– Dr. Kumar Vadivel, DDS, MS, MBA, FDSRCS — Board-certified periodontist and founder of ToothHQ Dental Specialists, with offices in Carrollton, Grapevine, Cedar Hill, and Dallas (Mockingbird/SMU).
Periodontics is the dental specialty focused on the structures that hold your teeth in place — your gums, the bone underneath them, and the ligaments connecting tooth to bone. If your gums bleed, have pulled away from your teeth, or you’ve been told you have “pockets” or bone loss, a periodontist is the specialist who treats it, using anything from a non-surgical deep cleaning to laser gum surgery to bone grafting, depending on how advanced the problem is. This guide walks through every major treatment option, in plain easy English, so you know what to expect before you sit in the chair.
What does a periodontist actually treat?
A general dentist checks your teeth. A periodontist checks the foundation your teeth sit in. That distinction matters because gum disease (periodontal disease) is a bacterial infection that, left untreated, slowly destroys the bone and connective tissue anchoring your teeth — and unlike a cavity, you often can’t feel it happening until teeth start loosening.
Takeaway: if a general dentist has flagged “pockets,” bleeding, recession, or bone loss on your chart, that’s a periodontal referral, not a routine cleaning.
Cross-section diagram comparing healthy gum attachment to periodontal pocket with bone lossWhat are the warning signs of gum disease?
Most patients wait too long because early gum disease genuinely doesn’t hurt. Watch for:
- Gums that bleed when you brush or floss (not “normal,” even if it’s been happening for years)
- Gums that look red, swollen, or shiny instead of firm and pink
- Persistent bad breath that toothpaste and mouthwash don’t fix
- Gums that appear to be “shrinking” or teeth that look longer than they used to
- Loose teeth, or teeth that have shifted position
- Pus between the gum and tooth, or a bad taste that won’t go away
Takeaway: bleeding gums are the single most common early sign patients dismiss — and the easiest stage to treat.
Glossary: terms you’ll see on a periodontal chart
- Pocket depth — the space between your gum and tooth, measured in millimeters. 1–3mm is healthy; 4mm+ signals disease.
- Attachment loss — permanent loss of the gum/bone connection to the tooth root.
- Gingivitis — early, reversible gum inflammation with no bone loss yet.
- Periodontitis — advanced gum disease involving bone loss; not reversible, but manageable.
- Recession — the gum line pulling back, exposing more of the tooth root.
- Scaling and root planing (SRP) — the non-surgical “deep cleaning” that removes bacteria below the gumline.
The full range of periodontal treatments, from least to most involved
1. Scaling and root planing (non-surgical deep cleaning)
SRP [Scaling & Root Planing] is almost always the first line of treatment once gum disease is diagnosed. Using hand instruments and ultrasonic tools, your periodontist removes plaque and tartar from below the gumline, then smooths (“planes”) the tooth root so gum tissue can reattach more cleanly. It’s typically done in one or two visits, under local anesthesia, and is very different from a routine hygiene cleaning — it’s treating an infection, not just polishing teeth.
Takeaway: scaling and root planing is the deep-cleaning gateway treatment most patients with mild-to-moderate gum disease need first, before anything surgical is on the table.
2. Gum disease treatment (ongoing periodontal maintenance)
For patients whose gum disease is under control but not “cured” — which is most periodontitis patients, since bone loss doesn’t reverse — ongoing periodontal maintenance visits (typically every 3–4 months, more frequent than a standard 6-month cleaning) keep bacteria levels down and catch flare-ups early.
Takeaway: periodontal disease is managed, not cured, which is why maintenance frequency doubles compared to a healthy patient’s cleaning schedule.
3. Laser gum therapy and advanced laser cleaning
For patients who don’t need full surgery but need more than scaling and root planing, laser therapy uses targeted light energy to remove diseased tissue and reduce bacteria in the pocket with less bleeding, swelling, and discomfort than traditional instruments alone. It’s often used alongside SRP as a combination approach.
Takeaway: laser cleaning is a middle-ground option — more targeted than a standard deep cleaning, less invasive than surgery.
4. LANAP® laser gum surgery
LANAP® (Laser-Assisted New Attachment Procedure) is an FDA-cleared, minimally invasive alternative to traditional gum flap surgery. Instead of cutting and suturing the gums, a laser fiber is used to remove diseased tissue and bacteria while preserving as much healthy gum as possible, which can mean less pain, less swelling, and faster recovery than conventional surgery for eligible patients. Not everyone is a candidate — your periodontist will confirm eligibility based on your pocket depth and bone loss pattern.
Takeaway: LANAP® can achieve what traditional gum surgery achieves, without a scalpel or sutures, for patients who qualify.
5. Traditional gum surgery (flap surgery)
For more advanced periodontitis, or in cases where LANAP® isn’t appropriate, traditional gum surgery lifts the gum tissue back to allow direct access for deep tartar removal and, if needed, bone reshaping, then sutures the gum back into place for a tighter fit around the tooth.
Takeaway: traditional flap surgery remains the standard for deeper, more complex bone loss cases.
