Gingivitis or periodontitis?
Gum disease starts where the gum meets the tooth. Plaque left there irritates the gum, which turns red, swells a little and bleeds when you brush or floss. That first stage is gingivitis, and it reverses: after a thorough cleaning, and with better cleaning at home, the gum settles down again.
Left alone, the inflammation works its way below the gum line. The gum comes away from the tooth to form a pocket, the pocket collects more bacteria, and the bone that holds the tooth slowly breaks down. That is periodontitis. Bone lost this way does not grow back on its own, so from then on the aim is to stop it going any further.
What are the signs of gum disease?
It rarely hurts until it is well along, which makes the early signs easy to explain away:
- Bleeding gums when you brush or floss.
- Gums that are red, puffy or tender.
- Receding gums, so the teeth look longer than they used to.
- Bad breath, or a bad taste that keeps coming back.
- Teeth that feel loose, or a bite that feels different.
How the gums are measured
At every cleaning and exam, the hygienist measures the gum around each tooth with a thin probe marked like a tiny ruler. Healthy gum fits snugly and the reading is shallow. A deeper reading means a pocket has formed. The numbers are recorded at each visit, so we can see whether a pocket is holding steady or getting deeper.
X-rays show what the probe cannot: the level of the bone around each root. Together they tell us whether this is gingivitis or periodontitis and how far along it is, and we show you both on the screen before anything is decided.
What happens in a deep cleaning?
Once pockets have formed, an ordinary cleaning cannot reach the bottom of them. The treatment is scaling and root planing, usually called a deep cleaning. The area is numbed first with local anesthetic. Then the tartar and bacteria are cleaned out of each pocket and the root surfaces are smoothed, so the gum can heal and tighten back around the tooth.
It is often done a section of the mouth at a time, depending on how many teeth are involved. Where they help, laser therapy and ARESTIN, an antibiotic placed directly into a pocket, can be part of the same treatment. Neither replaces the cleaning. They are added for the pockets that need more help to heal.
The fee depends on how many areas need treatment, so you get a written estimate before anything is scheduled. See insurance for the plans we work with, or the Virginia Dental Club if you have no dental insurance.
Keeping gum disease under control
Treated gum disease tends to come back if the bacteria below the gum line are left too long, so the cleanings come closer together: every 3 to 4 months rather than every six. These periodontal maintenance visits clean below the gum line and measure the pockets each time, so any change is caught while it is small.
Your part is daily: brushing along the gum line and cleaning between the teeth, with floss or small brushes, whichever you will actually use. We will show you what is being missed. Kept up, the management works, and the aim is for you to keep your teeth.
Gum disease, diabetes and smoking
Gum disease is linked with other health conditions, most clearly diabetes: each tends to make the other harder to control. If you have diabetes, tell us, and tell your physician that you are being treated for your gums.
Smoking makes gum disease more likely and slows healing after treatment, and it can hide the bleeding that would otherwise warn you. Links with heart disease and other conditions have been reported too, but a link is not proof of cause, and nobody can promise that treating your gums will prevent anything else.
Will I need to see a gum specialist?
Gum disease treatment, from the first deep cleaning to the maintenance visits, is done here in the office on Tazewell Street. When the disease is advanced, when pockets stay deep despite treatment, or when surgery on the gum or bone could help, we will refer you to a gum specialist and explain why before you go.
Questions patients ask
Can gum disease be cured?
Gingivitis, the early stage, can be reversed with a thorough cleaning and good care at home. Periodontitis cannot be undone, because the bone it has taken does not grow back on its own, but it can be stopped and kept under control with treatment and regular maintenance cleanings.
Does scaling and root planing hurt?
The area is numbed first, so most people feel pressure and scraping rather than pain. The gums are often tender afterward and the teeth can be sensitive to cold for a while. Both settle as the gums heal.
Why do I need cleanings every 3 to 4 months?
Treated gum disease comes back if the bacteria below the gum line are left too long. Cleanings every 3 to 4 months keep them in check and let us measure the pockets often enough to catch any change early.
Will my receded gums grow back?
Not on their own. Treatment aims to stop the recession getting worse and to protect what is left. Where a receded area is causing trouble, a gum specialist can sometimes graft gum over it, and we will tell you if that is worth considering.