Periodontitis Explained
Being told you have periodontitis can feel alarming, especially when the diagnosis comes with numbers and letters attached. This guide explains what those labels mean, what treatment involves and what you can realistically expect from it.
What Is Periodontal Disease and How Is It Treated in Edinburgh?
Periodontal disease, or periodontitis, is gum disease that has spread below the gum line and is destroying the bone that holds teeth in place. It is described by a stage (how much damage there is) and a grade (how fast it is progressing), and treated with a course of deep cleaning followed by lifelong maintenance. At Comely Bank Dental in Edinburgh, deep cleaning is usually carried out in four stages, each £167.
What Is Periodontal Disease?
Periodontal disease, usually called periodontitis, is the advanced form of gum disease. Plaque bacteria below the gum line trigger an inflammatory response that, in susceptible people, breaks down the fibres attaching gum to tooth and then the bone around the root. Gaps called pockets form, and those pockets collect more bacteria, so the process tends to feed itself.
Three points are worth knowing from the start:
- It is very common. Most adults have some degree of gum disease, and a sizeable minority develop periodontitis at some point.
- It is usually painless until it is well advanced, so many people are surprised by the diagnosis.
- Lost bone doesn't grow back on its own, but the disease itself can be stopped. With treatment and good daily cleaning, most people keep their teeth stable for many years.
If you only have bleeding gums with no bone loss, that is gingivitis, which is fully reversible. Our patient guides cover its early signs.
What Does the Stage of Periodontitis Mean?
Since 2017, dentists across the UK and Europe have used a shared classification that gives every diagnosis a stage and a grade. The stage describes how much damage has already been done, judged mainly from gum measurements, X-rays and any teeth already lost to gum disease.
| Stage | In plain words | What we typically see |
|---|---|---|
| I | Early | Bone loss limited to the top part of the root, shallow pockets |
| II | Moderate | Bone loss up to about a third of the root, pockets up to around 5mm |
| III | Severe | Bone loss into the middle of the root or beyond, deeper pockets; some teeth may have been lost |
| IV | Very severe | As stage III, plus several teeth lost, teeth drifting or a collapsing bite that needs wider rebuilding |
We also note the extent: localised if fewer than about a third of your teeth are affected, generalised if more. A less common pattern affecting mainly the front teeth and first molars is described separately because it often starts at a younger age.
Been Told You Have Gum Disease?
Book a hygiene visit with Katie. We'll chart your gums, explain your diagnosis in plain words and give you a written plan with the fees before treatment starts.
And What Does the Grade Mean?
The grade describes how quickly the disease has progressed, which helps predict how it is likely to behave in future and how closely it needs watching.
- Grade A: slow progression
- Grade B: moderate progression
- Grade C: rapid progression
We work it out by comparing the bone loss on your worst-affected tooth with your age. The same amount of bone loss is far more significant at 35 than at 70, because it has happened over fewer years.
Two risk factors are recorded alongside, and they can push the grade up. Smoking ten or more cigarettes a day, or diabetes with poor blood sugar control, points towards grade C; lighter smoking or well-controlled diabetes towards grade B.
Putting it together. A full diagnosis might read: generalised periodontitis, stage III, grade B, currently unstable, risk factor smoking. "Unstable" means there are still deep pockets that bleed. After successful treatment the same person might be described as stable or in remission, although the stage and grade stay on record because they describe your history.
How Is Periodontitis Treated?
Treatment follows a set sequence, and each part matters as much as the others.
- Getting the foundations right. We explain your diagnosis, show you exactly where plaque is being left behind and agree the cleaning aids that suit your mouth. If you smoke or have diabetes, we'll talk about how they affect your gums. We also remove plaque and tartar above the gum line.
- Deep cleaning below the gum line. Over a planned course of appointments, usually four stages, the root surfaces inside each pocket are cleaned thoroughly. Each stage is £167. Here, a "stage" means a treatment appointment, normally covering one part of your mouth, not the stage of your disease.
- Re-evaluation. Around three months later we re-chart your gums to see how they have responded.
