Periodontal treatment is professional care for gum disease (periodontitis). Periodontitis is an infection of the structures supporting the teeth — the gum, bone, and ligament. If left untreated, it causes progressive loss of the bone holding the teeth, which eventually leads to loose teeth and tooth loss.
The BSP recommends a stepped approach to periodontal treatment, moving through stages based on how you respond to each level of care.
The stages of periodontal treatment
Periodontal treatment follows a structured pathway:
Step 1 — Risk factor management and education: Advice on improving your oral hygiene technique, diet, and addressing risk factors such as smoking. This stage alone can significantly improve gum health in milder disease.
Step 2 — Root surface debridement (deep cleaning): The dentist or hygienist uses specialist instruments to remove bacterial deposits (calculus) from below the gum line. Local anaesthetic is usually given. This is the core treatment for most patients with gum disease.
Step 3 — Periodontal surgery: If deep pockets remain after thorough non-surgical treatment, surgical access may be needed to clean roots thoroughly. (See our separate Gum Surgery leaflet.)
Step 4 — Supportive periodontal therapy: Long-term, regular maintenance appointments (typically every 3–6 months) to monitor stability and prevent relapse. This phase continues for life.
What is root surface debridement?
Root surface debridement (also called deep scaling, root planing, or subgingival debridement) is the main non-surgical treatment for periodontitis. It involves:
Local anaesthetic to numb the gums
Using hand instruments and/or an ultrasonic scaler to remove tartar (calculus) and bacterial deposits from root surfaces beneath the gumline
Smoothing the root surface to reduce future bacterial attachment
Treatment is usually carried out in quadrants (quarters of the mouth) at separate appointments. A full course of treatment may take 2–4 appointments of 45–90 minutes each.
What to expect during and after treatment
During treatment, local anaesthetic means you should not feel pain. You may feel pressure and vibration.
After each session:
The gums will be tender for 2–5 days — paracetamol or ibuprofen can help
Gums may bleed more than usual for a day or two before settling
Teeth may feel more sensitive, particularly to cold — this usually improves over weeks
You may notice gum shrinkage as swelling reduces — teeth can look slightly longer. This is normal.
Risks and important considerations
Periodontal treatment is not a cure — periodontitis is a chronic condition that must be managed long-term. Key points:
You will need lifelong supportive care appointments — typically every 3–6 months. Missing these increases the risk of disease recurrence.
Teeth with severe bone loss may not be saved despite treatment
Some gum recession is expected after treatment as inflammation reduces — this can increase sensitivity and change the appearance of teeth
The outcome depends heavily on your own daily oral hygiene. Professional treatment combined with excellent home care gives the best results.
Smoking significantly worsens the prognosis of periodontal treatment. Stopping smoking is one of the most important things you can do for your gum health.
Questions to ask your dentist
What stage of gum disease do I have (mild, moderate, or severe)?
How many teeth are affected and are any of them at risk of being lost?
How many treatment appointments will I need?
What maintenance frequency will I need in the long term?
Are there any lifestyle changes I should make alongside treatment?
This leaflet is for general information only and does not replace professional dental advice. It is intended to support — not replace — the discussion with your dentist about your individual options, risks, and treatment plan. Treatment outcomes vary between patients depending on individual circumstances. Your dentist will confirm exact fees and what is suitable for your specific circumstances before you agree to any treatment.
References
Aligned with guidance from: BSP (British Society of Periodontology), SDCEP, FGDP(UK), NICE.