Periodontitis: A Guide
What sets periodontitis apart from early gum disease, what happens below the gum, who is most likely to get it, and how staged treatment and ongoing care help you keep your teeth.
What Is Periodontitis, and What Does Treatment Involve in Lanark?
Periodontitis is gum disease at its more serious stage, when the damage has spread beyond the gum to the bone and fibres that hold your teeth in. Bone that has gone won't regrow, but the disease itself can be stopped. Here in Lanark, Fiona Dyer, our hygienist, treats it with deep cleaning under local anaesthetic, usually across four visits at £100 each. She then re-measures your gums and keeps them stable with hygiene appointments every three months, which Plan B includes.
How Periodontitis Differs From Gingivitis
Both are forms of gum disease; the difference is how far down the problem reaches. With gingivitis, only the gum is inflamed. It may bleed and look puffy, but the structures holding the tooth are untouched, and thorough cleaning puts it right entirely.
With periodontitis, the inflammation has travelled further, into the ligament and the bone. The gum pulls away from the tooth, pockets open up and the bone around the root wears away over time. You might see the gums shrinking back, notice a taste that won't go, or find teeth drifting apart or loosening. Bone that has gone is gone for good, but more loss can be prevented.
Periodontitis is always preceded by gingivitis, although most gingivitis never gets that far. This guide carries on from our gum disease guide and looks at what happens once bone is affected.
What Happens Below the Gum
In a healthy mouth the gum forms a snug cuff around each tooth, a little under the edge you can see. When plaque collects in the shallow groove there, your immune system responds with inflammation. It is mostly that response, more than the bacteria themselves, that breaks the cuff down and eats into the bone.
As a pocket deepens, it fills with plaque and tartar that brushing and flossing cannot get to, and a deeper pocket houses more of the most destructive bacteria. From then on the process feeds itself. It is rarely painful, so many people have it for years without realising, until a tooth shifts or a space opens up. By that point a good deal of support may already be lost, so we chart the gums at every dental examination rather than waiting for something to hurt.
Been Told You Have Gum Pockets?
Book a dental examination that includes a full gum assessment.
Who Is Most Likely to Get It?
- Smokers, more than anyone. Smoking starves the gum of blood, masks bleeding and slows healing, so treatment works less well
- People with diabetes, especially when blood sugar is often high. Gum treatment can, in turn, help with blood sugar control
- Those with a family pattern of teeth loosening, or of dentures needed early in life
- Anyone whose teeth are difficult to keep clean because of crowding, older bridgework or fixed braces
- People living with long-term stress, or with medicines or conditions that suppress the immune system
A risk factor doesn't make periodontitis certain, and having none doesn't rule it out. Measuring your gums is the only reliable way to find out.
Staging and Grading
We measure pocket depths and bleeding all the way round each tooth, test for mobility and note any recession. X-rays then reveal how much bone remains around the roots. Those results let us classify the disease under the British Society of Periodontology system:
| Feature | What it tells us | Scale |
|---|---|---|
| Stage | How much of the tooth's support has been lost so far | 1 (early) to 4 (severe) |
| Grade | How fast the damage is happening for someone your age, taking smoking or diabetes into account | A (slow) to C (rapid) |
Together, stage and grade set how much treatment you need and how often maintenance visits should be. We explain both to you and record them, so every later re-measurement shows plainly whether things are stable.
Your Treatment Plan
| Phase | What happens |
|---|---|
| 1. Groundwork | Fiona clears plaque and tartar above the gum, builds a home routine around your mouth, and supports you with stopping smoking or managing blood sugar. Without this, deeper treatment won't last |
| 2. Deep cleaning | With the area numbed, and one quarter of the mouth at each visit, Fiona cleans every root surface down to the base of its pocket so the gum has a chance to reattach. £100 per stage, or £90 if you're on one of our dental plans 1 |
| Re-measure | Roughly three months later we chart every pocket again to see which areas have healed |
| 3. Further treatment | Any sites still inflamed are cleaned again. If pockets remain deep despite good home care, we can refer you to a periodontist to discuss whether gum surgery would help |
| Maintenance | Hygiene visits, normally three-monthly, for as long as you keep your teeth |
Before anything begins, you'll have a written plan showing how many stages you need and what they cost.
After Each Deep-Cleaning Visit
The area is numb while Fiona works, so what you notice is pressure and a scraping feeling rather than pain. When the numbness fades the gum may feel bruised for a day or two, and ordinary paracetamol or ibuprofen usually deals with that.
Over the following weeks the swelling subsides and the gum tightens as it shrinks back. Teeth may look slightly longer, small dark spaces can show between them, and newly exposed roots may react to cold. All of that is part of healing, and a toothpaste for sensitive teeth helps. Clean the treated area softly from day one, since that is what stops the pocket filling up again.
Can It Be Cured?
To be straightforward: no. Bone and attachment that have gone will not return, so rather than calling periodontitis cured, we aim to make it stable. That is a very good result. Most people who finish treatment, clean between their teeth daily and keep up maintenance hold on to their teeth for many years.
The most common reason for the disease flaring up again is missed maintenance appointments. If it is very advanced, or deep cleaning hasn't been enough, we'll tell you at your re-measurement and talk about referral, or go through the choices if a tooth can't be kept.
Why Maintenance Makes the Difference
Each quarter, Fiona re-measures your pockets, removes fresh deposits from under the gum and finishes with Airflow, so the damaging bacteria never have time to re-establish. Between appointments, clean between every tooth each day with the brush sizes she recommends, and brush into the gum edge morning and night. If you smoke, giving up will help your gums more than anything else you can do.
Plan B, at £40.16 a month, is built around exactly this pattern. Each year you get four hygiene visits with Airflow plus two dental examinations, so the visits that keep your gums stable are paid for in advance.
Questions
This guide is general information, not a diagnosis. A dentist needs to examine you to say what is right for your teeth.