Gum Disease Treatment

Gum disease often starts without pain. Any of the following signs is a reason to see a dentist²:

• Gums that bleed when you brush or eat something hard
• Red, swollen or sore gums
• Bad breath that does not go away

Gums can also pull back from the teeth, so that the teeth look longer; recession can also happen without disease. In advanced disease, teeth can become loose or move out of place. Loose teeth need an urgent appointment (see "When should you see a dentist?").

Does a little bleeding mean disease?

The definition of healthy gums does not require that they never bleed. In a mouth considered healthy, bleeding can occur at fewer than 10 per cent³ of the points the dentist measures. Gingivitis is diagnosed when the bleeding points reach 10 per cent or more⁴. A single bleeding point is not a diagnosis. These percentages refer to points the dentist measures with a probe; they do not apply to bleeding you notice at home. Whether you have periodontitis is decided by also measuring pocket depth and the loss of supporting tissue. Even so, bleeding that keeps recurring when you brush should be checked.

The main cause is bacterial plaque that builds up on the tooth surface and along the gum line. Plaque that is not cleaned away hardens and turns into tartar⁵. The rough surface of tartar makes it easier for new plaque to stick.

• Smoking. In an analysis that pooled 14 prospective studies, the risk of periodontitis starting or getting worse was about 85 per cent higher⁶ in smokers. This is observational evidence. Smoking also weakens the response to treatment; stopping can prevent further deterioration³.
• Diabetes. Dental guidance advises assuming³ that anyone with diabetes has a higher risk of gum disease. Well-controlled diabetes is not counted as a risk factor on its own. But blood sugar control can change over time, so your dentist will ask about it.
• Some medicines. Medicines that cause a dry mouth, such as some antidepressants, and medicines that can cause gum enlargement. Gum enlargement is seen most often with calcium channel blockers, a group of blood pressure medicines.
• Pregnancy. Gums swell and bleed more easily in pregnancy; this is covered separately below.

The evidence on how stress, diet, weight and cannabis use affect gum disease is insufficient³.

How common is it?

In the United Kingdom, almost half of adults³ have some degree of irreversible periodontitis. Severe periodontitis affects about 10 in every 100 people³ in the world's population and is most common between the ages of 60 and 64.

When treatment is needed

• Anyone found to have gingivitis or periodontitis at an examination. How much treatment is needed depends on the stage of the disease.
• People with diabetes who have periodontitis. Gum treatment can also help blood sugar control; the details are in the risks and benefits section.

When treatment may not be needed, or another route is considered

• Receding gums without signs of disease. Recession is common in adults and increases with age. If there are no signs of disease, monitoring the receded area⁷ is considered the appropriate approach; not every recession needs an operation. If the recession is getting worse, if the root is sensitive, decayed or worn, or if the appearance bothers you, surgery may be considered⁷.
• Healthy gums. If your gums are healthy, you do not need a deep cleaning. Your dentist decides how often routine cleaning is done. More on this is on the deep cleaning and root planing page.
• Gum problems not linked to plaque. Some gum conditions usually do not clear up⁸ when plaque is cleaned away, and they can be a sign of a general illness. These need a separate assessment.

Tell your dentist before treatment

If you take a blood thinner or any other regular medicine, have diabetes or heart disease, or are pregnant, tell your dentist before treatment. Bring a written list of your medicines with you. Do not stop or change⁹ your blood thinner for dental treatment unless your doctor or dentist tells you to.

• Doing nothing. Gingivitis continues if hygiene does not improve, and it can progress to periodontitis. In periodontitis, the supporting tissue that has been lost largely does not grow back. For recession without signs of disease, monitoring is an option.
• Improving oral hygiene. This is the core treatment for gingivitis. Brushing and cleaning between the teeth are planned for you; risk factors such as smoking and diabetes are addressed.
• Professional cleaning (scale and polish). Plaque and tartar above the gum line are cleaned off. Tartar does not dissolve at home; it comes off only with a professional cleaning⁵.
• Deep cleaning (cleaning below the gum line, also called scaling and root planing). In periodontitis, plaque and tartar that have built up in the pockets below the gum are cleaned away. The details are on the deep cleaning and root planing page.
• Periodontal surgery. This is considered for pockets that stay deep after deep cleaning. Where the bone loss is suitable, regenerative surgery can also be done. See periodontal surgery.
• Gum graft. Tissue taken from elsewhere in the mouth, or a ready-made material, is placed to cover an exposed root surface.
• Extracting a tooth that cannot be saved. In advanced disease, some teeth may not be saveable. Which teeth can be kept is decided after the examination and measurements.
• Supportive care. After treatment for periodontitis, regular check-ups and cleaning are part of the treatment.

