Periodontitis, Explained
How periodontitis differs from gingivitis, what each step of treatment involves, and how to keep your gums stable for good.
What Is Periodontitis, and What Does Treatment Involve?
Periodontal disease, also called periodontitis, is gum disease that has gone beyond the gums. Inflammation triggered by plaque bacteria spreads into the fibres and bone that anchor the teeth, opening pockets and gradually eroding that support. Lost bone can't be replaced, but the disease can be halted. Treatment is deep cleaning beneath the gum line under local anaesthetic, done in stages, then re-assessment and regular maintenance. At Peninsula Dentists on Greenwich Peninsula, each stage of periodontal therapy costs £100, most people need four, and the three-monthly maintenance that follows is built into Plan B.
Gingivitis Versus Periodontitis
| Feature | Gingivitis | Periodontitis |
|---|---|---|
| Affects | Gum tissue alone | Gum, bone and the fibres attaching the tooth |
| Typical signs | Bleeding, redness, swelling | Bleeding, recession, bad breath, loosening teeth |
| Pocket depth | Shallow | Deep, where gum has separated from tooth |
| Can it be undone? | Yes, with improved cleaning | Lost support can't be rebuilt, but the disease can be halted |
Periodontitis always begins as gingivitis, yet plenty of people with gingivitis never progress further. The dividing line is whether inflammation has reached the bone. The early warning signs and causes are in our gum disease guide; this one picks up the story once bone is involved, and explains how we treat it.
What Goes on Beneath the Gum
In a healthy mouth, the gum is fixed to the tooth a little below its visible margin, leaving a shallow groove. If plaque stays in that groove long enough, the immune reaction it provokes, as much as the bacteria themselves, begins to dissolve the attachment. The gum lifts away into a pocket, plaque and tartar creep down inside it beyond the reach of any brush, and the underlying bone gradually disappears. A deeper pocket shelters more bacteria, so the disease drives itself forward. It's seldom painful, and it can progress quietly for years until teeth start to loosen or fan out and gaps open up. By that stage much of the support is gone, which is why we measure pockets at every visit instead of waiting for symptoms.
Concerned About Your Gums?
Book a dental examination with a full gum assessment, or see our hygienist directly.
Risk Factors
- Smoking. The biggest single risk. It cuts blood flow to the gums, masking bleeding, delaying healing and blunting the effect of treatment
- Diabetes, above all when blood sugar runs high; gum disease in return makes diabetes harder to manage
- Relatives who had gum disease or lost teeth young
- Difficulty cleaning between the teeth, for example with crowding, bridges or braces
- Prolonged stress, and illnesses or medicines that dampen the immune system
Having one of these doesn't make periodontitis inevitable, and having none of them doesn't make you immune. Regular gum assessments are the only reliable way to find out where you stand.
Diagnosis, Staging and Grading
A fine probe measures the pocket depth around each tooth, and we record where the gums bleed and whether any teeth move. X-rays then reveal the level of bone supporting each root. That information lets us classify your periodontitis by stage and grade, following the British Society of Periodontology scheme. The stage, from 1 (early) to 4 (severe), records the amount of support lost. Grade A to C reflects how quickly it is advancing for someone of your age, and whether a factor such as smoking or diabetes seems to be speeding it up. The two together set how intensive treatment should be and how often maintenance will be needed. We go through your stage and grade with you and keep a record of them, so each re-assessment shows clearly whether your gums are holding steady.
How Treatment Works
- Step 1: a home-care routine built around your mouth, removal of plaque and tartar above the gum, and work on risk factors such as smoking and blood sugar. Deeper cleaning won't last without this foundation
- Step 2: cleaning beneath the gum line, normally in four stages, a quarter of the mouth at a time, with local anaesthetic. Slim instruments clear tartar and bacteria from the root surface inside each pocket, allowing the gum to heal back onto the tooth. Each stage is £100, or £90 on a dental plan2
- Re-assessment after a few months, measuring every pocket again to see which areas have healed
- Step 3: repeat cleaning for any pockets that haven't settled. Where disease is advanced, gum surgery with a periodontist (a dentist with additional training in treating gums) may be recommended, and we arrange the referral
- Maintenance: hygiene appointments, often three-monthly, to hold the gains
After Each Stage
Because the area is numb, you'll be aware of pressure and scraping but not pain. Once the anaesthetic wears off, expect a day or two of tender gums, eased with everyday painkillers. Over the following weeks, as the swelling subsides, the gums firm up and often recede a little, so teeth may look slightly longer and small spaces can show between them near the gum. That's a sign of healing rather than harm, although newly exposed root may twinge with cold drinks for a while, and a sensitivity toothpaste helps. Start cleaning the treated area gently from day one, because that's what stops the pockets filling with plaque again.
Is There a Cure?
Strictly speaking, no. The bone and attachment already lost don't regenerate. What a combination of treatment, careful cleaning at home and regular maintenance can do is stabilise periodontitis and keep it controlled for life, and that allows most people to hold on to their teeth for many years. When it does return, the usual reason is missed maintenance appointments. Advanced cases, and those that don't respond to deep cleaning, may need a specialist periodontist, for example for gum surgery. If that's the right path for you, we'll say so plainly at your re-assessment.
Staying Stable for the Long Term
Long-term success depends on maintenance. Every three months, Stefanie Goodall, our dental hygienist, re-checks your pockets, clears any fresh deposits from beneath the gum and finishes with Airflow, so the bacteria never regain a foothold. At home, brush twice a day with the bristles angled into the gum and clean between your teeth daily using the interdental brush sizes she has given you. If you smoke, quitting is the most valuable change you can make. On Plan B (£40.16 a month), four Airflow hygiene visits and two dental examinations a year are included, so your maintenance is covered before you book it.
Questions
This guide explains the options in general terms. Only an examination can tell you which of them suits your own teeth.