Periodontitis Explained
How periodontitis differs from early gum disease, what's going on beneath the gum, who's most at risk, and how staged treatment and maintenance keep your teeth.
What Is Periodontitis, and How Is It Treated in Hamilton?
Periodontitis is the advanced form of gum disease, where the damage has moved past the gum into the bone and fibres anchoring your teeth. The lost bone won't grow back, but the disease can be halted. In Hamilton, our hygienist Simra Ashraf treats it with deep cleaning under local anaesthetic, usually in four stages at £100 each, then re-checks your gums and keeps them stable with three-monthly hygiene visits, which Plan B covers.
Periodontitis Versus Gingivitis
Both are gum disease, at different depths. In gingivitis the inflammation stays in the gum: it bleeds and swells, but nothing holding the tooth has been damaged, and good cleaning reverses it completely.
In periodontitis the inflammation has gone deeper, into the ligament and bone. The gum separates from the tooth, pockets form, and the bone that supports the root is gradually lost. You may notice gums receding, a persistent taste, teeth spreading or loosening. The bone loss is permanent, but further loss can be prevented.
Gingivitis always comes first, though most cases never progress. This guide picks up where our gum disease guide leaves off: what happens once the bone is involved.
Beneath the Gum Line
Healthy gum seals around each tooth just below its visible edge. When plaque sits in the shallow groove there, the body fights the bacteria with inflammation, and it's largely that defensive reaction, rather than the bacteria alone, that breaks the seal and dissolves bone.
Once a pocket forms, it fills with plaque and tartar that no brush or floss can reach, and a deeper pocket shelters more of the bacteria that do damage. It becomes a self-sustaining cycle. Because it seldom hurts, people often go years without knowing, until a tooth moves or a gap appears. By then a lot of support can be gone, which is why we measure the gums at every dental examination instead of waiting for symptoms.
Told You Have Gum Pockets?
Book an examination and a full gum assessment.
Who Is Most at Risk?
- Smokers, by a long way. Smoking reduces blood supply to the gum, hides bleeding, slows healing and blunts the effect of treatment
- People with diabetes, particularly if blood sugar runs high. Treating the gums can help with blood sugar control too
- Families with a history of loose teeth or dentures at a young age
- Anyone whose teeth are hard to clean: crowding, old bridges, fixed braces
- People under prolonged stress, or taking medicines or living with conditions that dampen the immune system
Having a risk factor doesn't mean you'll get it, and having none doesn't make you immune. The only way to know is to have your gums measured.
Diagnosis: Stage and Grade
We probe around every tooth to record pocket depths and bleeding, check for movement and look for gum recession. X-rays then show how much bone is left around each root. From those findings we classify the disease using the British Society of Periodontology system:
| Feature | What it describes | Range |
|---|---|---|
| Stage | How much support has already been lost | 1 (early) to 4 (severe) |
| Grade | The speed of the damage relative to your age, adjusted for smoking or diabetes | A (slow) to C (rapid) |
The stage and grade together set the intensity of treatment and the spacing of your maintenance visits. We explain both to you and keep them on record, so each re-check shows clearly whether things are holding steady.
The Treatment Plan
| Phase | What happens |
|---|---|
| 1. Foundations | Simra removes plaque and tartar above the gum, works through a home routine fitted to your mouth, and helps you tackle smoking or blood sugar. Deeper treatment won't hold without this |
| 2. Deep cleaning | Under local anaesthetic, one quarter of the mouth per visit, Simra cleans the root surfaces down to the base of each pocket so the gum can reattach. £100 a stage, or £90 for plan members 1 |
| Re-check | About three months on, every pocket is measured again to see where healing has happened |
| 3. Further care | Areas that haven't settled are cleaned again. Where pockets stay deep despite good care, we can refer you to a specialist periodontist for an opinion on gum surgery |
| Maintenance | Hygiene visits, usually every three months, for as long as you have teeth |
We'll give you a written plan with the number of stages and the fee before anything starts.
After Each Deep-Cleaning Stage
You'll be numb during the appointment, so expect a sensation of scraping and pressure, not pain. Once the anaesthetic wears off, the gum can feel bruised for a day or two, and paracetamol or ibuprofen is usually enough.
Over the next few weeks the swelling goes down and the gum shrinks back to a tighter fit. Teeth can look a touch longer, small dark triangles may appear between them, and the newly exposed root can be sensitive to cold. That's healing, and a sensitive toothpaste helps. Start cleaning the treated area gently on day one: it's what stops the pocket refilling.
Is It Ever Cured?
Honestly, no. The bone and attachment that have been lost don't come back, so we talk about periodontitis being stable rather than cured. Stable is a very good outcome: with treatment, daily cleaning between the teeth and regular maintenance, most people keep their teeth for many years.
The commonest reason for relapse is skipped maintenance. Where the disease is very advanced, or doesn't respond to deep cleaning, we'll say so at your re-check and discuss referral, or talk through options if a tooth can't be saved.
Maintenance: Where It Succeeds or Fails
Every three months, Simra re-checks your pockets, clears any new deposits from beneath the gum and finishes with Airflow, so the harmful bacteria never get a chance to rebuild. Between visits, clean between every tooth daily with the brush sizes she's given you, and brush twice a day into the gum line. If you smoke, stopping will do more for your gums than anything else.
Plan B, at £40.16 a month, is designed around this rhythm: four Airflow hygiene visits a year and two dental examinations are included, so the appointments that protect your gums are already paid for.
Questions
This guide is general information, not a diagnosis. A dentist needs to examine you to say what is right for your teeth.