Whether surgery would help you is discussed once the pockets have been measured again at the re-assessment. Additional antibiotics or laser are not among the topics we give sources for on this page; if they are suggested, ask your dentist why.

Reshaping the gum line for appearance is a different treatment. It is described on the cosmetic gum contouring page.

The European Federation of Periodontology's guideline describes treatment for periodontitis in four steps¹⁰. After each step the gums are re-assessed to see whether the next one is needed. For gingivitis, treatment often stops at the first step. How many appointments you need is planned after the examination. Which steps can be done in Antalya, and which usually continue in the UK, is covered in "Treatment in Antalya, follow-up in the UK".

If it is not treated

• Loss of supporting tissue. As periodontitis progresses, the bone that holds the tooth breaks down; teeth can become loose and be lost. This loss is irreversible¹, but treatment can bring the disease under control.

Risks and side effects of treatment

• Sensitivity and gums that look receded. As the inflammation settles and the swelling goes down, the gum margin can sit lower. Exposed root surfaces can be sensitive to hot and cold. We cannot say on this page how often this happens. For dentine sensitivity, toothpastes containing stannous fluoride or arginine are recommended among the first options¹¹. This recommendation is based on studies of dentine sensitivity in general; it is not specific to the period after gum treatment.
• Air escaping into the tissues (emphysema, not the lung disease). Air escaping into the tissues during dental treatment is an infrequently reported complication¹². The case reports include tooth cleaning and air-polishing. Swelling that appears suddenly after treatment and crackles when touched should be checked straight away.
• Surgery and grafts. Like any surgical procedure, they can cause pain, swelling and bleeding. On a root surface covered with a graft, the gum margin can show a tendency to recede again over time¹³.
• Chlorhexidine mouthwash. It is used only for a short time. Used for 4 to 6 weeks, it can stain the teeth¹⁴; altered taste and irritation inside the mouth have also been reported.

Benefits

• Gum health can be restored⁸ with treatment, and periodontitis can be brought under control.
• In people with periodontitis and diabetes (mostly type 2), gum treatment lowered HbA1c by 0.43 percentage points on average¹⁵ at 3 to 4 months. HbA1c is the long-term measure of blood sugar. This result is based on 30 studies and 2,443 participants, and the certainty of the evidence is moderate. Gum treatment does not replace diabetes treatment.

Heart and blood vessel disease

A strong statistical association¹⁶ has been reported between periodontitis and heart and blood vessel disease. This is not evidence of cause and effect. There is not enough evidence to support or rule out the idea that gum treatment prevents heart attack or stroke.

Pregnancy

Bleeding gums are common in pregnancy. In an analysis that pooled 20 studies, gum bleeding was found at examination in about 67 in every 100¹⁷ pregnant women. Gum treatment in pregnancy is safe and improves the condition of the gums¹⁸. The American College of Obstetricians and Gynecologists also considers dental treatment safe¹⁹ in pregnancy, including examinations, dental X-rays and local anaesthetic. Putting treatment off can let problems grow. Guidelines differ²⁰ on whether a lead apron or thyroid collar is needed for dental X-rays in pregnancy.

Periodontitis is disease of the supporting tissue, not bleeding gums alone. In observational studies, periodontitis in pregnancy has been linked with a small increase in the risk of premature birth²¹. This link does not show that gum disease causes premature birth. Gum treatment has also not been shown to prevent premature birth. Across 11 studies of 5,671 pregnant women, no clear difference was found²² in the rate of premature birth. The quality of this evidence is low.

In the first days after a deep cleaning or surgery, the gums can be tender and bleed a little. Bleeding that does not stop, or pain and swelling that keep getting worse, are not normal; contact your dentist. For what to expect after a deep cleaning, see the deep cleaning page.

