Gum disease is a common issue for many adults, possibly causing red or bleeding gums. Treatment may involve cleaning bacteria from under the gums and maintaining good dental hygiene at home.

Periodontal diseases are infections of the areas around teeth, including the gums, parts of the bone, and periodontal ligaments.

You may notice this mild oral infection from a common early symptom, such as reddening or mild bleeding of the gums around a tooth, known as gingivitis.

Depending on the severity of periodontal disease, there are several types of treatments. They can be nonsurgical or surgical, involving removing plaque and bacteria and applying medication under your gums to help treat the infection.

You may need more than one treatment, and your dentist may decide to treat different parts of your mouth at separate appointments. If left untreated, this condition can lead to more severe issues in your teeth and mouth and can affect your overall health.

Periodontal disease is very common. It affects nearly half of adults in the United States 30 years and older, and it affects an even greater percentage of adults over age 65 years.

Periodontal diseases are caused most often by a combination of bacteria and dental plaque. Symptoms may include:

  • bleeding gums
  • swollen gums
  • persistent bad breath
  • painful chewing
  • suddenly sensitive teeth
  • loose teeth
  • gum recession

Gum disease should be treated as soon as possible because it shares risk factors with conditions like:

Your dentist will evaluate your periodontal disease and determine the best course of treatment. Depending on its severity and other factors, including your overall oral health, they may decide to divide your treatment into different appointments for better care.

Often, the first part of the process is when your dentist or dental health professional examines each tooth and the gums surrounding it and counts off numbers for each one. This is known as “staging.” Some dentists count up to 4 for the most severe periodontal disease, while others may count higher to distinguish more severe or faster progression.

Depending on that evaluation, your dental health professional will work with you on the treatment plan. They will also discuss with you what may be causing your periodontal disease, as well as dental hygiene and other health habits that may play a part.

At this point, they may also perform “scaling” or “root planing” procedures, which involve deeply cleaning teeth and removing plaque and calculus underneath the gums.

During this process, they scrape off tartar from above and below the gum line and remove rough spots on the tooth. This helps clear bacteria that contribute to gum disease while also getting rid of areas where the bacteria may gather.

Your dentist may also prescribe medications, including systemic antibiotics that you take orally or local antibiotics in gel form that you apply topically. These are often not enough on their own to treat periodontal disease, but they can help make scaling and root planing more effective.

Other medications your dentist may prescribe or use at the time of treatment include:

  • prescription antimicrobial mouth rinse
  • antiseptic chip, which is a tiny piece of gelatin that contains medication
  • enzyme suppressant, which contains a low dose of doxycycline to keep destructive enzymes from flourishing

If those nonsurgical treatments aren’t enough and are ineffective, your dental health team may want to use surgical methods to treat your periodontal disease. This will likely happen if the pockets of infection or plaque and tartar are too deep to clean.

During this procedure, your dentist will clean the pocket carefully, removing tartar deposits after lifting the gums to clean underneath them. They will then suture the gums to fit more tightly around the tooth.

This may be called “flap surgery.”

Surgery could also include leveling shallow bone defects or using regenerative surgical techniques for deep bone defects.

These surgeries aim to remove the pockets of space between the teeth and the bone, which can be broken down or destroyed with periodontal disease. This, in turn, will eliminate the room for bacteria, plaque, and tartar to fester.

You may receive general anesthesia during surgery. While everyone’s experiences differ, you may feel pain after the surgery or experience sensitive, swollen, or bleeding gums afterward.

Bone and tissue grafts

If your periodontal disease has caused a loss of bone or gum tissue, your dentist may recommend bone or tissue grafts in addition to surgical pocket reduction. This will help regenerate the lost bone or tissue.

During bone grafting, your dentist will place natural or synthetic bone in the loss area, which can help promote bone growth.

Your dentist may use guided tissue regeneration. During this procedure, they insert a mesh-like material between the bone and gum tissue to prevent the gum from growing where the bone should be and allow it to regrow properly.

During gum grafting, they will use a soft tissue graft — of either synthetic material or tissue taken from another area of your mouth — to cover exposed tooth roots.

No matter the type of periodontal treatment you receive, your dentist may prescribe antibiotics for you to take after the appointment. Your dental care team can also advise you on any specific aftercare instructions or whether you’ll need to eat any soft foods afterward.

A key part of treating periodontal disease outside of your dentist’s office is maintaining good oral health. This involves routine brushing and flossing and using any prescribed medications or rinses that your dentist recommends.

If you do not properly care for your oral health after treatment, periodontal disease can return.

Your dentist will carefully detail the oral hygiene practices you need to follow, including brushing your teeth properly and flossing daily.

Periodontal disease can increase your risk of conditions like stroke, heart disease, diabetes, and respiratory diseases. Untreated, it can also lead to tooth extraction.

Periodontal therapies and treatments can be effective as long as you follow the instructions your dentist provides during the maintenance stage at home. This includes careful oral hygiene and avoiding the use of tobacco products.