What This Guide Covers and Who It Is For
This guide explains each gum disease treatment option, organized by the stage of disease it addresses. It is written for adults who have been told they have gum disease, or who suspect they might.
Gum disease, also called periodontal disease, is a bacterial infection of the tissues that surround and support your teeth. [1] It starts with inflammation of the gums (gingivitis) and can progress to destruction of the bone that holds teeth in place (periodontitis). The treatment that fits your situation depends on how much damage has already occurred.
You will find information on non-surgical treatments like deep cleaning, surgical procedures like bone grafts, newer options like laser therapy, and the ongoing maintenance visits that follow. Each section covers what the treatment involves, who it is for, and what results you can typically expect.
If you are unsure whether you need a general dentist or a specialist, the final sections of this guide will help you decide. You can also visit the periodontics page to learn more about what periodontists do.
Gum Disease Stages and Their Matching Treatments
Treatment is matched to the stage of gum disease, and each stage has specific signs a dentist or periodontist can measure.
Gingivitis: The Reversible Stage
Gingivitis is inflammation of the gums without any bone loss. It is the only stage of gum disease that is fully reversible. [1]
Signs of gingivitis include red, swollen gums that bleed when you brush or floss. You may also notice persistent bad breath. At this stage, the bone and connective tissue that hold teeth in place have not yet been damaged.
Treatment for gingivitis is straightforward. A dental hygienist performs a professional cleaning (prophylaxis) to remove plaque and tartar (hardened plaque, also called calculus) above and just below the gumline. [2] Your dentist will then coach you on daily home care. This means brushing twice a day with fluoride toothpaste and cleaning between teeth daily with floss or an interdental brush.
With consistent home care and regular dental visits, gingivitis typically resolves within a few weeks. If left untreated, it can progress to periodontitis. [1]
Mild to Moderate Periodontitis: Non-Surgical Deep Cleaning
When gum disease advances past gingivitis, the infection begins to destroy bone. This stage is called periodontitis, and it is not reversible, though it can be managed.
A periodontist or dentist measures the depth of the pockets between your gums and teeth using a small probe. Healthy pockets measure 1 to 3 millimeters. Pockets of 4 to 6 millimeters typically indicate mild to moderate periodontitis. [1]
The standard first-line treatment is scaling and root planing (SRP), commonly called a deep cleaning. Scaling removes plaque and tartar from the tooth surface above and below the gumline. Root planing smooths rough spots on the tooth root where bacteria collect. [1] The procedure is usually done under local anesthesia (numbing) and may take two or more visits, treating one or two quadrants of the mouth at a time.
In some cases, your periodontist may place a local antibiotic, such as minocycline microspheres, directly into deep pockets after SRP. This delivers medication right where the infection is, which can help reduce pocket depth in combination with mechanical cleaning.
Moderate to Severe Periodontitis: Surgical Treatments
If pockets remain deeper than 5 millimeters after scaling and root planing, or if significant bone loss has occurred, surgical treatment is typically the next step. [1] Several surgical options exist, and a periodontist will recommend one or a combination based on the pattern and extent of damage.
Flap surgery (pocket reduction surgery) involves lifting the gum tissue back so the periodontist can access and clean the root surfaces and damaged bone underneath. The tissue is then repositioned snugly around the teeth, reducing pocket depth and making future cleaning easier.
Bone grafting is used when periodontitis has destroyed the bone around a tooth. The periodontist places graft material (from your own body, a donor, or a synthetic source) in the area of bone loss. This graft acts as a scaffold for your body to regenerate new bone over several months. [1]
Guided tissue regeneration (GTR) is sometimes performed alongside bone grafting. A small piece of biocompatible membrane is placed between the bone graft and the gum tissue. This barrier prevents fast-growing gum tissue from filling the space before slower-growing bone has a chance to regenerate.
Laser-Assisted Treatment (LANAP)
LANAP stands for laser-assisted new attachment procedure. It uses a specific wavelength of laser to remove diseased tissue and bacteria from periodontal pockets without cutting the gum with a scalpel.
Proponents of LANAP point to less post-operative pain, less bleeding, and faster healing compared to traditional flap surgery. The laser energy also stimulates a blood clot that can encourage reattachment of the gum to the tooth root.
LANAP received FDA clearance (meaning it was found to be safe and substantially equivalent to existing devices, which is different from FDA approval of a new drug). While short-term clinical results are promising, long-term evidence comparing LANAP to traditional surgery across large patient populations is still developing. Patients considering LANAP should discuss the current evidence with their periodontist.
Not every case is suitable for laser treatment. Deep, complex bone defects may still require conventional surgical approaches for the best outcome.
Practical Details: Timing, Preparation, and Maintenance
Knowing what to do before and after treatment helps you get the best possible results from any gum disease procedure.
Who Needs Treatment and When
Gum disease can affect anyone, but risk increases with age, smoking, diabetes, and certain medications that cause dry mouth. [1] According to the American Academy of Periodontology, a periodontal evaluation is recommended as part of routine dental checkups. [1]
Early detection matters. The sooner gum disease is identified, the simpler and less costly the treatment. Gingivitis found at a routine cleaning requires only that cleaning and better home care. Periodontitis found years later may require surgery and months of healing.
If you have not seen a dentist in more than a year and notice bleeding gums, loose teeth, or receding gumlines, scheduling a dental exam is a reasonable first step. Your general dentist can assess the situation and refer you to a periodontist if needed.
How to Prepare for Treatment
Before any periodontal procedure, your provider will take full-mouth X-rays and measure pocket depths at multiple points around each tooth. This charting creates a baseline for tracking progress.
