Bleeding during brushing or flossing is the earliest clinical sign — healthy gums do not bleed. Other early indicators include persistent bad breath, redness or swelling of the gum margins, and gum tissue that appears puffy rather than firm and stippled. These signs indicate gingivitis, the reversible stage of periodontal disease. Without treatment, gingivitis progresses to periodontitis with irreversible bone loss.

Gingivitis is fully reversible with professional cleaning and improved home care. Periodontitis (with bone loss) cannot be "cured" in the sense of restoring all lost bone, but it can be arrested — meaning disease progression stops, pockets stabilize or reduce, and no further bone is lost. Some bone regeneration is possible in specific defect types using guided tissue regeneration techniques.

Comprehensive periodontal probing measures the depth of the gum pocket around every tooth at six sites per tooth. Depths exceeding 3 mm with bleeding on probing indicate disease. Radiographs reveal bone levels. Clinical attachment loss, tooth mobility, and furcation involvement are assessed. The combined data is classified using the AAP staging and grading system to determine disease severity and progression risk.

The primary cause is bacterial biofilm (plaque) that accumulates below the gum line when oral hygiene is inadequate. Risk factors that increase susceptibility include smoking (the strongest modifiable risk factor), diabetes, genetic predisposition, hormonal changes (pregnancy, menopause), certain medications that reduce saliva flow, and immune suppression. Stress and poor nutrition also contribute.

Substantial research links periodontal disease to cardiovascular disease, diabetes (bidirectional — each worsens the other), adverse pregnancy outcomes, respiratory infections, and systemic inflammatory burden. The oral inflammatory load from periodontitis enters the bloodstream, contributing to endothelial dysfunction and systemic inflammation. Treating periodontal disease measurably improves glycemic control in diabetic patients.

A regular prophylaxis (cleaning) removes plaque and calculus above and slightly below the gum line in a patient with healthy gums. Periodontal treatment (scaling and root planing) is a therapeutic procedure performed under local anesthesia to remove infected deposits from deep pockets (4 mm and deeper), debride diseased root surfaces, and disrupt the pathogenic biofilm causing bone loss. They are fundamentally different procedures for different conditions.

Every three to four months for most periodontal patients. This maintenance schedule — more frequent than the standard six-month recall — is essential because subgingival bacteria recolonize previously treated pockets within three to four months. Maintenance visits include probing, localized re-treatment of any recurrent pockets, and professional biofilm removal. Patients who stretch intervals beyond four months show measurably higher rates of disease recurrence.

Many teeth with advanced periodontal disease can be retained with appropriate treatment — but not all. The prognosis depends on the extent of bone loss, the tooth's strategic importance, the patient's ability to maintain hygiene around the tooth, and whether the bone defect is amenable to regeneration. Honest prognosis assessment at ADSC helps patients make informed decisions about which teeth to invest in treating and which may be better replaced.

Dramatically. Smokers are three to six times more likely to develop periodontal disease and respond significantly less well to treatment. Nicotine constricts gingival blood vessels, reducing immune cell delivery to infected tissues, impairing healing after treatment, and masking the bleeding that would otherwise alert patients to disease. Smoking cessation is the single most impactful thing a patient can do to improve periodontal outcomes.

Guided tissue regeneration uses a biocompatible membrane placed between the gum tissue and bone defect. The membrane prevents fast-growing gum tissue from filling the space, allowing slower-growing bone and ligament cells to regenerate in the defect. Bone graft material is often placed beneath the membrane as a scaffold. New bone formation takes 6-12 months.

Scaling and root planing is performed under local anesthesia — the procedure itself is not painful. Post-treatment sensitivity to cold and mild gum tenderness are common for several days. Surgical procedures involve post-operative discomfort managed with prescribed medications. Patients with dental anxiety can receive nitrous oxide or IV sedation for both non-surgical and surgical periodontal treatment at ADSC.

Platelet-Rich Fibrin is a concentrated blood product prepared from the patient's own blood by centrifugation. The resulting fibrin membrane contains concentrated platelets, white blood cells, and growth factors (VEGF, PDGF, TGF-beta) that accelerate tissue healing. PRF is placed into extraction sockets, surgical sites, and bone grafts to enhance soft tissue closure, reduce post-operative pain, and improve bone regeneration outcomes.

Most dental plans cover scaling and root planing as a basic service at 80 percent. Periodontal surgery coverage varies by plan — some cover it as a basic service, others as a major service at 50 percent. Periodontal maintenance visits are typically covered but may have frequency limitations. The front desk verifies your specific benefits before treatment.

Periodontal disease is the number one cause of tooth loss in adults. As the bone supporting the tooth roots is destroyed by the chronic inflammatory process, teeth become mobile, painful, and eventually non-functional. Advanced bone loss (greater than 50 percent of root length) significantly compromises tooth prognosis. Early intervention — before bone loss becomes severe — is the most effective strategy for preventing tooth loss.

General dentists manage gingivitis and mild periodontitis. Referral to a periodontist is appropriate for moderate to severe disease (probing depths of 5 mm or greater, significant bone loss), cases that do not respond to initial non-surgical treatment, patients requiring surgical pocket reduction or regeneration, and complex cases involving systemic risk factors. ADSC provides specialist-level evaluation and treatment for all periodontal stages.