Gum care · 7 min read
Gum disease is painless for most of its course, which is why it is usually found late. Here is how it progresses, what treatment each stage needs, and where the cost rises steeply.
Most patients who come to us with loose teeth are surprised to hear they have had gum disease for years. It rarely hurts. It does not usually stop you eating. By the time it becomes obvious, a good deal of the damage is permanent.
The useful thing about gum disease is that it follows a predictable path. If you know which stage you are at, you know what treatment you need and roughly what it will cost. Here is that path, stage by stage.
Worth describing first, because many people have never seen healthy gums and assume their own are normal. Healthy gums are pale pink, firm, and sit tightly against the tooth in a thin scalloped edge. They do not bleed when brushed or flossed, not even a little.
On the chart, pocket depths measure 1 to 3mm at every point. There is no bleeding on probing and no bone loss visible on X-ray.
Plaque sits along the gumline long enough to harden into calculus, and the gum responds with inflammation. It becomes red, slightly swollen, and bleeds when you brush. This is gingivitis and it is extremely common.
The important detail is what has not happened yet: no bone has been lost. Nothing is permanent at this point. A thorough professional clean plus a corrected home routine resolves it, usually within two weeks.
This is also the stage most people ignore, because bleeding gums do not hurt and it is easy to assume you are brushing too hard. The bleeding is the warning that arrives before the damage.
If inflammation continues, it moves below the gumline. The fibres attaching gum to tooth break down, and pockets form between the two. Bacteria colonise those pockets, where no toothbrush reaches. The bone that holds the tooth starts to resorb.
On the chart, pockets now measure 4 to 6mm and bleed when probed. X-rays show the first loss of bone height. Patients often notice nothing at all, or only bad breath that keeps coming back.
Treatment moves from cleaning to deep cleaning: scaling and root planing under local anaesthetic, quadrant by quadrant, cleaning inside the pockets and smoothing the root surfaces so the gum can reattach. We re-measure six to eight weeks later and compare with the original chart.
The bone lost at this stage does not come back. Treatment stops the process; it does not rewind it. That is the first point where waiting costs you something you cannot buy back.
Pockets exceed 6mm, substantial bone has been lost, and teeth begin to loosen, drift, or splay outward. Patients notice gaps opening between front teeth, a bite that feels different, or a tooth that moves when pushed with the tongue.
Deep cleaning alone often cannot reach the base of pockets this deep. Surgical access is usually required, so the root surfaces and bone defects can be cleaned directly, and grafting may be considered in specific defects.
Some teeth at this stage cannot be saved. Where a tooth is lost, replacement becomes the next conversation: an implant, a bridge, or a denture, all considerably more expensive than the treatment that would have prevented the loss.
The jump is not gradual. Treating gingivitis costs about the same as a routine cleaning. Treating moderate periodontitis costs several times that. Treating advanced disease, including replacing teeth you lose, costs an order of magnitude more.
This is the only real argument for early examination, and it is a financial one as much as a clinical one. A gum check costs a consultation fee. The alternative, discovered five years later, is measured in implants.
Not by looking in the mirror. Pocket depth is measured with a graduated probe at six points around every tooth, and bone level is assessed on X-ray. That charting takes about twenty minutes and gives you a definite answer rather than an impression.
If your gums bleed when you brush, if your breath is persistently bad, or if you have simply never had your gums charted, that examination is the thing worth booking.
Written by Dr. Niyukty Arjal, MDS Periodontist, Gums & Giggles Dental Clinic. This article is general information about dental health and is not a diagnosis. Symptoms vary between patients, so book an examination for advice specific to your own teeth and gums.
Gum care · 6 min read
Bleeding gums are the single most common thing patients mention and the single most common thing they ignore. Seven causes a periodontist sees weekly, and what to do about each.
Read moreTreatments · 6 min read
Both straighten teeth. They differ in price, treatment time, visibility, and how much of the result depends on you remembering to wear them.
Read moreFind us
Conveniently located on Dhobidhara Marg, minutes from Lazimpat, Maharajgunj, Naxal, Baluwatar, and Thamel.
Book a consultation at our Dhobidhara Marg clinic and get an answer based on an examination, not an article.
