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Gum disease rarely hurts, and by the time it is obvious it has usually cost some of the bone that holds the teeth. It is controllable. Treatment at Vizcaya Dental Arts starts with measuring how active the disease is, then scaling and root planing to remove the deposits below the gum line, a reassessment about a month later, and maintenance visits every three months. Most of the control after that is in your daily home care.
How gum disease develops
Plaque, the soft film of bacteria that forms on teeth every day, hardens into tartar below the gum line where a brush cannot remove it. The gum reacts with inflammation: it reddens, swells and bleeds. That stage, gingivitis, is reversible. Left alone, the inflammation moves deeper, the bone that holds the teeth begins to dissolve, the gum detaches from the tooth and a pocket forms where more bacteria collect. That is periodontitis, and the bone it costs does not grow back. Over years, teeth loosen and are lost. It rarely hurts at any stage, which is why so much of it is found at a routine examination.
Signs you can notice yourself:
- Gums that bleed when you brush or floss
- Gums that look red or puffy
- Bad breath that does not go away
- Gums that have pulled back, so teeth look longer
- Teeth that feel loose or have shifted
- A bite that seems to have changed
Smoking, diabetes, a family history of gum disease and medications that dry the mouth all raise the risk and change how we plan treatment.
Old damage and active disease
X-rays show the history: the level of bone around each tooth today. Gum measurements, bleeding and inflammation show the present: whether the disease is active. A deep pocket that is clean and does not bleed is a different problem from a shallower one that bleeds at a touch. We put the whole picture together, with your history, your home care and your health, and treat what is active.
Gingivitis, inflammation of the gum alone, responds to a routine cleaning and better home care. Periodontitis, where the inflammation has reached the bone, needs treatment below the gum line.
Scaling and root planing
Scaling and root planing, often called a deep cleaning, removes the hardened deposits and bacteria from the root surfaces below the gum, where a toothbrush cannot reach, and smooths the roots so the gum can reattach and the surface is easier to keep clean.
- Step 1 of 5 Assessment
A full gum measurement, X-rays, and a review of what is active, what is old damage, and how home care has been going.
- Step 2 of 5 First treatment visit
One half of the mouth is numbed and treated. Doing half at a time keeps the visit manageable and lets you eat comfortably on the other side.
- Step 3 of 5 Second treatment visit
The other half. Where the disease is limited to a few areas, a different arrangement may suit better.
- Step 4 of 5 Home care from day one
We tailor a routine to your mouth and your hands: brushing technique, interdental brushes or floss, a water flosser if it helps. This is the part that matters most.
- Step 5 of 5 Reassessment at about a month
Every pocket is measured again. Most improve. Areas that have not responded may need additional treatment or a periodontist's opinion.
Occasionally we add a local antibiotic placed into a stubborn pocket, or a short course of oral antibiotics, alongside the cleaning. They support the treatment in selected cases and do not replace it.
We perform some limited periodontal surgery in the office. When a case needs more than that, we refer you to a periodontist and coordinate with them.
What treatment can and cannot do
Scaling and root planing removes the deposits, reduces the inflammation and lets the gums heal and tighten. It does not grow back bone that is gone, and it does not change what happens tomorrow. It gives you a mouth that is possible to keep clean. With daily home care and maintenance visits, the gums stay healthy and become easier to maintain. Without them the disease returns.
After treatment
- The gums shrink back to a healthier, tighter shape, which can make the teeth look slightly longer.
- Exposed root surfaces may be sensitive to cold for a while. The sensitivity usually eases over the following weeks, and a sensitivity toothpaste helps.
- Bleeding on brushing should stop.
- If an area still bleeds or feels tender a month on, it is one of the sites we look at closely at the reassessment.
Maintenance
After treatment, most patients move to periodontal maintenance every three months. At each visit:
- The pockets are measured and recorded.
- The areas below the gum line are cleaned.
- Any site that has slipped is treated.
- Your home care is adjusted to what the measurements show.
The three-month interval is about how long the bacteria take to re-establish below the gum line after a cleaning. As the gums stay stable, the interval can stretch to four months and, in some cases, six. If things slip, it shortens again.
Home care
There is no single routine for everyone. What works depends on the spaces between your teeth, your dexterity and your habits, so we show you specific tools and techniques. Brushing along the gum line, cleaning between every tooth every day with whatever tool you will use, and keeping your maintenance visits do more for your gums than anything we do in the chair, because you do it every day and we see you a few times a year.
Gums and the rest of your dentistry
Gum disease is the main reason adults lose teeth, and the same bacteria that attack bone around teeth attack bone around dental implants. Treating active gum disease comes before any implant, veneer or major restorative work here, because a restoration on an inflamed foundation does not last.
Frequently asked questions
Does a deep cleaning hurt?
The area is numbed, so the treatment itself is comfortable. Gums can be tender for a day or two afterward and teeth a little sensitive to cold as the inflamed tissue heals and shrinks back. Both settle.
Can gum disease be cured?
It can be controlled, often very well, but not cured in the sense of going away for good. Treatment removes the cause and lets the gums heal; keeping it controlled depends on daily cleaning and regular maintenance. The bone that was lost does not grow back, but the teeth can be stable for decades.
Why every three months instead of six?
Because that is roughly how long it takes the bacteria that cause gum disease to re-establish themselves below the gum line after a cleaning. For treated gums, three months keeps the disease from regaining ground; as things stabilize, the interval can lengthen to four and sometimes six months.
My insurance only covers two cleanings a year. What then?
Many plans cover periodontal maintenance differently from routine cleanings, and some cover more visits. We check your plan and tell you what it pays. If the gap is yours to cover, we tell you that too, so you can decide; we will not thin out the care to match the plan without telling you.
I had a deep cleaning years ago. Why do I need another?
Usually because home care and maintenance lapsed, and the disease came back. A cycle of deep cleanings every few years with nothing in between is exactly what we try to avoid: ideally a deep cleaning happens rarely, and everything after it is maintenance.
Will I need surgery or a specialist?
Most gum disease is treated without surgery. We perform some limited periodontal surgery here and refer to a periodontist when a case needs more than that. If your reassessment shows areas that have not responded, we tell you what the next step is.
Sources
Professional guidelines and peer-reviewed reviews this page draws on.
- Smiley CJ, Tracy SL, Abt E, et al. Evidence-based clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts. Journal of the American Dental Association. 2015;146(7):525-535. DOI
- Eke PI, Thornton-Evans GO, Wei L, Borgnakke WS, Dye BA, Genco RJ. Periodontitis in US adults: National Health and Nutrition Examination Survey 2009-2014. Journal of the American Dental Association. 2018;149(7):576-588. DOI