If you have had surgery or a graft, that area needs different care. Follow the written instructions your dentist gives you on when and how to brush it. Keep up your daily care in the rest of your mouth.

Daily care

• Brush your teeth at least twice a day with a fluoride toothpaste. After brushing, spit the toothpaste out and do not rinse² your mouth with water.
• For most people, a toothbrush with a small head and medium bristles²³ is suitable. Both electric and manual toothbrushes are effective at controlling plaque. Electric toothbrushes reduced plaque and gingivitis slightly more²⁴; the clinical importance of the difference is unclear.
• Clean between your teeth every day. Dental floss or interdental brushes, used in addition to brushing, may reduce²⁵ gingivitis and plaque; the certainty of the evidence is low. For people who have been treated for periodontitis, interdental brushes are recommended as the first choice¹⁰. Floss is an option where the brush does not fit.
• Use chlorhexidine mouthwash only if your dentist recommends it, and only for a short time.
• If you smoke, ask for support to stop.
• Keep going to the supportive care appointments your dentist sets. If you were treated in Antalya, these are usually with your own dentist or hygienist in the UK.

After treatment for periodontitis, gum health can be restored. But in someone who has been treated, the risk of the disease coming back remains increased⁸, and it needs close monitoring. The European guideline recommends a supportive care interval of at least 3 and at most 12 months¹⁰, depending on the person's risk. This interval is for people who have been treated for periodontitis; for healthy gums, your dentist sets the check-up interval separately.

Bone destroyed by periodontitis largely does not grow back. The aim of treatment is to stop the loss and keep the remaining teeth.

In 40 studies that followed treatment to cover exposed roots for at least 5 years, the gum margin tended to recede again over time¹³. How stable it stayed varied with the technique. After a graft, keep up your daily cleaning and go to your follow-up appointments.

This matters if you are planning implants. Across 14 pooled studies, the rate of implant loss in people treated for periodontitis was about 1.75 times that²⁶ of people without this history. This figure comes from published studies, not from our own records. This is why regular care matters after an implant too. More on dental implants.

See a dentist if you have any of the following:

• Gums that bleed when you brush or eat hard food
• Sore or swollen gums
• Bad breath that does not go away
• Your child's gums are sore and bleeding

Get an urgent appointment² if:

• Your gums are very painful and swollen
• Your teeth are loose or falling out
• You have ulcers or red patches in your mouth, or a lump in your mouth or on your lip

If you do not have a dentist, the NHS in England says to call 111 or get help from 111 online²⁷. The same applies if you cannot get an emergency appointment.

Swelling that appears suddenly after dental treatment and crackles when touched should be checked without waiting¹². If you cannot reach your dentist straight away, see a dentist where you are or go to an emergency department.

Emergencies. The following need urgent medical help²⁷. Do not wait for a dental appointment or for the clinic's reply. In the UK, call 999 or go to A&E. In Turkey, the emergency number is 112.

• Swelling that makes it hard to breathe, speak or swallow
• Swelling of the eye or the neck²⁸, a painful eye, or sudden problems with your eyesight
• A lot of swelling inside the mouth
• Finding it hard to open your mouth

Before you fly home

Make sure you have a written record of what was done in which areas, with the pocket measurements and any X-rays, and written care instructions. Know when your re-assessment is due and who will carry it out. If you have had surgery or a graft, check that you know how to clean that area. Know whom to ask about it, too. Ask whether the area will be checked, and any stitches removed, before you fly.

Once you are back in the UK

If a problem comes up that is not urgent, write to the clinic and send photographs. For anything that needs someone to look in your mouth, see your own dentist in the UK. If you have no dentist, use NHS 111 as described above. In the emergencies above, do not wait for a reply.

Your treatment is provided by our clinic in Antalya, Turkey, and carried out there by the clinic's dentists.

Periodontology, the branch of dentistry that deals with the gums, is one of the nine dental specialties set by law in Turkey²⁹. Turkish law ties the specialist title to a specialist certificate²⁹, issued and registered by the Ministry of Health³⁰. In the UK, a dentist may call themselves a specialist only if they are on the GDC's specialist list³¹. On this page, "your dentist" means the dentist who examines and treats you. "Your own dentist in the UK" means the dentist you see at home.

