Gum treatment (periodontal therapy) aims to stop infections affecting the gums and jawbone that surround and support the teeth. Gum disease is like a disease of the soil around a tree’s roots: just as a tree loosens when the soil is washed away, a tooth becomes loose and may be lost when the gum recedes and bone is lost. At our clinic in Denizli, Turkey, treatment is planned as a three-part process combining clinical treatment, the patient’s home care and regular maintenance visits.
- Scaling and root surface cleaning
- Curettage and flap surgery for advanced cases
- Maintenance visits every 3, 6 or 12 months, based on how quickly tartar forms
- Long-term follow-up supported by oral hygiene coaching
Treatment process
Examination and assessment
The gums, pocket depths and bone levels are assessed clinically and with X-rays.
Scaling and hygiene coaching
Tartar and plaque are removed from the tooth and root surfaces, and home-care habits, including floss and interdental brushes, are taught.
Curettage or flap surgery
In advanced cases, deposits within the pockets are cleaned by curettage or by flap surgery, in which the gum is gently opened.
Regular maintenance
Check-ups and cleaning are scheduled every 3, 6 or 12 months according to how quickly tartar re-forms.
What is gum disease?
Gum (periodontal) disease is an infection affecting the gums and bone that surround and support the teeth. In Turkey it is one of the main reasons people end up wearing removable dentures.
The primary cause is microbial dental plaque. Plaque hardens into tartar (calculus) with minerals from saliva. How fast tartar builds up depends on each person’s saliva, and because this can run in families, some people form a lot of tartar and others very little.
As tartar accumulates, it advances down inside the gum pocket towards the root rather than towards the biting surface, and the bone around the tooth is gradually lost. The gum recedes and bone support shrinks. Symptoms that begin with bleeding can progress to sensitivity to hot and cold, discomfort when biting, loose teeth and eventually tooth loss.
Why early treatment matters
Tartar does not affect a single tooth; over the years it affects every tooth in the mouth. While a decayed tooth can be restored, untreated gum disease can lead to bone loss throughout the jaw and the loss of teeth as they become loose.
Treatment can halt further bone loss, but bone that has already been lost usually does not grow back on its own. The earlier action is taken, the better the outlook.
Brushing and flossing reduce tartar build-up but cannot prevent it entirely. People whose saliva forms tartar quickly need especially careful home care and more frequent check-ups.
Healthy gums, gingivitis and periodontitis
Healthy gums
Healthy gums are light pink, matt and slightly stippled like orange peel, and feel firm. They do not bleed with normal brushing and flossing.
Gingivitis (gum inflammation)
The infection affects only the gums; there is no bone loss around the tooth yet. The key sign is bleeding during brushing or spontaneously. Gums become red, swollen, shiny and soft. The main cause is inadequate oral hygiene, though systemic conditions, medication, family history, trauma, faulty dental work and foreign-body reactions can also play a part. Gingivitis can resolve completely with hygiene coaching, professional cleaning, correction of faulty restorations and anti-plaque agents.
Chronic periodontitis
This is infection and breakdown of the tissues supporting the tooth. Plaque and tartar track down between the tooth and gum, causing bone loss and gum recession. Signs include dark red or purplish gums, recession or overgrowth, teeth drifting apart, lengthening, rotating or becoming loose, food packing into pockets, abscesses and bad breath. Early stages can be treated without surgery; advanced cases require curettage or flap surgery. Stress, smoking, diabetes and immune disorders affect the response to treatment.
Periodontal abscess
A foreign object lodged in the gum or local irritation can cause a gum abscess, with redness, swelling and tenderness; it should not be confused with a tooth abscess. Once the cause is removed it usually settles quickly. In untreated cases with advanced bone loss, deeper abscesses can develop, with loose teeth, dull throbbing pain, fever, fatigue and swelling. Emergency care involves drainage and antibiotics where needed, followed by surgical treatment.
Signs of gum disease
- Bleeding gums when brushing (healthy gums do not bleed)
- Red, swollen, puffy or tender gums
- Persistent bad breath
- Gums that pull away or recede from the teeth
- Pus between the teeth and gums
- Loose teeth, or teeth drifting apart with new or widening gaps
- Exposed root surfaces
Smoking constricts blood vessels and reduces bleeding. Smokers may therefore not see this key warning sign, and the disease can progress unnoticed.
How is gum disease treated?
Periodontal treatment is a three-part process, and each part must be carried out fully; a gap in any one of them affects the outcome:
- Clinical treatment: the appropriate treatment carried out thoroughly by the dentist (scaling, curettage, flap surgery and so on).
- Home care: brushing alone is not enough; floss, interdental brushes and mouth rinses need to become daily habits.
- Regular maintenance: however well the teeth are cleaned and cared for, tartar will form again. How fast depends on your saliva, so a maintenance interval of 3, 6 or 12 months is set for you.
