less than treatment of the whole mouth. Surgery or regeneration in any area adds to the total.

Ask for the cost of each step before you begin. Treating gum disease earlier generally means simpler care. Waiting can turn a deep cleaning into a longer plan, and a lost tooth brings the separate cost of replacing it.

• How many areas of your mouth need treatment, and how many teeth in each
• How deep the pockets are and how much bone has been lost
• Whether new X-rays are needed
• Whether any area needs surgery, laser treatment or regeneration after the first cleaning
• How often you need maintenance visits afterward
• What your dental plan covers, which varies from plan to plan

Care at Perio One

At Perio One in Lafayette, gum disease care starts with an examination before any plan is made. Dr. Randal Comeaux, DDS, Diplomate of the American Board of Periodontology, treats gum disease from the first deep cleaning through surgery and long-term maintenance.

The exam typically includes your health history, gum measurements and X-rays. Dr. Comeaux then explains the findings in plain language, including which teeth are affected and why.

We coordinate with your general dentist, so both offices work from the same plan. Referrals are welcome. Once your gums are under control, our periodontal maintenance program helps keep them stable.

What to expect

1. Call or get a referral

   Call us, or ask your dentist to send a referral. Bring a list of your medicines and any recent X-rays.

2. Your examination

   We review your health history, measure the pockets around each tooth and check X-rays for bone loss.

3. Your findings, in plain words

   Dr. Comeaux explains what the exam found and what each treatment option involves, so you can decide with the full picture.

4. Deep cleaning

   Most people start with scaling and root planing, done in sections with the gums numbed.

5. Recheck

   A few weeks to about two months later, your gums are measured again to see how they healed and whether any area needs more care.

6. Maintenance

   Regular maintenance visits keep the pockets clean and let any change be caught early.

Sources

• American Academy of Periodontology: Gum disease information
• American Academy of Periodontology: Periodontal treatments and procedures
• National Institute of Dental and Craniofacial Research: Periodontal (gum) disease
• American Academy of Periodontology: What is a periodontist?

This page is general education, not a diagnosis. Your periodontist will recommend care after an examination.