Tell your provider about all medications you take, especially blood thinners, as these can affect bleeding during and after treatment. If you have diabetes, discuss your blood sugar control, since poorly managed blood sugar can slow healing. [1]
If you smoke, your provider will likely discuss cessation. Smoking significantly reduces the success of periodontal treatments and increases the risk of disease returning. [1] Quitting, even shortly before treatment, can improve outcomes.
Lifelong Maintenance After Treatment
Periodontal disease is a chronic condition. Even after successful treatment, the bacteria that cause it are always present in your mouth. Maintenance is what prevents relapse.
The standard recommendation after periodontal treatment is a periodontal maintenance cleaning every 3 to 4 months, rather than the typical 6-month schedule for patients without periodontitis. [1] During these visits, the hygienist measures pocket depths, removes any new plaque and tartar, and checks for signs of returning disease.
Skipping maintenance visits is one of the most common reasons gum disease comes back. Think of it like managing high blood pressure: the condition is controlled, not cured, and it requires ongoing attention.
What to Expect During and After Each Treatment
Each gum disease treatment has a different process, recovery timeline, and set of follow-up steps.
During and After Scaling and Root Planing
The area being treated is numbed with local anesthesia. Your hygienist or periodontist uses hand instruments and ultrasonic scalers to remove deposits from the tooth roots below the gumline. Each appointment typically takes 45 to 90 minutes and covers one or two quadrants of your mouth.
After the numbness wears off, you may feel soreness and sensitivity to hot and cold for a few days. Over-the-counter pain relievers such as ibuprofen usually manage any discomfort. Your gums may bleed slightly when you brush for the first day or two.
A follow-up evaluation is typically scheduled 4 to 6 weeks after the last SRP appointment. At that visit, your provider re-measures pocket depths to see how much healing has occurred. In many cases, pockets shrink by 1 to 2 millimeters after SRP, and gum tissue feels firmer and less inflamed.
During and After Periodontal Surgery
Surgical procedures are performed by a periodontist, usually under local anesthesia with optional sedation. The specific steps depend on the type of surgery (flap surgery, bone graft, GTR, or a combination). Most procedures take 1 to 2 hours.
After surgery, expect swelling, mild to moderate discomfort, and some bleeding for the first 24 to 48 hours. Your periodontist will prescribe pain medication and may prescribe antibiotics. You will be asked to eat soft foods and avoid brushing the surgical area for a specific period, usually 1 to 2 weeks.
Sutures (stitches) are placed during most periodontal surgeries and are removed at a follow-up visit, typically 7 to 14 days later. Full healing of the soft tissue usually takes several weeks. Bone regeneration, if a graft was placed, takes several months and is monitored with X-rays.
Your periodontist will transition you to the maintenance cleaning schedule once healing is complete. Results vary by patient, and smoking, diabetes, and home care habits all influence the final outcome.
During and After LANAP
LANAP is performed under local anesthesia. The periodontist passes a thin laser fiber between the gum and tooth to remove infected tissue and kill bacteria. The laser energy then helps form a stable blood clot at the bottom of the pocket.
Most patients report less pain after LANAP compared to traditional flap surgery. Swelling is typically mild. You can usually return to normal activities the next day, though you may be advised to eat soft foods for about two weeks.
Follow-up visits are scheduled over the next several months to monitor healing and pocket depth changes. As with all periodontal treatments, long-term success depends on regular maintenance cleanings and thorough daily home care.
Cost Ranges and Insurance Considerations
Costs for gum disease treatment vary widely based on the type of procedure, the number of teeth involved, and your geographic area.
A standard prophylaxis cleaning for gingivitis typically costs $75 to $200. Scaling and root planing (deep cleaning) typically costs $200 to $400 per quadrant, meaning a full-mouth deep cleaning may range from $800 to $1,600. Costs vary by location, provider, and case complexity.
Surgical procedures cost more. Flap surgery may range from $1,000 to $3,000 per quadrant. Bone grafting can add $250 to $1,200 per site, depending on the type of graft material used. LANAP treatment for the full mouth typically falls in the range of $2,000 to $8,000. These are broad estimates, and costs vary by location, provider, and case complexity.
Dental insurance often covers a portion of periodontal treatment, especially scaling and root planing, when documented with clinical measurements. Coverage for surgical procedures varies by plan. Many periodontist offices will verify your insurance benefits and explain your expected out-of-pocket costs before treatment begins. Asking for a written treatment plan with cost estimates is always reasonable.
When to See a Periodontist vs. a General Dentist
A general dentist can treat gingivitis and mild periodontitis, but moderate to severe cases typically need a periodontist's expertise.
A periodontist is a dentist who completed an additional 3 years of specialized training in the prevention, diagnosis, and treatment of gum disease, as well as the placement of dental implants. [1] General dentists are trained to recognize gum disease and perform basic treatments like scaling and root planing. Many general dentists refer patients to a periodontist when the disease is more advanced.
You should consider seeing a periodontist if any of the following apply to you: your gum disease has not improved after a deep cleaning by your general dentist; you have pockets deeper than 5 millimeters; you have noticeable bone loss on X-rays; your teeth are becoming loose; you have gum recession that is exposing tooth roots; or you have a health condition like diabetes that complicates treatment. [1]
A referral from your general dentist is common but not always required. Many periodontists accept self-referrals. If you are uncertain whether you need a specialist, a periodontal evaluation can give you a clear picture of your disease stage and the treatment options available to you.
Find a Periodontist Near You
If you have been diagnosed with gum disease or have symptoms like bleeding gums, persistent bad breath, or loose teeth, a periodontist can evaluate your condition and recommend the right treatment for your specific stage of disease. Visit the periodontics page on My Specialty Dentist to search for a qualified periodontist in your area, read about their credentials, and schedule a consultation.
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