Periodontal Therapy

If you have been told you have periodontal (gum) disease, you’re not alone. Many adults in the U.S. currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost.

Whether your gum disease is maintained, or gets worse depends a great deal on how well you care for your teeth and gums every day, from the time of diagnosis.

What causes gum disease?

Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.

stages of periodontal disease houston texas | Dr. Trejo


The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.


When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth”). In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.

Who gets gum disease?

People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.

How do I know if I have gum disease?

Symptoms of gum disease include:

  • Bad breath that won’t go away
  • Red or swollen gums
  • Tender or bleeding gums
  • Painful chewing
  • Loose teeth
  • Sensitive teeth
  • Receding gums or longer appearing teeth

Any of these symptoms may be a sign of a serious problem, which should be checked by a dentist.

How is gum disease treated?

The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.

Deep Cleaning (Scaling and Root Planing)

The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. In some cases a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.


Medications may be used with treatment that includes scaling and root planning, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time. Listed on the next page are some medications that are currently used.

Surgical Treatments

Flap Surgery. Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.

Bone and Tissue Grafts. In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration. In this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow. Growth factors – proteins that can help your body naturally regrow bone – may also be used. In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots.

Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with oral care at home, and certain risk factors, such as smoking, which may lower the chances of success. Ask your periodontist what the level of success might be in your particular case.

How can I keep my teeth and gums healthy?

  • Brush your teeth twice a day (with a fluoride toothpaste).
  • Floss regularly to remove plaque from between teeth. Or use a device such as a special brush or wooden or plastic pick recommended by a dental professional.
  • Visit the dentist routinely for a check-up and professional cleaning.
  • Don’t smoke

Can gum disease cause health problems beyond the mouth?

In some studies, researchers have observed that people with gum disease (when compared to people without gum disease) were more likely to develop heart disease or have difficulty controlling blood sugar. Other studies showed that women with gum disease were more likely than those with healthy gums to deliver preterm, low birth weight babies. But so far, it has not been determined whether gum disease is the cause of these conditions.

There may be other reasons people with gum disease sometimes develop additional health problems.

For example, something else may be causing both the gum disease and the other condition, or it could be a coincidence that gum disease and other health problems are present together.

More research is needed to clarify whether gum disease actually causes health problems beyond the mouth, and whether treating gum disease can keep other health conditions from developing.

In the meantime, it’s a fact that controlling gum disease can save your teeth – a very good reason to take care of your teeth and gums.

Common Questions about Periodontal Therapy

What is periodontal disease?

Periodontal disease is a condition where the gingiva is inflamed and infected. Periodontal disease can lead to the destruction of vital oral tissue if left untreated. Treating periodontal disease as soon as possible is important for improving one’s chances of reversing his or her condition. When the periodontal disease progresses past a certain point, the condition is only manageable – not curable.

What causes gum disease?

The leading cause of gum disease is tartar accumulation. When we practice oral hygiene, any plaque that is left behind after brushing and flossing will harden once exposed to calculus. If people do not practice proper oral hygiene and/or skip routine dental cleanings, they have a greatly increased risk of developing periodontal disease.

The reason tartar is problematic is the fact that this substance accumulates at the gum line. Since tartar is full of bacteria, it is very irritating to the gums. In fact, the gingiva will recede from teeth as an inflammatory response to irritation. Unfortunately, gum recession makes the periodontal disease worse. This is because a receding gum line creates a new surface area for tartar to cling. As tartar builds up and as the gums recede further, more of the tooth’s root is exposed to oral bacteria and debris.

Beyond inadequate oral hygiene and tartar accumulation contributing to gum disease, there are other factors that might increase one’s risk of developing this condition. Hormonal fluctuations such as those that occur during pregnancy or menopause can increase the risk for gum disease because hormones affect blood flow to all soft tissue, including the gums. When the gums’ blood flow is increased, they are more easily irritated. This is why pregnant women and others undergoing hormonal changes should practice vigilant oral hygiene.

How can I prevent periodontal disease?

Preventing periodontal disease should begin with a two-step approach – daily oral care at home and routine visits to the dentist. First, it is important to understand that brushing and flossing help reduce the accumulation of tartar by removing plaque from the surfaces of teeth and the gums. Removing plaque before it hardens into tartar is essential to keeping teeth and gums healthy. Flossing should never be overlooked as this oral hygiene practice cleans where a toothbrush cannot reach.

Beyond daily oral hygiene, patients should commit to receiving routine checkups and cleanings. Visiting our practice frequently increases the odds of early detection. The sooner gum disease is detected, the better a patient’s prognosis. Even if a person’s oral hygiene routine is thorough, dental cleanings are still necessary. This is because tartar cannot be removed by brushing and flossing. It is removed with handheld dental instruments that gently scrape it away without scratching the enamel surface of teeth. Regular dental cleanings control tartar buildup and therefore help prevent periodontal disease.