Periodontitis: The Facts
What separates periodontitis from early gum disease, what is happening below the gum, who is most vulnerable, and how treatment in stages followed by maintenance keeps your teeth where they are.
What Is Periodontitis, and What Does Treating It in Broughty Ferry Involve?
Periodontitis is gum disease in its advanced form, where the damage has spread beyond the gum and into the fibres and bone that anchor your teeth. Bone that has gone will not return, but the disease itself can be stopped. At our Broughty Ferry practice, our hygienist treats it by deep cleaning the roots under local anaesthetic, normally across four stages at £100 a stage, then measures your gums again and keeps them stable with hygiene visits every three months, which Plan B pays for.
Gingivitis and Periodontitis: The Difference
They are the same disease at two different depths. With gingivitis the inflammation is confined to the gum itself: it swells and bleeds, yet the structures that hold the tooth are untouched, and thorough cleaning reverses it completely.
With periodontitis the inflammation has worked its way down into the ligament and bone. The gum peels away from the tooth, pockets form, and bone around the root is slowly eaten away. Signs include receding gums, a taste that will not go, and teeth that drift apart or feel loose. That bone loss cannot be undone, but it can be stopped from going any further.
Every case starts as gingivitis, though most never go beyond it. This guide continues from where our gum disease guide stops: what happens once bone is involved.
What Goes on Under the Gum
A healthy gum forms a seal around every tooth just beneath its visible margin. When plaque collects in that shallow groove, the body responds to the bacteria with inflammation, and it is chiefly this defensive response, rather than the bacteria as such, that breaks the seal and dissolves the bone.
As soon as a pocket exists it fills with plaque and tartar beyond the reach of any brush or floss, and the deeper it gets the more of the damaging bacteria it harbours. The process feeds itself. It rarely causes pain, so many people carry it for years unaware, until a tooth shifts or a gap opens. A great deal of support can be lost by then, which is why we measure your gums at every examination rather than waiting for you to notice something.
Been Told You Have Pockets?
Book an examination with a full assessment of your gums.
Who Is Most Vulnerable?
- Smokers, far more than anyone else. Smoking cuts blood flow to the gum, masks bleeding, slows healing and weakens the response to treatment
- Diabetics, especially where blood sugar is poorly controlled. Treating the gums can in turn help the blood sugar
- Anyone with a family history of teeth loosening or dentures early in life
- People whose teeth are awkward to clean: crowded teeth, old bridgework, fixed braces
- Those under sustained stress, or on medication or living with conditions that suppress immunity
A risk factor is not a sentence, and having none offers no guarantee. The only reliable test is to have your gums measured.
How It Is Diagnosed: Stage and Grade
Using a fine probe, we record pocket depth and bleeding around each tooth, check for looseness and note any recession. An X-ray survey then shows the bone left around every root. The findings are classified using the British Society of Periodontology system:
| Feature | Meaning | Scale |
|---|---|---|
| Stage | The amount of support already gone | 1 (early) up to 4 (severe) |
| Grade | How quickly damage is occurring relative to your age, with smoking or diabetes factored in | A (slow) through to C (rapid) |
Between them, stage and grade determine how intensive treatment needs to be and how often you need maintenance. Both are explained to you and recorded, so at every re-check it is obvious whether things are stable.
Your Treatment, Step by Step
| Phase | What is involved |
|---|---|
| 1. Groundwork | Our hygienist clears plaque and tartar from above the gum line, designs a home routine for your particular mouth, and supports you with smoking or blood sugar. Without this, deeper treatment will not last |
| 2. Deep cleaning | With local anaesthetic, a quarter of the mouth at each visit, our hygienist cleans the root surfaces right to the floor of every pocket so the gum can reattach. £100 per stage, or £90 on a plan 1 |
| Re-check | Around three months later, each pocket is measured again to find where healing has taken place |
| 3. Further treatment | Sites that have not responded are cleaned a second time. If pockets remain deep in spite of good care, a referral to a specialist periodontist for advice on gum surgery is possible |
| Maintenance | Hygiene appointments, typically at three-month intervals, for as long as you have your own teeth |
Before anything begins you receive a written plan setting out the number of stages and the fee.
Recovering From Each Stage
The area is numb throughout, so what you feel is pressure and scraping rather than pain. As the anaesthetic fades, the gum may feel tender and bruised for a couple of days, and ordinary paracetamol or ibuprofen generally copes.
Over the weeks that follow, the swelling goes down and the gum tightens back against the tooth. Teeth may look slightly longer, small dark gaps can appear between them, and freshly exposed root can be sensitive to cold. All of this is healing in progress, and a sensitivity toothpaste will help. Begin cleaning the treated area gently from the first day; that is what stops the pocket refilling.
Can It Be Cured?
Strictly speaking, no. Lost bone and attachment do not regenerate, so the aim with periodontitis is stability rather than cure. Stability is a genuinely good result: with treatment, daily interdental cleaning and ongoing maintenance, the majority of people hang on to their teeth for many years.
Missed maintenance is the most frequent cause of relapse. If the disease is very far advanced, or fails to respond to deep cleaning, we will tell you so at your re-check and discuss a referral, or go through the options where a tooth cannot be saved.
Maintenance: The Make-or-Break Part
Once every three months, our hygienist measures your pockets again, removes any fresh deposits from under the gum and rounds off with Airflow, denying the harmful bacteria any chance to re-establish. At home, clean between each tooth every day using the brush sizes you have been given, and brush into the gum line twice daily. For smokers, quitting does more good for the gums than anything else you could do.
Plan B, £40.16 a month, was designed with exactly this pattern in mind: it includes four Airflow hygiene visits a year plus two examinations, so the appointments that safeguard your gums are already covered.
Questions
This guide is general information, not a diagnosis. A dentist needs to examine you to say what is right for your teeth.