Gum disease treatment and deep cleaning, step by step.

Periodontitis, still sometimes called pyorrhoea, is a long-running inflammation of the tissues that hold each tooth in its socket. It starts with the bacterial film called plaque at the gum line. In many mouths that film causes gingivitis, gums that are red and bleed easily, and goes no further. In a susceptible person the inflammation reaches deeper, and the fibres and bone that anchor the tooth are slowly lost. The gap this opens between the gum and the root is the pocket that the probe measures.

Susceptibility is partly inherited: the genetic share of the risk is estimated at up to half. The rest is acquired, and much of it can be changed: smoking, diabetes that is undiagnosed or not well controlled, and obesity all add to it ^[1]. That is why two people with the same amount of plaque can have very different gums, and why your chart, not the look of your gums, decides what you need.

Severe periodontitis is common. It affects about 11% of adults worldwide, and new cases are most frequent at around the age of 38 ^[5]. Your thirties are a sensible time to have your gums properly charted, even if nothing hurts and your teeth feel firm.

Since the 2017 world classification, periodontitis is described with two labels rather than one vague diagnosis ^[6]. The stage, from I to IV, records how much support has already been lost and how complex the case is to treat: how far the attachment loss reaches, how much bone the X-ray shows as lost, whether teeth have already been lost to the disease, and features such as deep pockets, vertical bone defects or loose teeth ^[2]. The table further down this page sets the four stages side by side.

The grade, A, B or C, describes speed: how fast the disease appears to be moving, judged from earlier X-rays where they exist and from the pattern of loss where they do not ^[2]. Grade B, moderate progression, is the starting point until the evidence moves it. Two risk factors push a case towards grade C, the fastest: smoking 10 or more cigarettes a day, and diabetes with an HbA1c of 7.0% or more ^[2][4].

Put simply, the stage tells you how much has been lost and the grade how quickly it is being lost. Both are written into your notes, so the next examination has something firm to be compared against, and you can see for yourself whether treatment is working.

Deep cleaning is the first active treatment for periodontitis. Its clinical names are scaling and root planing, or subgingival instrumentation. It is a different treatment from a routine scale and polish: a routine clean removes plaque, tartar and stain above the gum and just at its edge, while a deep cleaning reaches down the root surfaces inside the pockets, where the bacteria that drive the disease live.

First, the area is numbed with local anaesthetic, so the cleaning below the gum can be done thoroughly and comfortably. The root surfaces are then cleaned with an ultrasonic scaler, a fine tip that vibrates in a spray of water, and with hand instruments where a finer touch is needed. The European guideline's review found no difference between hand and powered instruments, and the guideline supports either or both ^[3][4]. The mouth can be treated a quarter at a time over several visits, or all at once within 24 hours; both gave similar results, so the choice is made around your mouth, your comfort and your diary ^[3][4].

What it achieves: in that review, pockets were on average about 1.4 mm shallower and about three in four had closed at 6 to 8 months ^[3], and an American Dental Association review of 72 studies found an average attachment gain of about 0.5 mm ^[7]. Antibiotic tablets are not a routine part of it: the guideline advises against using them routinely ^[4]. Dr. Khalid carries out the deep cleaning for the earlier, shallower stages himself. Sites with pockets deeper than 5 mm are treated by our periodontist in the same clinic, on the same plan, which Dr. Khalid, our periodontist and the team make together from your chart so the finished result, agreed first, meets the standards of function, aesthetics and biomimetics; Dr. Khalid stays on your case.

The European Federation of Periodontology's guideline sets treatment out in four steps, and each step starts only once the one before it has been checked ^[4]. Step 1 is for everyone: coaching on cleaning at home, with interdental brushes where the gums are inflamed, help with risk factors such as smoking and blood sugar, and a professional clean above the gum line. Gingivitis is treated with this kind of care, and gum health can be restored ^[8]. Step 2 is the deep cleaning described above.

After the deep cleaning, the gums are given time to heal, and every site is measured again about three months later. The target is clear: no pocket deeper than 4 mm that bleeds, and none of 6 mm or more ^[4]. Sites that reach it go straight on to supportive care. Sites that do not go on to step 3: a repeat deep cleaning, or gum surgery, in which the gum is gently opened so the root can be cleaned under direct vision and the pocket reduced. Where bone has been lost in a vertical, crater-like defect 3 mm or deeper, the guideline recommends regenerative surgery, which aims to rebuild part of the lost support ^[4].

In step 3, pockets deeper than 5 mm and any surgery are treated by our periodontist in the same clinic, and the work is planned before anything is booked: Dr. Khalid, our periodontist and the team plan the case together from the same chart and X-rays, so the finished result meets the standards of function, aesthetics and biomimetics. That result is agreed first, so the surgery is planned to the finished tooth rather than the tooth fitted to whatever the surgery leaves, and our periodontist carries out the surgery. Dr. Khalid stays on your case throughout, does the restorative work, and they review the result together. Step 4, supportive care, then keeps the result, with visits every 3 to at most 12 months ^[4].

Dr. Khalid examines and charts your gums, gives you the stage and grade, and treats gingivitis and the earlier, shallower stages of periodontitis without surgery: the coaching, the professional cleaning and the deep cleaning. He also provides your supportive care visits, and he carries out every cleaning himself.

