Periodontitis is a chronic inflammatory disease that destroys the bone and soft tissue holding teeth in place. Treated properly, it can be stabilised and the teeth retained for decades. Left alone, it doesn’t stabilise on its own.
If you’ve been told you have periodontitis, or if you suspect you might, this page walks through what treatment for gum disease looks like at our practice in Westcliff-on-Sea, from the first appointment through to long-term maintenance. The process is structured, evidence-based, and reasonably predictable. Patients tend to find the treatment less unpleasant than they feared.
The first appointment: assessment
The first appointment is diagnostic, not treatment. We need to know exactly what’s going on before we can plan what to do about it. This visit usually runs forty-five minutes to an hour.
The clinical examination includes a six-point pocket depth chart for every tooth, bleeding-on-probing scores, plaque scores, and an assessment of any tooth mobility or furcation involvement. We’ll take a small number of x-rays, usually horizontal bitewings and periapicals of any teeth showing concerning signs, to assess bone levels around the roots.
From this, the case is given a stage (1 to 4, indicating severity) and a grade (A, B, or C, indicating rate of progression) under the current international classification.
You’ll leave the appointment with a clear diagnosis and a written treatment plan. No treatment is carried out at this visit unless something urgent comes up.
Step 1: oral hygiene phase
The most important phase of periodontitis treatment isn’t the deep cleaning. It’s the oral hygiene phase that comes before it.
This sounds counterintuitive. The thinking is straightforward: any deep cleaning we do will fail unless the patient can maintain plaque control at home. So we start by teaching effective brushing technique, demonstrating interdental cleaning with the correct size of interdental brush for each gap, and reviewing diet and any contributing factors like smoking.
Most patients need one or two appointments in this phase, usually with our hygienist. We’re looking for plaque scores below 20% before moving to the next stage. Patients who can’t or won’t reach that level don’t move forward, because the deep cleaning won’t hold.
It’s an honest conversation. Some find it confronting. Most appreciate the clarity.
Step 2: non-surgical periodontal therapy
This is what most people picture when they hear “deep cleaning”. It’s properly called subgingival instrumentation or root surface debridement, and it involves carefully removing plaque, calculus, and bacterial deposits from the root surfaces below the gum line.
Local anaesthetic is used, so the procedure itself is comfortable. We typically work through the mouth quadrant by quadrant, with each quadrant taking around 45 to 60 minutes. Most patients complete the full mouth across two to four appointments.
Some patients prefer to do the whole mouth in fewer, longer sessions. Others prefer shorter visits. We’ll discuss what suits you. Both approaches are clinically valid.
What to expect after each visit
The first 24 to 48 hours after deep cleaning can involve some tenderness, particularly when eating. The gums often look slightly different too: they may appear to have receded a little, but what’s actually happened is that the swollen, inflamed tissue has tightened up and now sits at its true position. This is the gum showing you where the supporting bone actually is.
Sensitivity to cold is common for two to three weeks afterwards because exposed root dentine reacts to temperature changes. Most of this settles, and a desensitising toothpaste helps in the meantime.
Bleeding usually reduces noticeably within ten days. By six weeks, you should be looking at firmer, paler, less inflamed gum tissue.
Step 3: re-evaluation
Around twelve weeks after the last debridement appointment, we reassess. Pocket depths are remeasured, bleeding scores recorded, and the chart is compared against the baseline.
The British Society of Periodontology recommends this twelve-week interval because it allows enough time for the periodontal tissues to reattach to the cleaned root surfaces and for inflammation to resolve. Measuring earlier produces unreliable numbers.
What happens next depends entirely on what the re-evaluation shows.
Possible outcomes at re-evaluation
The re-evaluation produces one of three broad outcomes, each with a different next step.
| Outcome | Findings | Next step |
|---|---|---|
| Stable | Pockets 4mm or less, minimal bleeding | Move to maintenance phase |
| Partial response | Some sites improved, others still 5mm+ | Targeted re-instrumentation of residual sites |
| Limited response | Multiple deep pockets persist, bleeding continues | Specialist periodontist referral, consider surgical options |
Most patients fall into the first or second category. Specialist referral is reserved for the more advanced cases or for sites that haven’t responded as expected, often around teeth with complex root anatomy.
The maintenance phase
Once the disease is stable, the work isn’t finished. Periodontitis is a chronic disease, and stability has to be actively kept up. Maintenance visits are usually every three or four months, sometimes adjusted to two-monthly for very high-risk patients.
At each maintenance visit, the hygienist remeasures any pockets that previously read 4mm or more, removes any new deposits, and reinforces home cleaning. Spotting recurrence early matters more than anything else at this stage. A pocket that creeps from 4mm to 6mm between visits is straightforward to manage if caught at the next appointment. If it’s missed for a year, the situation is different.
Three-monthly intervals aren’t a sales tactic. They’re what the evidence supports.
What patients should know going in
A few things consistently catch people off guard, and it’s worth flagging them upfront.
- Some teeth that looked fine may end up looking longer afterwards because the swelling subsides
- Sensitivity to cold is normal for two to four weeks
- Black triangles between teeth can appear where gum tissue has shrunk back to its true level
- The disease can recur if maintenance is skipped
- Smoking dramatically reduces treatment success and increases the chance of further bone loss
None of these are reasons to avoid treatment. They’re reasons to go in with realistic expectations.
Booking an assessment
If you’ve been told you have periodontitis, or if your gums bleed regularly, breath has become persistently bad, or teeth have started to feel slightly mobile, an assessment is the right step. The earlier we see the case, the more straightforward the treatment usually is. To book with our team at Westcliff Dental Practice, call 01702 344 500 and we’ll arrange a periodontal assessment at a time that suits.
