Gum treatment with a periodontist: periodontitis, periodontosis and curettage

If your gums bleed, swell or pull away from the teeth, it is most often periodontitis — an inflammation that can be treated. Here is how it differs from periodontosis, what happens at a periodontist's appointment, when curettage is needed and what to do at home so the result lasts.

Periodontitis or periodontosis: the difference

The two words are confused even in dental offices, although they are different conditions.

Periodontitis is inflammation. It is triggered by plaque and tartar near the gums. The gums turn red, bleed when you brush, gradually pull away from the tooth, and a pocket forms between tooth and gum. Without treatment the inflammation destroys the bone around the root and teeth start to loosen.

Periodontosis is a rare condition without inflammation: gums and bone slowly recede and roots become exposed, but there is almost no bleeding. Most people who say they have periodontosis actually have periodontitis — which is good news, because inflammation can be treated.

If your gums bleed when you brush, the reason is usually early periodontitis rather than a hard toothbrush. The first signs are covered in bleeding gums.

Signs that mean it is time to see a periodontist

Gums rarely hurt in the beginning, so inflammation is easy to miss. Book an examination if you notice at least one of these:

• gums bleed when you brush or bite into an apple;
• gums look red and swollen rather than pale pink and firm;
• teeth seem longer, the necks are exposed, and cold causes sensitivity;
• food has started getting stuck between teeth where it did not before;
• bad breath returns right after brushing;
• a tooth is slightly loose or has shifted.

The earlier inflammation is found, the simpler the treatment: at an early stage professional hygiene and proper home care are often enough, and no bone has been lost yet.

What a periodontist does at the first visit

First comes the examination and diagnosis. The dentist measures the depth of the pockets around each tooth with a special probe, checks bleeding, tooth mobility and X-rays to see how much bone has been lost.

The plan depends on this. Shallow pockets and mild inflammation are often resolved by professional hygiene and home care. Deeper pockets need treatment in several stages. By the end of the consultation you know what is happening with your gums, how many visits are needed and what to do at home.

Gum curettage: what it is and when it is needed

Curettage is cleaning the pocket under the gum: the dentist removes tartar and plaque from the root surface where a toothbrush and regular hygiene cannot reach. After that the gum can fit tightly to the tooth again and the pocket shrinks.

We perform closed curettage — without incisions, under local anaesthesia. The periodontitis protocol at Houston is Air-Flow PERIO + closed curettage + pocket irrigation, usually 2–4 visits.

Curettage is needed when pockets are deeper than hygiene can clean. If the gums bleed a little and there are no pockets, professional GBT hygiene is enough.

Why we do not use “vector therapy”

The Vector device is often advertised as a gentle alternative to curettage. A Cochrane review and independent randomised trials found no statistically significant advantage of Vector over conventional curettage. We work by evidence-based protocols, so we use what has proven effectiveness and do not charge for the name of a method.

How long treatment takes and what happens between visits

A course of periodontitis treatment usually takes 2–4 visits. Curettage is done area by area so that a single appointment does not load the whole jaw, and the gums have time to settle between visits.

For the first days after the procedure the gums may be sensitive and sometimes bleed a little. This is a normal reaction: tissue that was inflamed for a long time is healing. The dentist will give you rinsing and brushing instructions for this period.

A few weeks after the course the dentist measures the pockets again and compares them with the first examination, which shows how much the inflammation has decreased. After that periodontitis needs maintenance: professional hygiene as often as the dentist recommends, because tartar forms again. If you plan crowns, veneers or fillings near the gums, the gums are treated first: on an inflamed gum the margin of a restoration cannot be placed accurately.

What can be added to treatment

In some cases the dentist suggests additional procedures. They do not replace pocket cleaning but help the gums heal:

• photodynamic therapy (laser) — from UAH 3 350;
• PRF plasma therapy — from UAH 3 000.

Whether you need them is decided after the examination. If the pockets are shallow, the dentist will tell you that you can do without them.

How much gum treatment costs

Professional hygiene at Houston costs from UAH 2 300 (GBT Light), full GBT hygiene by the EMS protocol from UAH 3 100. The price of curettage depends on the number and depth of pockets, so it is calculated after the examination and fixed in the plan. More on cleaning prices: how much teeth cleaning costs.

What to do at home so the result lasts

Treatment removes what has built up. Only daily care keeps the result:

• brush twice a day with a soft brush, paying attention to the gum line;
• clean between your teeth every day — floss or interdental brushes of the right size;
• do not stop brushing if your gums bleed: they bleed precisely because of plaque;
• come for maintenance hygiene as often as your dentist recommends.

Bad breath is often linked to the gums as well — see a separate article.

Frequently asked questions

Anna Vasylenko

Periodontist

Deputy head doctor of Houston clinic. An evidence-based approach to hygiene, gum treatment and periodontitis.

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