Stopping gum disease before it takes teeth.

What's actually happening

Bacteria collect where the gum meets the tooth. Left there, they cause inflammation — that's gingivitis, and it's reversible. If it continues, the inflammation goes deeper and the body begins destroying the bone and fibres holding the tooth in. That's periodontitis, and the bone it takes does not come back on its own.

As the attachment breaks down, the space between gum and tooth deepens into what we call a pocket. Pockets are impossible to clean at home, so they harbour more bacteria, which deepens them further. That's the cycle we're breaking.

The reason this catches people out is that it doesn't hurt. By the time a tooth feels loose, a great deal of bone is already gone.

Signs worth acting on

• Gums that bleed when you brush or floss — this is not normal, however common
• Persistent bad breath or a bad taste
• Gums that look red and puffy, or have pulled back from the teeth
• Teeth that feel loose, or that have started to shift or splay
• A change in how your teeth fit together, or how a denture fits

How we treat it

Scaling and root planing

The first step for most patients, and often the only one needed. We numb the area and clean the root surfaces thoroughly below the gumline, removing the hardened deposit that a routine cleaning can't reach, and smoothing the root so tissue can reattach.

Usually done in two visits, half the mouth each. This is a genuine treatment, not a deep clean with a fancier name — and for mild and moderate disease it works.

Pocket therapy and re-evaluation

Six to eight weeks later we measure every pocket again and compare. Most shrink and stop bleeding. Where a few deep sites remain, we treat those specifically — sometimes with locally placed antibiotics, sometimes with LANAP laser treatment, sometimes with conventional surgery. We choose based on what the numbers show, not on a standard package.

Regenerative procedures

Where a defect in the bone has a favourable shape, we can sometimes rebuild it rather than just clean it — placing graft material and a membrane so bone and attachment can regrow. Not every site is suitable. Where one is, it's the difference between holding a tooth and losing it.

Crown lengthening

Two quite different reasons for the same procedure. Sometimes a tooth has broken or decayed below the gumline and there isn't enough tooth left for your dentist to fit a crown onto — we reshape the gum and bone to expose more of it. Other times it's cosmetic: a smile that shows a lot of gum, where reshaping gives more even, less gummy proportions.

Extractions

Sometimes a tooth is too far gone. When that's the case we'd rather remove it cleanly, preserve the socket with a graft at the same appointment, and set you up properly for an implant — than spend two more years and more money holding onto something that was never going to make it.

Oral biopsies

If we find a sore, patch or lump that doesn't look right, we can take a small sample and send it for analysis. Most turn out to be nothing. The ones that aren't are far better caught early, and this is a quick, straightforward appointment.

Does it hurt?

Scaling and root planing is done with the area numbed, so you shouldn't feel it. For a few days afterward the gums are tender and the teeth are often sensitive to cold, and both settle. Over-the-counter pain relief is normally enough.

Surgical treatment is more involved, and we'd tell you plainly what to expect for the specific procedure. IV sedation is available for any of it.

How long does it take?

• Consultation and full periodontal charting: about an hour.
• Scaling and root planing: two visits of 60–90 minutes.
• Re-evaluation: 6–8 weeks later, about 30 minutes.
• Maintenance: ongoing, usually every 3–4 months.

What recovery is really like

After non-surgical therapy, most people carry on with their day. Gums are tender for two or three days and teeth may be cold-sensitive for a couple of weeks as the roots are no longer insulated by inflamed tissue. Soft food for a day or two helps.

You'll likely notice your gums looking and feeling different within a fortnight — firmer, paler, and no longer bleeding when you brush. That's the point.

Who is a good candidate

Anyone with bleeding gums, deep pockets or bone loss on their x-rays. Some people are at higher risk and worth checking sooner: smokers, people with diabetes, anyone with a family history of losing teeth, and anyone who has noticed their gums receding.

Gum disease also has a documented relationship with heart disease, diabetes control and pregnancy outcomes — which is a good reason to treat it even when your teeth feel fine.

The one thing we'll be straight about: this only works with maintenance. Gum disease is a chronic condition, like blood pressure. We can bring it under control, but it comes back if the cleanings stop.