Periodontal care is the prevention, diagnosis, and treatment of gum disease, the infection that damages the soft tissue and bone supporting your teeth. About 47% of U.S. adults over 30 have some form of periodontitis, and that number climbs to roughly 70% in adults 65 and older. Periodontal care ranges from routine cleanings and at-home habits to deep cleanings and surgery, depending on how far the disease has progressed.
What Gum Disease Actually Does
Gum disease starts with bacteria in plaque, the sticky film that forms on your teeth every day. When plaque isn’t removed, it hardens into tartar, which you can’t brush away on your own. The bacteria irritate your gums, causing inflammation. In its earliest stage, called gingivitis, your gums may bleed when you brush or look red and puffy. Gingivitis is reversible with good care.
Left untreated, gingivitis progresses to periodontitis. The inflammation moves deeper, creating pockets between your gums and teeth where bacteria thrive. In a healthy mouth, the space between gum and tooth measures 1 to 3 millimeters. Pockets deeper than 4 mm indicate periodontitis. Once pockets exceed 5 mm, routine brushing and flossing can’t reach the bacteria inside them. Over time, the infection breaks down the bone that holds teeth in place, and teeth can loosen or fall out entirely.
Why It Matters Beyond Your Mouth
Periodontal disease doesn’t stay confined to your gums. Bacteria from infected gum tissue can enter the bloodstream and trigger inflammation throughout the body. This systemic response has been linked to cardiovascular disease: oral bacteria can contribute to the buildup of arterial plaques and increase the risk of blood clots. The connection to diabetes runs in both directions. Poorly controlled blood sugar makes gum disease worse, and the chronic inflammation from periodontitis makes blood sugar harder to control. Both conditions share elevated levels of the same inflammatory markers, creating a cycle that amplifies each disease.
Non-Surgical Treatment: Deep Cleaning
The cornerstone of periodontal treatment is scaling and root planing, commonly called a deep cleaning. It’s the first line of treatment for mild to moderate gum disease. During the procedure, your gums are numbed with local anesthesia. Then a dentist or hygienist removes plaque and tartar from your tooth surfaces and below the gumline (scaling), and smooths the root surfaces (planing). Smoothing the roots makes it harder for bacteria to reattach and gives your gum tissue a clean surface to heal against.
Deep cleanings are typically done in one or two visits, sometimes treating one half of the mouth at a time. Afterward, expect some gum tenderness and tooth sensitivity, particularly to hot and cold. Your gums may feel sore for a few days. As the tissue heals and inflammation subsides, you may notice your gums recede slightly. This is actually a sign of healing: swollen gum tissue is shrinking back to a healthier state. For many people with early to moderate disease, scaling and root planing is enough to stop the progression and avoid surgery.
When Surgery Becomes Necessary
Advanced periodontitis with deep pockets or significant bone loss often requires surgical intervention. The most established option is flap surgery (pocket reduction surgery), where a periodontist lifts the gum tissue back, removes tartar from deep pockets, and repositions the gums to fit more snugly around the teeth. This reduces pocket depth and makes ongoing cleaning easier. Recovery typically takes several weeks, with noticeable swelling and tenderness during that time.
A newer alternative is laser-assisted treatment, which uses a specialized laser to target and remove infected tissue while leaving healthy gum intact. The key advantage is precision: traditional surgery may remove some healthy tissue along with diseased areas, while laser treatment selectively eliminates bacteria and damaged tissue. Laser procedures can also stimulate regrowth of bone and connective tissue around the teeth, something traditional flap surgery doesn’t typically achieve. Most people return to normal activities within 24 hours after laser treatment, compared to several weeks of healing with conventional surgery.
The Maintenance Schedule
Once you’ve been treated for gum disease, your cleaning schedule changes permanently. Standard dental cleanings every six months aren’t frequent enough. The American Academy of Periodontology recommends that most patients with a history of periodontitis start with maintenance visits every three months. This more frequent schedule significantly reduces the likelihood of the disease progressing again compared to less frequent visits.
Periodontal maintenance appointments are more involved than a standard cleaning. Your provider measures pocket depths, checks for bleeding, removes tartar from above and below the gumline, and monitors any areas that showed bone loss. Over time, depending on how your gums respond, the interval between visits may be adjusted to every three to six months. Skipping or stretching these appointments is one of the most common reasons periodontal disease comes back.
At-Home Care That Actually Works
What you do between dental visits matters as much as the professional treatment. Brushing twice a day with a soft-bristled or electric toothbrush is the foundation, but brushing alone misses the spaces between teeth where gum disease often starts.
For cleaning between teeth, interdental brushes (the small bristled picks you insert between teeth) are consistently more effective than traditional floss. A European Federation of Periodontology consensus statement identified interdental brushes as the most effective method for removing plaque between teeth, outperforming both floss and wooden picks. Multiple studies have found that floss, when used routinely, often fails to significantly reduce plaque beyond what brushing alone achieves. The likely reason is technique: effective flossing is difficult, and most people don’t do it thoroughly enough to make a difference. Interdental brushes, by contrast, are easier to use correctly and have been shown to reduce bleeding, plaque, and pocket depth in people with gum disease. They’re especially recommended for anyone in a periodontal maintenance program.
If the gaps between your teeth are too tight for interdental brushes, a water flosser is a reasonable alternative. The goal is consistent disruption of bacterial buildup between teeth, using whatever tool you’ll actually use well.
Smoking and Treatment Outcomes
Smoking is the single most significant controllable risk factor for gum disease. Clinical outcomes for smokers are 50 to 75% worse than for nonsmokers. Smoking restricts blood flow to the gums, slows healing after procedures, and masks early warning signs like bleeding (because reduced circulation means gums bleed less even when they’re infected). This makes gum disease harder to detect and harder to treat in smokers. If you smoke and are undergoing periodontal care, quitting is the most impactful thing you can do to improve your results.
Other factors that increase your risk include diabetes, hormonal changes during pregnancy, certain medications that cause dry mouth, and genetics. You can’t control all of these, but being aware of them helps you and your dental provider tailor a maintenance plan that accounts for your specific level of risk.