6. Gum grafting
When gums have receded and exposed tooth roots — from aggressive brushing, genetics, grinding, or past gum disease — grafting adds tissue (usually from the roof of the mouth or a donor source) back over the exposed root. Gum Grafting protects the root from sensitivity and further recession and can improve how the smile looks.
Takeaway: gum grafting is the fix for exposed roots, whether the cause is disease, brushing habits, or genetics.
7. Gum contouring (crown lengthening / gum reshaping)
Gum contouring reshapes uneven or excess gum tissue — sometimes for medical reasons (exposing more tooth structure so a crown can be properly placed) and sometimes primarily for a more even, symmetrical smile line. It’s a shorter procedure than grafting and typically has a quicker recovery.
Takeaway: gum contouring can be medically necessary or primarily cosmetic — worth asking which category your case falls into, since that can affect insurance coverage.
8. Bone grafting
When periodontal disease or missing teeth have caused enough bone loss that a tooth is unstable — or that there isn’t enough bone to support a future dental implant — bone grafting rebuilds that foundation using graft material that your body gradually incorporates as its own bone over several months.
Takeaway: bone grafting is frequently the deciding factor in whether a patient is currently a candidate for implants, or needs to rebuild bone first.
Which treatment matches which stage of gum disease?
This is a general guide, not a diagnosis — actual staging and treatment always depends on a clinical exam and X-rays.
When is gum disease a dental emergency?
Most periodontal treatment is scheduled, not urgent — but see a periodontist promptly, rather than waiting for your next cleaning, if you notice:
- A tooth that has suddenly become loose or shifted
- Swelling with pain, especially if it’s spreading toward your face or jaw
- Pus actively draining from the gum
- A gum abscess (a painful, swollen bump near the gumline)
Takeaway: sudden mobility or swelling with pain is a “call today,” not a “wait for your cleaning” situation.
Recovery: what to expect by periodontal treatment type
- Scaling and root planing: mild soreness for 1–3 days, back to normal eating quickly
- Laser gum therapy: minimal downtime, often same-day return to normal activity
- LANAP®: typically less swelling and faster return to normal function than traditional surgery, though healing time still varies by case
- Traditional flap surgery: more noticeable swelling, soft-food diet for several days to a week
- Gum grafting: tenderness at both the donor and graft site for about a week, with full tissue maturation over several weeks to months
- Bone grafting: healing and integration is a longer process, often several months, before the site is ready for the next step (like an implant)
Recovery experiences vary by patient, extent of treatment, and how closely post-op instructions are followed — your periodontist will give you a timeline specific to your procedure.
What does periodontal treatment cost?
Costs vary widely based on how many teeth or areas are involved, which treatment is needed, and your insurance coverage — scaling and root planing is typically the most affordable entry point, while surgical procedures and bone grafting cost more due to complexity and materials. Many dental insurance plans cover a portion of periodontal treatment, especially non-surgical care; ToothHQ’s team can walk you through an estimate and financing options at your free consult.
Periodontics FAQ
What’s the difference between a regular cleaning and a deep cleaning? A regular cleaning removes plaque and tartar above the gumline on healthy gums. A deep cleaning (scaling and root planing) treats existing infection below the gumline and is only recommended once gum disease has been diagnosed.
Is LANAP® better than traditional gum surgery? LANAP® isn’t universally “better” — it’s a different approach that avoids cutting and suturing, which can mean less discomfort and faster recovery for eligible patients. Whether it’s the right option depends on your specific pocket depth and bone loss pattern.
Can receding gums grow back on their own? No — gum recession doesn’t reverse on its own. Once tissue has pulled back and exposed the root, grafting is the treatment that restores coverage; addressing the underlying cause (brushing technique, grinding, disease) prevents it from progressing further.
Do I need bone grafting before I can get a dental implant? Only if imaging shows there isn’t enough bone volume to support the implant. Your periodontist will evaluate this with X-rays or a 3D scan before recommending implants.
How often should I get periodontal maintenance cleanings? Most patients with a history of periodontitis are seen every 3–4 months, rather than the standard 6-month interval, since gum disease requires ongoing management even after initial treatment.
Is gum contouring covered by insurance? It depends on whether it’s classified as medically necessary (for example, needed before a crown can be placed properly) or elective/cosmetic. Your treatment coordinator can check this against your specific plan.
Does gum disease treatment hurt? Most non-surgical treatments involve mild, manageable soreness rather than significant pain, and are done under local anesthesia. Surgical options also use anesthesia, with recovery discomfort typically managed by over-the-counter or prescribed medication as directed.
What happens if periodontitis goes untreated? Untreated periodontitis progressively destroys the bone and tissue holding teeth in place, which can lead to tooth mobility and eventual tooth loss — it’s also been linked in research to broader health concerns, which is part of why early treatment matters.
Not sure which stage you’re at? A periodontal evaluation takes one visit to tell you exactly where you stand — and every treatment option, from a deep cleaning to LANAP®, starts there. Book a free consultation at our Carrollton, Grapevine, Cedar Hill, or Dallas office.
