Gum treatment: care for gingivitis and periodontitis

1 Gingivitis vs. periodontitis: what are the differences?

• Gingivitis is a superficial and reversible inflammation of the gums, primarily caused by the accumulation of bacterial plaque along the gumline. It can cause redness, swelling, sensitivity, and bleeding during brushing or flossing, but it does not involve bone loss or destruction of the tissues that support the teeth. When treated early with proper oral hygiene and professional dental cleaning, it can resolve without permanent consequences.

• Periodontitis, on the other hand, affects the deeper tissues and bone that support the teeth. It can cause periodontal pockets, gum recession, progressive bone loss, and, in more advanced cases, tooth mobility or tooth loss. The damage already caused is not completely reversible, but the disease can be controlled and stabilized through appropriate treatment and a regular maintenance program.

2 What are the symptoms and risk factors?

The most common symptoms of periodontitis include red, swollen or bleeding gums, persistent bad breath, gum recession, dental sensitivity and discomfort during brushing or chewing. As the disease progresses, spaces may develop between the teeth, the bite may change, the teeth may become mobile and pus may drain from the periodontal pockets. Periodontitis can nevertheless progress without obvious pain, so frequent bleeding, receding gums or persistent bad breath should not be considered normal and require a dental assessment.

The main risk factors are bacterial plaque accumulation, inadequate oral hygiene, smoking, poorly controlled diabetes and genetic predisposition. Stress, a weakened immune response, certain medications and irregular dental attendance may also contribute to disease progression. Gum recession, however, does not always indicate periodontitis: it may also result from aggressive brushing, tooth position, thin gum tissue or previous orthodontic treatment. To distinguish between the different causes, the gums, periodontal pockets and bone levels must be assessed.

3 How are gingivitis and periodontitis diagnosed?

The diagnosis of gingivitis and periodontitis is based on a complete clinical examination of the gums, combined with periodontal probing and, when indicated, targeted dental radiographs. During the appointment, the dentist or periodontist checks for plaque, tartar, redness, bleeding, recession and tooth mobility. A calibrated periodontal probe is used to measure pocket depth and clinical attachment loss, which are essential parameters for distinguishing superficial inflammation from disease that has already affected the supporting tissues.

Dental radiographs make it possible to assess the amount and distribution of bone loss around the roots and to identify vertical bone defects or furcation involvement. Combining clinical findings, radiographic findings and risk factors allows periodontitis to be classified according to stage and grade, defining its severity, extent and expected rate of progression. An accurate diagnosis therefore makes it possible to establish a personalized treatment plan and determine the appropriate frequency of follow-up appointments.

4 How is gingivitis treated?

Gingivitis is treated by removing plaque and tartar and achieving a lasting improvement in daily oral hygiene. Treatment generally includes a professional dental hygiene session, during which the deposits responsible for inflammation are removed, followed by personalized instructions on the use of a toothbrush, dental floss and interdental brushes. Thorough cleaning of the gum line and spaces between the teeth helps gradually reduce bleeding, swelling and redness, allowing gum health to recover.

5 How is non-surgical periodontal therapy performed?

Non-surgical periodontal therapy involves removing plaque and tartar from the root surfaces below the gum line through scaling and root planing, also known as subgingival instrumentation and root surface debridement. The treatment is performed using manual and ultrasonic instruments to reduce the bacterial load within the periodontal pockets and promote a reduction in inflammation. Depending on the extent and severity of the periodontitis, it may require local anaesthesia, one or more treatment sessions and division of the treatment into quadrants.

6 When is periodontal surgery necessary?

Periodontal surgery may be necessary when deep pockets, bone defects or root surfaces that are difficult to reach with conventional instruments remain after non-surgical therapy and subsequent clinical reassessment. Surgery provides direct access to the roots and supporting tissues, improving the removal of residual deposits and infection control. Depending on the clinical situation, access procedures, pocket reduction surgery or regenerative techniques may be performed in bone defects with suitable characteristics.

When receding gums are present, mucogingival surgery may be recommended to protect exposed roots, increase tissue thickness and improve the appearance of the smile. The procedure may involve a gum graft or another root coverage technique, with the aim of reducing sensitivity and limiting further recession.

7 How often should periodontal maintenance be performed?

Periodontal maintenance is generally scheduled every 3–6 months, while the interval may be extended to 12 months in stable, low-risk patients. The frequency depends on the presence of residual pockets, plaque control, gum bleeding, smoking, diabetes and the response achieved after treatment. A personalized maintenance schedule makes it possible to identify early signs of disease reactivation and intervene before further loss of support occurs.