Gum Disease Treatment (Periodontics)

Periodontics is the branch of dentistry that deals with the tissues holding a tooth in place: the gum, the jawbone and the fibres that attach the root to the bone. Gum disease is these tissues' inflammatory response to the bacterial plaque that builds up on the tooth surface. At first it affects only the gum; left alone, it moves down into the bone and the teeth begin to loosen.

What makes the disease so insidious is that it usually progresses without pain. Many patients first come to us when a tooth has started to move, even though their gums have been bleeding on brushing for years. This page sets out the overall picture of the disease and the order in which treatment proceeds; each step is covered in detail on its own page.

Gingivitis or periodontitis?

They are two stages of the same disease, and the difference between them decides the treatment.

Not every case of gingivitis turns into periodontitis, but every case of periodontitis starts as gingivitis. That is why bleeding gums should not be ignored on the assumption that they will settle by themselves.

Which symptoms need an examination?

• Gums that bleed when you brush or floss
• Red, swollen gums that are tender to the touch
• Bad breath or a bad taste in the mouth that does not go away
• Receding gums, or teeth that look longer than they used to
• New gaps opening between the teeth, or front teeth fanning forwards
• A loose tooth, or a bite that feels as if it has changed
• Pus coming from between the gum and the tooth

In smokers, bleeding may not be obvious: nicotine narrows the blood vessels in the gum and makes the disease look milder than it really is. No bleeding does not mean no disease.

What pocket measurements tell us

Around a healthy tooth there is a shallow groove of 1–3 mm between the tooth and the gum. In periodontitis the gum detaches from the tooth and this groove deepens into a "pocket". Neither a toothbrush nor floss can reach inside it, so bacteria find a sheltered place to thrive.

At the examination we use a thin probe marked in millimetres to measure six points around every tooth. These readings are recorded together with any bleeding, tooth mobility and the bone level seen on X-ray. The resulting chart determines the stage of the disease (how far it has progressed) and its grade (how fast it tends to progress). When the same charting is repeated months later, these numbers also show whether treatment has worked; we go by the measurements, not by an impression that things "look better".

In what order does treatment proceed?

Periodontal treatment is not a single procedure but a series of steps. The pockets are measured again after each step, and we move on to the next one only if it is needed.

1. Cleaning and home care. Plaque and tartar above the gum line are removed, and we go through your brushing and cleaning between the teeth together. Treatment for gingivitis often ends here; the details are on the scale and polish page.
2. Cleaning below the gum. If there are pockets, the root surfaces are cleaned right down to the bottom of each pocket under local anaesthetic. This is known as deep cleaning (root planing).
3. Re-evaluation and, if needed, surgery. The pockets are measured again after 6–8 weeks. If deep pockets remain, the gum is opened so that the roots can be cleaned under direct vision: periodontal flap surgery.
4. Supportive care. Once the disease has been brought to a halt, a check-up and professional cleaning every 3–6 months. For anyone who has had periodontitis, this step is not optional; it is a permanent part of the treatment.

The exception to this order is acute infection. If a painful swelling with pus has suddenly appeared in the gum, the gum abscess is treated first, and the step-by-step plan begins after that.

The part played by diabetes, smoking and your general health

Gum disease is caused by bacterial plaque, but how severe it becomes depends largely on how your body responds. That is why at the examination we ask about your general health as well as your mouth.

• Diabetes. When blood sugar is poorly controlled, periodontitis is more common and progresses faster. The relationship works both ways: studies show that treating gum disease also makes a small but measurable contribution to blood sugar control. If you have diabetes, bringing your latest HbA1c result makes planning easier.
• Smoking. One of the strongest modifiable risk factors for the disease. It slows healing, reduces the response to treatment and has a marked effect on the results of surgery.
• Other factors. Hormonal changes in pregnancy, severe stress, certain blood pressure and epilepsy medicines, treatments that suppress the immune system and a family history of early tooth loss are also taken into account.

Does lost bone grow back?

The honest answer: mostly not. The real aim of periodontal treatment is to stop the disease progressing and to preserve the bone that remains. With some vertical bone defects, regenerative surgery can achieve a partial gain, but it is not a solution that can be applied to every case.

As the inflammation settles, the swelling goes down and the gum recedes a little; the teeth may look slightly longer and the gaps between them more noticeable. This is the treatment revealing the disease, not new damage. For teeth that have lost most of their bone support, we also talk openly about options such as extraction followed by an implant. But an implant placed before periodontitis is under control is exposed to the same risk.

How many visits, and what decides the cost?

If there is only gingivitis, one or two visits may be enough. In advanced periodontitis, cleaning, deep cleaning and re-evaluation take several months. The cost depends on how many teeth and areas are affected, whether surgery is needed and how many reviews are planned; you receive a written, itemised quote after the examination. At our clinic in Bayraklı, İzmir, we finalise the plan and its scope with you once the measurements and X-rays have been done.