Treatments / Everyday dentistry
Gum & Periodontal Treatment
Gum disease is one of the most common reasons adults lose teeth, and it usually does not hurt until it is advanced. A periodontist attends the clinic for surgical gum treatment. Laser techniques are used where they suit the case. Gum disease treatment starts with an assessment of the gums and the bone supporting the teeth.
Who this is for
- Bleeding gums, bad breath or receding gums
- Gum infection, or what many people call pyorrhoea
- Loose teeth, or gums that have pulled away from them
- Dark gum pigmentation, where depigmentation is wanted
- Gum care around existing implants
What actually happens
- Charting of the gums to measure pocket depths rather than judge by eye
- Scaling and root planing, usually over one or two appointments
- Gum flap surgery or laser gum surgery where pockets remain deep
- A maintenance interval set to your case, not a standard six months
Signs of gum disease, and why it often does not hurt
The early signs are easy to brush aside: gums that bleed when you brush or floss, gums that look red or puffy, and bad breath or a bad taste that keeps coming back. Later, the gums pull back so the teeth look longer, gaps open between teeth, teeth feel loose or your bite feels different, and you may notice pus at the gum line.
It often does not hurt because the damage happens slowly, below the gum line, as the bone holding the teeth is lost. Bleeding is easy to put down to brushing too hard, and smoking can reduce bleeding and hide the problem. By the time a tooth feels loose, a good deal of support has usually gone.
A swelling that spreads towards the eye or into the neck, or makes it hard to swallow, breathe or open your mouth, or comes with a high fever, is an emergency. Go to a hospital emergency department, and call 108 if breathing is difficult.
Deep cleaning, gum surgery and depigmentation
Scaling and root planing is a deep clean below the gum line. Tartar and bacteria are removed from the root surfaces and the roots are smoothed, so the gum has a clean surface to settle against. It is usually done under local anaesthetic, and the gums are measured again some weeks later.
Where pockets stay deep after that, gum surgery may be suggested, carried out by the periodontist who attends the clinic. In flap surgery, the gum is lifted back so the roots and bone can be cleaned under direct view, then stitched back in place. Laser gum surgery uses a laser to treat the diseased tissue inside the pocket. Which one suits depends on the pockets. Ask why one is suggested over the other.
Depigmentation is purely cosmetic. Dark gums are usually natural pigment, not a sign of disease. Depigmentation removes the pigmented surface layer, and in some people the colour slowly returns. A dark patch that is new, changing or in one spot only should be examined first, not treated as cosmetic.
After treatment, and around implants
Once bone has been lost, gum disease is kept under control rather than cured for good. Tartar builds up again below the gum line, so maintenance visits continue after treatment. At each one the pockets are measured, problem areas are cleaned again and your cleaning at home is checked. Smoking and poorly controlled blood sugar both make it harder to keep in check.
Implants need healthy gums too. The gum and bone around an implant can become inflamed and infected much as they do around a natural tooth, and it can progress without much discomfort. If you lost teeth to gum disease, that tendency does not go away with the teeth, so gum treatment comes before an implant and maintenance carries on after it.
If it started with gums that bleed when you brush, what bleeding gums usually mean covers why you should keep brushing and the signs that it has gone further.
Questions people ask
Can gum disease be cured?
Early gum inflammation usually settles with a professional clean and good brushing at home. Once bone has been lost, the disease can usually be controlled, but the lost bone does not normally grow back by itself, which is why maintenance visits continue.
Does scaling and root planing hurt?
It is usually done under local anaesthetic, so the area is numb while it is cleaned. Afterwards the gums can feel tender and the teeth sensitive for a few days, and this usually settles.
What is the difference between flap surgery and laser gum surgery?
In flap surgery the gum is lifted back so the roots and bone can be cleaned directly, then stitched back in place. Laser gum surgery uses a laser to treat diseased tissue inside the pocket. Which suits you depends on how deep the pockets are and where they are.
Are dark gums a sign of gum disease?
Usually not. Dark gums are most often natural, healthy pigment, and depigmentation is a cosmetic choice. A new or changing dark patch should be examined first.
Can I have an implant if I have gum disease?
Gum disease is treated and brought under control first. An implant can then be considered, with regular maintenance afterwards, because the gum and bone around an implant can become diseased too.
