Gum disease treatment

Gum disease usually starts when plaque, a sticky film of bacteria, builds up on the teeth. Plaque can harden into tartar, which only a professional cleaning can remove (NIDCR).

• Gingivitis is the mildest form. It can be reversed with good home care and professional cleanings (CDC).
• Periodontitis is more advanced. It cannot be reversed, but treatment can slow it and keep it under control (CDC).

Signs include (CDC):

• Red, swollen, tender or bleeding gums
• Gums that pull away from the teeth
• Loose or sensitive teeth, or pain when chewing
• A change in how your teeth fit together, or in how a partial denture fits

The CDC estimates that about 4 in 10 US adults aged 30 and older, and about 6 in 10 adults aged 65 and older, had periodontitis in 2009 to 2014 (CDC). Smoking is the most important risk factor. Older age, diabetes and genetics also raise the risk (NIDCR).

The dentist or hygienist measures the space between each tooth and the gum with a small probe. In a healthy mouth this space is usually 1 to 3 millimeters deep. Deeper pockets can be a sign of gum disease. X-rays show any bone loss (NIDCR). Treatment depends on how far the disease has gone.

1. Deep cleaning. Scaling and root planing removes plaque and tartar above and below the gumline and smooths the tooth roots (Cleveland Clinic). It usually takes one to two hours, in one visit or split over two, with the gums numbed (Cleveland Clinic).
2. Medicines. The dentist may prescribe an oral rinse or place medicine under the gums (CDC). Antibiotics may also be placed around the roots or taken by mouth (Cleveland Clinic).
3. Lasers. Some practices use lasers. The AAP says controlled studies show results similar to some non-surgical treatments, including scaling and root planing alone (AAP).
4. Surgery. If non-surgical treatment does not bring the gums back to health, gum surgery may be suggested (AAP). Severe cases may be referred to a periodontist, a dentist with advanced training in gum disease (CDC).

Many people do not need more treatment after a deep cleaning. Most need ongoing maintenance visits to keep their gums healthy (AAP). Ask your dentist how often you should come back.

• Brush twice a day with fluoride toothpaste (NIDCR).
• Clean between your teeth every day with floss, small brushes, picks or a water flosser (NIDCR).
• If you use tobacco, ask for help to quit (NIDCR).

After a deep cleaning (Cleveland Clinic):

• Some bleeding is normal. Call the dentist if it does not stop.
• Gums may be tender for a couple of days.
• Teeth may be more sensitive to hot and cold. This usually goes away within a month or two.
• Teeth may feel a little loose for a while, and gums may recede as the swelling goes down.

Without treatment, gum disease can damage the bone that supports the teeth (NIDCR). Untreated periodontitis can also make other conditions, such as diabetes, worse (CDC).

• How many areas of the mouth need a deep cleaning.
• Medicines placed under the gums or prescribed.
• Whether you need surgery, and who does it.
• How often you need maintenance visits afterward.
• What your dental plan covers for deep cleanings and maintenance, and any yearly maximum.

Ask for a written estimate that lists each procedure separately, with its CDT code (ADA). If cost is a concern, the CDC points to dental school clinics, which may charge based on ability to pay (CDC).

1. Do I have gingivitis or periodontitis? How deep are my pockets?
2. Do I need a deep cleaning, or will a regular cleaning do?
3. Will you place or prescribe any medicine? Why?
4. When will you check whether the treatment worked?
5. How often will I need maintenance visits?
6. Should I see a periodontist?
7. What will this cost, and what will my plan pay?