Gum treatment

Periodontal disease starts as inflammation of the gums, caused by plaque that hasn't been removed. Plaque hardens into calculus, which forms alongside and underneath the gums. That build-up creates a pocket between the gum and the tooth which can't be cleaned properly without treatment.

Left untreated, the disease can do irreversible damage to the teeth, gums and the bone supporting them — and can end in losing teeth.

Before we start, treatment needs a comprehensive examination with a full medical history, the relevant tests and X-rays, and a proper discussion and plan. At the first debridement appointment we complete a full periodontal analysis and charting, which gives us a baseline. We chart again through the maintenance phase to track whether the disease is progressing.

The areas with deep pockets are numbed, and the build-up of plaque and calculus on the tooth roots below the gum line is removed with specialised instruments. That leaves the root surface clean and smooth so the gum can heal and reattach to the tooth.

If a filling or crown is contributing to the problem — an overhang, for instance — it may need reshaping or replacing so the gum can heal.

Afterwards the gums will be tender and sore for the first few days and need gentle care over the following weeks. We'll show you how to improve your brushing and flossing, and demonstrate the specific products and techniques that get the best result.

At your review appointments we assess how the gums have responded. If they've healed well and your hygiene is good, we'll set up a program to maintain it. Some areas may need re-treating during the maintenance phase if disease starts to progress again. If the gums haven't responded well, further treatment such as periodontal surgery may be needed.

Gum treatment isn't successful in every case. There's no method that accurately predicts how gums or bone will heal, and if the result isn't satisfactory a second procedure may be needed, at full fee.

• Infection, bleeding, pain, swelling, bruising or discomfort after the debridement.
• Tooth or gum sensitivity, injury, or increased mobility of a tooth.
• A periodontal abscess.
• Loss of a tooth where there isn't enough supporting structure left.
• Numbness of the lip, tongue, chin, gum or palate from the anaesthetic — transient, and permanent only very rarely.
• Jaw joint tenderness or restricted opening for a few days or weeks.
• Allergic reactions.
• Delayed healing. Gums heal at different rates in different people; we assess it at your reviews, and a second debridement is sometimes needed where an area isn't settling.
• Gum shrinkage or recession as the inflammation resolves.

Soreness, tenderness, bruising and lingering numbness usually settle over the following days and weeks, though how long is not always predictable, and there's a slight chance a change becomes permanent. Tell us at your follow-up if pain, tenderness or numbness is still there or has got worse.

• Regular cleaning above the gum line only, which doesn't reach the deposits causing the problem.
• Referral to a periodontist for specialist care.
• Doing nothing. If the disease isn't treated, expect continued loss of bone and supporting structure, gum inflammation, infection, sensitivity, teeth loosening, and eventually the need to remove them.

Oral hygiene after the debridement is critical — it plays a vital role in whether the treatment works. Several review appointments may be needed after the initial treatment to check healing and hygiene. Beyond that, this needs daily care at home and a check-up every 3 months, which isn't included in the cost of the initial treatment.

• Follow the instructions on brushing, flossing and cleaning between the teeth, and use a Savacol mouth rinse if your clinician recommends it.
• Attend your review appointments so we can monitor gum health and check your hygiene.
• Come in for examinations, periodontal charting and preventive care every 3 months as advised. There's a fee for these visits.

If you don't attend your follow-ups or keep up the maintenance, problems can develop to the point of being difficult, costly, or impossible to treat — and you would be liable for the full cost of correcting them.

• I have been informed of the reasons for gum treatment, the risks, the alternatives and the maintenance needed, before treatment begins.
• I understand the purpose and nature of periodontal debridement and root planing.
• The alternatives have been explained to me.
• I understand the risks include pain, swelling, infection, sensitivity, jaw joint pain or difficulty opening, gum recession, tooth mobility and, rarely, loss of a tooth — and that numbness of the lip, tongue, chin, cheek or teeth may occur and, very rarely, be permanent.
• I understand that if the gums don't respond, a second procedure may be needed at full fee, and that further treatment such as periodontal surgery may be required.
• I understand what may happen if the disease is not treated — loss of bone and supporting structure, inflammation, infection, sensitivity, loose teeth and possible extractions.
• I understand there is no way to accurately predict how any individual's gums and bone will heal.
• I understand that excessive smoking, alcohol or sugar may affect gum healing and limit the success of treatment.
• I agree to follow the home care instructions, and to attend for regular examinations and cleans as instructed.
• I understand my part in maintenance includes 3-monthly examinations and preventive care, which are charged separately, and that if I don't attend I may be liable for the full cost of correcting problems that follow.
• I agree to the type of anaesthetic my clinician chooses, and I understand I must not drive or operate hazardous equipment for at least 24 hours if sedation is used, until I've fully recovered.
• I have given an accurate report of my physical and mental health and medical history, including any previous allergic or unusual reactions to drugs, foods, anaesthetics, or any abnormal bleeding.
• I understand that no guarantee or assurance has been given that treatment will be completely successful in function or appearance, and that dentistry is not an exact science.
• I have read the information above and had the chance to ask questions.
• The costs have been explained to me, and I can ask for a written quote before treatment starts.
• I understand I can change my mind at any time before treatment starts.
• I understand my clinician will go through this with me and confirm my consent in person on the day.

This form records that you have read and understood the information above. It is not consent to proceed — your clinician confirms consent with you in person before treatment begins, and you can withdraw at any time.