Ask who will examine you, measure your gums and carry out the cleaning, and who decides on any surgery. Ask what their titles are, where they qualified, and whether any of them holds a Ministry-registered specialist certificate in periodontology. Ask for the answers in writing.

Gum disease care is a course of treatment, not a single visit. Some of it can be done during a stay in Antalya. The re-assessment and the supportive care that follow usually continue after you are home, with your own dentist or hygienist in the UK. Agree how this will work before treatment starts.

What can be done in Antalya

Gum disease cannot be staged from photographs. The pockets and the loss of supporting tissue are measured at the examination, with X-rays if needed. The treatment plan follows from those measurements. The General Dental Council says you should be assessed by a qualified dentist before being given a treatment plan and cost estimate³². For gum treatment, that assessment is the examination in Antalya.

• Examination and measurement. The stage of the disease and your risk are established.
• Hygiene advice and a professional cleaning. For gingivitis, a professional cleaning and advice on home care may be all that is needed.
• Cleaning below the gum line (deep cleaning). For periodontitis, this may take more than one appointment.

What usually continues in the UK

• The re-assessment. It comes only once the gums have healed, so it usually falls after you have gone home. Plan it with your own dentist in the UK, or plan a return visit to Antalya.
• Any surgery. Surgery, if it is needed, is decided only at the re-assessment. So do not expect the cleaning, the re-assessment and any surgery to fit into one trip.
• Supportive care. Regular check-ups and cleaning continue at intervals set by your risk (see "Does the result last?"). After periodontitis, supportive care is part of the treatment, not an optional extra.

What to agree in writing before you start

Before you book, you receive a written preliminary plan with the appointments and how many days they need. It is based on what you send, such as recent X-rays or gum measurements from your own dentist, and it is not a diagnosis. The examination confirms or changes it, and with it the days and the cost. The number of days depends on the stage of the disease and on how many areas need treatment. It also depends on whether surgery or a graft is planned. Other treatment to follow, such as implants or crowns, changes it too; gum disease is usually treated before that work starts.

Ask for the plan to answer these questions:

1. Which steps will be done in Antalya, and which are expected to continue in the UK?
2. When is the re-assessment due, and who will carry it out: your own dentist in the UK, or the clinic on a return visit?
3. If the re-assessment shows that more cleaning or surgery is needed, who decides, and where would it be done?
4. Which records will you take home for your own dentist?
5. Which supportive care interval is recommended for you, and who will provide that care?

You can also ask a dentist in the UK for an independent opinion before you decide. Ask which treatment you need, and what having it in the UK would involve. After the examination in Antalya, you can still decide not to go ahead. You can say no, or ask to stop, at any stage.

Flying. We have found no guidance that sets a waiting time before flying after a professional or deep cleaning specifically. A 2023 review of flying after dental treatment suggests waiting about a week after most dental interventions³³. The authors note that the research is limited and comes mainly from military aviation. If you have had surgery or a graft, ask your dentist when you can fly. Treat the review as a starting point for that advice, not as a rule.

Your own dentist or hygienist

The General Dental Council suggests talking to your own dentist³² before you go. They need to know the plan, because the supportive care that follows is usually theirs. Ask them before you travel whether they will take it on, and what that care will cost. If you do not have a regular dentist, find one before you travel. The NHS lists exchanging medical records and arranging aftercare back home³⁴ among the things to consider before treatment abroad. National guidance in England (NICE) says the interval between check-ups should be set for each person according to their risk³⁵ and discussed with them.

Your records

Ask the clinic for a written record of the treatment to take back to your own dentist. It should show the stage of the disease and the pocket measurements taken in Antalya. It should also say what was done in which areas, and which supportive care interval is recommended for you. Ask for copies of any X-rays too. In Turkey, the health tourism regulation entitles international patients to an itemised bill. On request, they also get free copies of the records of the materials used, the tests and the imaging³⁶.