- Maintenance. You return for regular supportive cleaning to keep the disease stable for the long term.
If only part of the mouth is affected, fewer stages may be needed. Fees are guide prices, and the number of stages and the total are set out in a written treatment plan before anything starts. Our gum disease treatment page has more detail.
What Happens During Deep Cleaning?
Deep cleaning, sometimes called root surface debridement, removes the hardened deposits and bacterial film from the roots inside the pockets so the gum can heal and tighten against the tooth.
On the day. The area is numbed with local anaesthetic, so you feel vibration and pressure rather than pain. We use a combination of a fine ultrasonic scaler, which uses vibration and a water spray, and slim hand instruments that reach into the depths of each pocket. A stage usually takes up to an hour.
Afterwards. Expect the gums to feel tender for a few days, and teeth may be sensitive to cold for a few weeks. Ordinary painkillers and a sensitive toothpaste usually help. Keep cleaning gently but thoroughly, including between the teeth, even if it bleeds at first.
What changes you may notice. As inflammation settles, swollen gums shrink. Teeth can look slightly longer and small gaps may appear between them. This is a sign of healing, but it is worth knowing in advance, particularly for front teeth.
Antibiotics are not used routinely. They are reserved for particular situations, such as rapidly progressing disease in younger people, because overuse carries its own risks.
If you feel anxious about treatment, our nervous patients page explains how we can help.
Re-Evaluation: Has Treatment Worked?
Gums take time to heal, so we wait roughly three months after the last stage of deep cleaning before charting them again in full. We compare every measurement with your starting chart and look at bleeding, pocket depths and whether any teeth have tightened up.
The usual targets are pockets of 4mm or less that don't bleed when gently probed. Most people see a clear improvement, and many reach that target across most of the mouth. Where a few sites remain deep and bleeding, the options are:
- a further, targeted clean of those sites
- a review of how cleaning is going in those particular areas
- referral to a periodontist if the pockets are deep or the bone loss is complex
The outcome depends heavily on daily cleaning and on risk factors such as smoking, so results vary from person to person. We'll be honest about what we see and what we think is realistic.
How Often Will I Need Maintenance Visits?
Periodontitis is a long-term condition, much like the way you'd manage blood pressure or asthma. Once it is stable, regular supportive visits keep it that way, and stopping them is the most common reason the disease returns.
Most people treated for periodontitis start with visits every three months. If your gums stay stable and your cleaning is consistently good, the interval can often be stretched to four or six months. People with stage III or IV disease, grade C disease, or ongoing smoking or diabetes usually stay on shorter intervals.
Each maintenance visit includes a check of your gum measurements, cleaning below the gum line where needed and a look at how home care is going. They are booked as hygiene visits: £90 for 30 minutes, or £135 for a longer appointment. Our dental plan can make regular visits simpler, and members save 10% on most private treatment.
When Is Referral to a Periodontist the Right Step?
A periodontist is a dentist who has completed several years of further training devoted to gum disease. Most periodontitis is treated well in general practice, but referral is worth discussing when:
- disease is stage III or IV with complex bone loss, such as deep defects next to a single tooth or bone loss between the roots of back teeth
- pockets stay deep and bleeding after a full course of deep cleaning, despite good home care
- disease is progressing rapidly, particularly in someone young
- gum surgery or regenerative treatment may help
- your medical history makes treatment more complicated
If a referral is appropriate, we'll explain why, what it is likely to involve and the options available in Edinburgh. You'd usually continue routine care with us alongside it.
Periodontal Care at Comely Bank Dental
Periodontal treatment at Comely Bank Dental is carried out by Katie Ventisei, our dental hygienist and therapist, working closely with our dentists. We see patients from Comely Bank, Stockbridge and across Edinburgh.
Adults are seen privately, and the children of our dental plan members under the NHS. If you already have a periodontitis diagnosis from another practice, bring any charts or X-rays you have. You can book online or call 0131 332 3971.
Questions
This guide is general information, not a diagnosis. A dentist needs to examine you to say what is right for your teeth.