Pockets deeper than 5 mm, gum surgery, regeneration and gum grafts are treated by our periodontist, who works in the same clinic. Whatever the stage, there is one plan: Dr. Khalid, our periodontist and the team plan your case together before anything is booked, from the same charts, X-rays and photographs, so no step is missed, the case is seen from more than one angle, and the finished result meets the standards of function, aesthetics and biomimetics. That result is agreed first and becomes the brief the gum treatment is carried out to; where a tooth will need a filling, an onlay or a crown, the gum and bone are shaped for the tooth they will support. Our periodontist carries out the surgery. Dr. Khalid stays on your case throughout, does the restorative work himself, and reviews the result with the periodontist.

One chart, one plan, one clinic. How shared cases are planned across gum treatment, orthodontics and implants is set out on team care.

Gum treatment here follows the same conservative, biological approach as the rest of the practice: keep your natural teeth, rebuild lost support where the evidence allows, and prevent the disease from coming back. Deep cleaning and supportive care do the keeping and the preventing; regeneration, where it fits, does the rebuilding.

Bone lost to gum disease does not grow back by itself. Deep cleaning is aimed at stopping the loss, although it can also improve the shape of some bone defects ^[9]. In selected defects, part of the lost support can be rebuilt: where bone has been lost in a vertical, crater-like defect 3 mm or deeper, the European guideline recommends regenerative surgery ^[4]. Across 79 randomised trials, regeneration added on average 1.34 mm of attachment compared with surgery that only cleaned the root ^[10]. In a ten-year trial of teeth whose support had been lost all the way to the root tip, the kind of tooth often called hopeless, 88% of the regenerated teeth were still in place at ten years, against 100% of the teeth that were removed and replaced; survival without complications was similar in both groups, and the regenerated teeth gained 7.3 mm of attachment ^[11].

Not every tooth or defect suits regeneration. That is decided when Dr. Khalid, our periodontist and the team plan your case together from the same chart and X-rays, so the finished result, agreed first, meets the standards of function, aesthetics and biomimetics; our periodontist carries out the surgery, and Dr. Khalid stays on your case and restores the tooth afterwards. Where it fits, it is a way of keeping a tooth rather than replacing it, which is what the practice is built around. If you have been told a tooth cannot be kept, can this tooth be saved? explains how that question is examined.

Active treatment ends; supportive care continues, and it is what keeps the result. The guideline recommends visits every 3 to at most 12 months, set by your risk ^[4]. At each visit your gums are charted again, bleeding sites are recorded, and any site that has started to change is treated at that visit rather than left for the next. Dr. Khalid provides these visits himself; after gum surgery, he runs them together with our periodontist.

The reason to keep coming is clear. In a review of eight studies that followed patients for at least five years, people who kept to their supportive care visits had a 44% lower risk of losing teeth than those who came irregularly ^[12]. Those studies are observational: no randomised trial has yet compared supportive care with monitoring alone, and trials have not yet shown that one schedule or protocol works better than another ^[13]. That is why your interval is set from your own chart and adjusted as it changes. A treated periodontitis patient whose gums are now healthy stays at higher risk of the disease returning, and is monitored for that reason ^[8].

Diabetes and gum disease affect each other. In a review of long-term studies, diabetes raised the risk of periodontitis starting or getting worse by 86% ^[14]. In the other direction, treating periodontitis lowered HbA1c, the long-term blood sugar measure, by 0.43 percentage points three to four months later, across 30 trials and 2,443 people ^[15]. Diabetes is common here: about one in five Emirati adults has it ^[16], and in a survey of 2,724 expatriate residents at visa renewal centres, 64% of those found to have diabetes had not been diagnosed before ^[17]. European guidance asks dental teams to help detect diabetes early ^[18]. A dentist does not diagnose diabetes, but if your gums or your history point that way, we may suggest a check with your doctor.

Smoking hides the usual warning sign. It suppresses gum bleeding, most strongly in people who smoke more than 10 cigarettes a day ^[19], so a smoker's gums can look calm while pockets deepen underneath. Shisha is not a gentler option for the gums. In a study of 200 men in Saudi Arabia, waterpipe smokers' gums and bone were as affected as cigarette smokers', and both groups were worse off than men who had never smoked ^[20]. A systematic review links waterpipe smoking with gum inflammation and periodontitis ^[21], and a 2026 review found waterpipe users' gum measurements comparable to cigarette smokers' ^[22].

The evidence on vaping is newer and less settled. One review of 40 studies found no difference between e-cigarette users and non-smokers in pocket depth or bone loss, although users had more plaque and the studies carried a high risk of bias ^[23]; the 2026 review found deeper pockets and more attachment loss in e-cigarette users than in non-smokers ^[22]. In a survey of 6,027 adults in England, people who both smoked and vaped reported the highest odds of a history of gum disease ^[24]. Whatever you use, tell us: it changes how your gums are read and how often you are seen, and help to stop is part of step 1 if you want it.

This page is the centre of gum care at the practice, and each related concern has its own page. If your gums bleed when you brush, start with bleeding gums. If your teeth look longer or roots are showing, see receding gums. If a tooth has started to move, see loose teeth, and if an X-ray has shown bone loss, see bone loss around teeth.

When a pocket stays deep after deep cleaning, pocket reduction and regeneration is the next step. The gum and bone can be reshaped to make room for a crown with crown lengthening. If a lot of gum shows when you smile, see gummy smile, and if your gums are darker than you would like, see gum depigmentation. Implants need healthy gums too: see peri-implantitis. And for gums that are already healthy, a routine teeth cleaning at the interval set for you helps keep them that way.