What Is Periodontal Disease?
Periodontal disease is a chronic bacterial infection of the gums and bone that surround and support the teeth. It begins when plaque, a sticky film of bacteria, builds up on the teeth and is not adequately removed. Over time, plaque hardens into tartar, which can only be removed by a dental professional. The bacteria in plaque and tartar produce toxins that irritate the gums and trigger an inflammatory response.
In the early stage, called gingivitis, inflammation is limited to the gum tissue and is reversible. When the infection progresses deeper, it becomes periodontitis. The gums pull away from the teeth, forming pockets that harbor more bacteria. The body's immune response, combined with bacterial toxins, begins breaking down the bone and connective tissue that hold teeth in place. This bone loss is what distinguishes periodontal disease from gingivitis.
How Periodontal Disease Progresses
Periodontal disease typically progresses slowly, often over years. Many patients do not realize they have it because it is usually painless in the early and moderate stages. By the time symptoms become obvious, such as loose teeth or shifting bite, significant damage may have already occurred.
The disease does not progress at the same rate in all areas of the mouth. Some teeth may have deep pockets and bone loss while others remain healthy. Factors that accelerate progression include smoking, uncontrolled diabetes, genetic susceptibility, certain medications that reduce saliva flow, and hormonal changes.
Risk Factors for Periodontal Disease
- Smoking or tobacco use (the single strongest modifiable risk factor)
- Diabetes, especially when blood sugar is poorly controlled
- Family history of periodontal disease
- Medications that cause dry mouth or gum overgrowth
- Hormonal changes during pregnancy or menopause
- Conditions that weaken the immune system, including HIV
- Poor oral hygiene habits
- Stress, which can impair the body's ability to fight infection
Non-Surgical Periodontal Disease Treatment
Non-surgical treatment is the first step for most periodontal disease cases. The primary goal is to control the bacterial infection and halt the progression of bone loss.
Scaling and Root Planing
Scaling and root planing is the standard initial periodontal disease treatment. During this procedure, a dental hygienist or periodontist uses specialized instruments to remove plaque and tartar deposits from above and below the gumline. Root planing smooths rough spots on the root surfaces where bacteria collect, making it easier for the gums to reattach to the teeth.
This procedure is performed under local anesthesia and is typically completed in two to four visits, treating one or two quadrants of the mouth at each appointment. After treatment, the gums typically shrink and tighten around the teeth as inflammation resolves. Your periodontist will re-evaluate pocket depths 4 to 6 weeks later to assess the response.
Antibiotic Therapy
Antibiotics are often used alongside scaling and root planing to help eliminate bacteria that persist in deep pockets. Local antibiotics, such as antibiotic microspheres or gel placed directly into the pockets, deliver medication where it is needed most. Systemic antibiotics (taken by mouth) may be prescribed for more widespread or aggressive infections.
Your periodontist will determine whether antibiotics are appropriate based on the severity of your disease and how well you respond to initial treatment.
Surgical Periodontal Disease Treatment
Surgery is recommended when periodontal disease has not responded adequately to non-surgical treatment, or when pocket depths remain too deep to maintain with home care and regular cleanings.
Flap Surgery (Osseous Surgery)
Flap surgery, also called osseous surgery, is the most common surgical periodontal disease treatment. The periodontist makes small incisions in the gum tissue and lifts it back to expose the roots and bone. Deep tartar deposits are removed, and irregular bone surfaces are smoothed to reduce areas where bacteria can hide. The gum tissue is then repositioned and sutured in place.
After flap surgery, pocket depths are typically reduced, making daily cleaning more effective. Healing takes one to two weeks, and soft foods are recommended during that time.
Bone Grafts and Guided Tissue Regeneration
When periodontal disease has caused significant bone loss, bone grafting can help rebuild the supporting structure around teeth. The periodontist places bone graft material, which may come from your own body, a donor, an animal source, or a synthetic material, into the areas of bone loss. This material acts as a scaffold for your body to grow new bone.
Guided tissue regeneration (GTR) is sometimes performed along with bone grafting. A biocompatible membrane is placed between the bone and gum tissue to prevent the fast-growing gum tissue from filling in the space where bone should regenerate. This gives the bone and connective tissue time to regrow.
Laser-Assisted Treatment (LANAP)
LANAP (Laser Assisted New Attachment Procedure) is an FDA-cleared alternative to traditional flap surgery. A specialized laser is used to remove diseased tissue and bacteria from periodontal pockets. The laser energy also promotes blood clot formation and stimulates bone regeneration. LANAP is less invasive than conventional surgery, with less cutting, suturing, and typically faster recovery.
Can Periodontal Disease Be Reversed?
This is one of the most common questions patients ask. The honest answer is that gingivitis can be fully reversed, but periodontitis cannot. Once bone has been lost, it does not grow back on its own. However, treatment can stop the disease from getting worse, and in some cases, bone grafting and regenerative procedures can partially restore lost bone.
The most important factor is catching the disease early and committing to ongoing treatment. Patients who follow through with periodontal maintenance visits every 3 to 4 months and maintain good oral hygiene at home can typically keep their teeth for life, even after being diagnosed with periodontitis.
Periodontal Maintenance After Treatment
Periodontal disease is a chronic condition. Even after successful treatment, it requires ongoing management to prevent recurrence. Periodontal maintenance visits are different from standard dental cleanings. They include measuring pocket depths, cleaning below the gumline, and monitoring for signs of disease activity.
Most periodontists recommend maintenance visits every 3 to 4 months. Patients who skip or delay maintenance appointments are at significantly higher risk for disease recurrence and further bone loss. Your periodontist and general dentist will work together to coordinate your ongoing care.
Periodontal Disease Treatment Cost
The cost of periodontal disease treatment varies based on the severity of your condition, the type of treatment needed, and your geographic location.
Scaling and root planing typically costs $200 to $300 per quadrant. A full-mouth treatment may range from $800 to $1,200. Flap surgery ranges from $1,000 to $3,000 per quadrant. Bone grafting adds $500 to $3,000 depending on the type and extent of grafting. LANAP laser treatment typically costs $1,000 to $4,000 per quadrant.
Most dental insurance plans cover a portion of periodontal treatment when it is medically necessary. However, annual maximums on dental plans often cap at $1,000 to $2,000, which may not cover all costs for advanced treatment. Ask your periodontist's office about insurance verification, payment plans, and financing options. Costs vary by location and provider.
When to See a Periodontist
A periodontist is a dental specialist with 3 years of advanced residency training beyond dental school, focused on treating diseases of the gums and bone. While general dentists diagnose and manage early periodontal disease, a periodontist is typically the right choice for moderate to advanced cases, cases that have not responded to initial treatment, or when surgery is needed.
You do not always need a referral. Many periodontists accept patients directly. If you have been told you have periodontal disease or are experiencing symptoms like bleeding gums, loose teeth, or receding gums, consider scheduling an evaluation. Learn more on our [periodontics specialty page](/specialties/periodontics).
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