Curettage and flap surgery
Curettage cleans deposits and inflamed tissue from the pocket without opening the gum. Flap surgery, used in more advanced cases, involves opening the gum to see the deeper parts of the root clearly, cleaning them and closing the gum with stitches.
Gum recession and risk factors
Causes of gum recession
- Gingivitis and periodontitis (the most common cause)
- Incorrect brushing technique
- Crowded or irregular teeth
- A high frenum attachment (lip attachment)
- Chronic trauma: nail biting, clenching and grinding
- Poorly made crowns, bridges or fillings
- Poorly managed orthodontic treatment
- Ageing
Factors that increase risk
- Smoking: masks bleeding, so the disease progresses silently and faster.
- Medication: oral contraceptives, antidepressants and some heart medicines can affect oral health; tell your dentist what you take.
- Hormonal changes: during pregnancy, puberty, menopause and menstruation the gums are more sensitive and tartar may form more readily.
- Stress: makes it harder for the body to fight infection.
- Clenching and grinding: accelerate breakdown of the supporting tissues; a night guard may be recommended.
- Poor nutrition: weakens the immune system.
- Diabetes: significantly increases the risk of gum infection.
- Overhanging fillings, crowns and bridges: press on the gum and cause problems.
Common misconceptions
- “My teeth have gaps since the cleaning.” Cleaning does not create gaps; it reveals spaces left by receded gums that were previously filled with tartar.
- “Once you have a cleaning, the tartar keeps coming back.” Tartar re-forms whether or not you have your teeth cleaned, which is exactly why regular maintenance is needed.
- “My parents lost their teeth young, so I will too.” A tendency linked to saliva can run in families, but careful home care and regular check-ups can keep its effect to a minimum.
- “I had no decay, but my teeth still became loose.” Gum disease can destroy bone support and lead to the loss of otherwise sound teeth.
- “I had gum surgery, but the problem came back.” Surgery alone is not enough; if home care and maintenance lapse, the disease can progress again.
Frequently asked questions
Is it normal for my gums to bleed when I brush?
No. Healthy gums do not bleed with normal brushing and flossing. Bleeding is the main sign of gum inflammation and should be checked by a dentist.
How often should I have my teeth scaled?
How quickly tartar re-forms varies with each person’s saliva. The maintenance interval is therefore set individually, usually at 3, 6 or 12 months.
Can scaling damage my teeth?
Properly performed scaling does not damage the teeth. Any gaps noticed afterwards are spaces caused by gum recession that had been filled with tartar. Temporary sensitivity may occur.
Can lost bone grow back?
Treatment can stop bone loss from progressing, but bone that has been lost usually does not return on its own. That is why early diagnosis and regular check-ups are so important.
How does smoking affect gum disease?
Smoking reduces gum bleeding, hiding the main warning sign and allowing the disease to progress unnoticed. It also reduces the response to treatment.
I brush regularly, but my bad breath won't go away. What can I do?
The literature describes 50–60 different causes of bad breath, and most of them relate to the gums. Common causes include gum inflammation (gingivitis, periodontitis), impacted wisdom teeth, poorly fitting crowns and bridges, or faulty fillings. There can also be causes outside the mouth, such as throat infections, chronic sinusitis, reflux, digestive problems or diet. That is why an accurate diagnosis should come first, with treatment planned accordingly.
I have my teeth cleaned, yet tartar and staining keep coming back. What should I do?
The main cause of gum disease is microbial dental plaque, and the make-up of your saliva plays a role in how it forms. Saliva composition is inherited, which is why tartar builds up faster in some people than in others. It cannot be changed, but preventive measures such as regular cleaning and check-ups can be stepped up. Tartar that is left in place advances down towards the root inside the gum pocket, dissolving bone and leading to gum recession, sensitivity, loose teeth and eventually tooth loss.
My gums bleed every time I brush. Why might this be?
If you run your hand over smooth glass, nothing happens; run it over a rough surface and it becomes irritated and may bleed. Your gums should likewise rest against a smooth tooth surface. Any roughness beneath the gum line, most often tartar, overhanging fillings or poorly fitting crowns and bridges, keeps irritating the gum and causes bleeding. The cause should be identified at an examination and removed.
Is frequent professional cleaning harmful? Is teeth whitening harmful?
Scaling (tartar removal) and whitening are not the same thing. Scaling is necessary for your health and should be done regularly. On the other hand, having tea, coffee or smoking stains polished off every month or every two to three months can wear down the enamel and may do harm. The real way to reduce staining is to cut back on these habits; whether whitening is suitable for you is assessed at an examination.
My parents needed full dentures at a young age. Will the same happen to me?
Not necessarily. Because saliva composition is inherited, you may have a similar predisposition. However, gum disease is largely preventable with measures taken early in life and regular check-ups.
The information on this website is for general information only and does not replace an examination, diagnosis or treatment plan by a dentist. Treatment and outcomes vary from person to person.