Gum disease begins as inflammation that bleeds when you brush, and can end with teeth that loosen and are lost. Treatment removes the bacterial deposit from the root surface and then keeps it off. The disease is controlled, not cured.
Almost anyone whose gums bleed is a candidate for initial treatment. What changes the plan is how deep the pockets are and how much bone has already been lost.
Smoking hides the signs: it narrows the blood vessels, so the gums bleed less while the disease carries on. Diabetes and pregnancy change the response too, which is why both are asked about.
Almost every case starts with the same step — removing what is on the root. The rest is decided by what the tissue does afterwards.
Deep cleaning under local anaesthetic, usually one quadrant at a time, removing calculus and bacterial deposits from below the gum line. This is the treatment for most cases; surgery is considered only if the pockets stay deep afterwards.
Where pockets remain deep after initial therapy, the gum is lifted, the root surfaces are cleaned under direct vision and the tissue is repositioned. It is reserved for sites that did not respond — not used as a first step.
Where a root is exposed, sensitive, or the recession is progressing, tissue is taken from the palate and grafted over the root. It covers the root and thickens the gum; it does not bring back bone that has already been lost.
Probing depth around every tooth, bleeding scores, mobility and x-rays for bone level. This record is what makes the change measurable later — without it, treatment is judged by impression.
Scaling and root planing over one to four appointments, a week or two apart, with local anaesthetic where the pockets are deep. Brushing technique is corrected at the same time, because the cleaning only buys a fresh start.
The pockets are measured again. Shallow ones often improve by a millimetre or two; deep ones frequently do not, and those are the sites that need a decision.
Planned only for sites that did not respond, and only after reassessment. It is a smaller procedure than it sounds, but it is still surgery, with its own healing time.
Visits every three to six months, with probing repeated. This is the part that decides whether the teeth are kept: the disease returns wherever the biofilm is allowed to rebuild undisturbed.
Most of what patients call a complication is the tissue healing. The genuine risks are different, and worth stating plainly.
Smoking is the most important factor you can change: it blunts the response to treatment and hides the bleeding that would have brought you in earlier. Stopping changes the prognosis more than any mouthwash.
No. Teeth can feel loose for a few days because the calculus that was splinting them has gone and the swelling has settled; they firm up as the tissue heals. Where bone loss is advanced, the tooth was already mobile before treatment.
No — it is control. Periodontitis does not go away, but it can be held still. Maintenance every three to six months is what keeps it still, and skipping it is the commonest reason teeth are lost later.
The cleaning is done under local anaesthetic, so not during. Afterwards the gums are tender for two or three days and the roots may be sensitive to cold for a few weeks; both settle with ordinary pain relief and a desensitising toothpaste.
Every three months if pockets were deep, you smoke or your diabetes is not well controlled; every six months for milder cases. The interval is set at reassessment, from the measurements rather than from a rule.
A photograph of the gum line and a recent x-ray are enough for a first opinion on whether this is gingivitis, periodontitis, or something that needs to be seen in the chair.
General information, not medical advice. Gum disease can only be diagnosed by probing and imaging; suitability for treatment is judged after examination, and results vary between patients.