What the NHS does and does not do

In England and Wales, an NHS dental practice may accept you for a course of treatment, not only an urgent appointment. If it does, it provides clinically necessary treatment, with your consent³⁷. This means the treatment that every NHS dental contract must offer. Having been treated abroad does not change that. But the NHS rules on further treatment within 2 months, and on free repair or replacement, do not apply³⁷ to work that another provider did. The NHS also states that it is not liable for negligence or failure of treatment³⁴ when you have treatment abroad. On the NHS England routes that fund planned treatment abroad, you cannot get reimbursement for dental treatment³⁸.

The NHS guidance quoted on this page is for England, and for England and Wales where stated. Scotland and Northern Ireland have their own NHS rules, and we hold no source for them on this page. If you live there, check the local arrangements.

Travel insurance

The NHS says that most travel insurance policies will not cover you for planned treatment abroad, so you may need specialist cover³⁴. Tell your insurer about your plans. Before you book, ask whether anything linked to the treatment is covered, such as a complication or an extra trip.

The General Dental Council lists questions to ask before treatment abroad³². Below are most of them, with what this page can answer today and what to ask for in writing.

1. Who will carry out my treatment, and what are their qualifications? The treatment is provided by our clinic in Antalya, Turkey. Ask for the name of the dentist who will examine and treat you. Ask where they qualified and what their title is (see who carries out the treatment, above).
2. Are you regulated by a professional body and registered with it? In Turkey, a health facility needs an authorisation certificate³⁶ from the Ministry of Health to treat international patients. Authorised facilities appear in a register the Ministry publishes³⁹, so you can check it yourself. The authorisation belongs to the facility, not to the dentist, and it says nothing about the result of your treatment. Ask for the treating dentist's own registration details as well. See health tourism authorisation.
3. Will someone explain the treatment in my language? Ask who will explain the plan, the consent form and the aftercare instructions to you in English, and whether you get them in writing.
4. How often have you done this treatment, and what are your success and complication rates? The figures on this page come from published studies, not from the clinic's own results. Ask the clinic whether it keeps its own figures, and how they were collected.
5. Is the work guaranteed, and for how long? Gum treatment can bring the disease under control, but the disease can come back (see "Does the result last?"). This page makes no guarantee. Ask what the clinic's written terms cover, for example further cleaning if the re-assessment shows that pockets are still deep.
6. What happens if I am not happy with the result? For gum treatment, the result is judged at the re-assessment, when the pockets are measured again. Ask for the clinic's answer in writing.
7. What aftercare do you provide, and who can I contact after the treatment? Your written plan should say who carries out the re-assessment and the supportive care. It should also say whom to contact, how, and in which language.
8. If there are complications, who pays for further treatment, extra flights and the hotel? Ask for the answer in writing before you commit.
9. What happens if the examination shows that the planned treatment is not the right one for me? Ask in advance what you pay for the examination, and what happens to anything you have already paid.
10. Do you have a complaints system, and can I see a copy? Ask for it before treatment. The GDC says it cannot resolve complaints or help with refunds⁴⁰; its investigations concern the dentists on its own register. Turkish regulation makes the facility responsible for complications and medical malpractice arising after the health service it provided³⁶.
11. Do you have insurance to cover this treatment? In Turkey a facility treating international patients must take out complication insurance for surgical and interventional procedures carried out in an operating theatre³⁶. That does not by itself tell you whether your treatment is covered, so ask which procedures in your plan, if any, fall under it. Ask too, in writing, whether the clinic or the treating dentist holds insurance for complications or errors, what it covers and whom it protects.

The NHS names warning signs to think about before booking any treatment abroad. They are a hard sell, a lack of information, pressure to make a quick decision, no discussion of possible complications, and no mention of aftercare³⁸. Apply them to this clinic too.

This page does not give prices. Your treatment plan is prepared for you after the examination. The main factors that shape the plan are:

• The stage of the disease and how many areas need treatment
• Whether you need only a professional cleaning, a deep cleaning, or surgery or a graft
• X-rays, if needed
• The number of re-assessment and supportive care appointments, and whether they take place in Antalya or with your own dentist in the UK

Ask for the plan in writing, showing what is included and which procedures will be assessed separately. Ask too who pays for further treatment and extra travel if there is a complication.

If you are comparing with a plan from a UK practice, compare what each one includes, item by item.