Treating periodontal disease starts with a professional deep cleaning and, depending on severity, may progress to antibiotic therapy, surgery, or laser treatment. About 42% of American adults over 30 have some form of periodontitis, and the rate climbs to nearly 60% for those 65 and older. The good news: with the right combination of professional care and daily home maintenance, the disease can be controlled and further bone loss prevented.
Deep Cleaning: The First Line of Treatment
For most people with periodontal disease, treatment begins with a procedure called scaling and root planing. This is more intensive than a standard dental cleaning. Your dentist or hygienist will numb your gums with local anesthesia, then use hand instruments or ultrasonic tools to remove plaque and tartar both above and below the gumline. The “root planing” part involves smoothing the surfaces of your tooth roots so bacteria have a harder time reattaching.
The procedure is typically done in two visits, one side of the mouth at a time, though some offices complete it in a single appointment. Afterward, your gums will feel sore for a few days and your teeth may be sensitive to hot and cold for a week or two. The goal is to reduce the depth of the pockets that have formed between your gums and teeth. Healthy gums sit in pockets of 3 millimeters or less. When those pockets deepen, bacteria colonize spaces your toothbrush can’t reach, and the infection progresses.
About six weeks after scaling and root planing, your dentist will re-measure your pocket depths to see how well your gums responded. If pockets have shrunk and bleeding has stopped, you’ll move into a maintenance schedule. If pockets remain deep or signs of active disease persist, additional treatment is needed.
Antibiotic Therapy for Stubborn Pockets
Sometimes deep cleaning alone isn’t enough to knock out the bacterial infection in certain pockets. In those cases, your dentist may place a localized antibiotic directly into the pocket. One common form uses tiny microspheres of antibiotic powder inserted below the gumline with a small cartridge. The medication dissolves slowly over days, delivering a concentrated dose right where the infection lives. This is typically used in pockets 5 millimeters or deeper that haven’t responded adequately to scaling and root planing alone.
Your dentist may also prescribe oral antibiotics after the deep cleaning procedure, particularly if the infection is widespread across multiple sites. Localized delivery tends to be preferred when only a few stubborn pockets remain, since it avoids exposing your whole body to antibiotics unnecessarily.
When Surgery Becomes Necessary
If non-surgical treatment doesn’t stabilize the disease, or if you already have significant bone loss when you’re first diagnosed, surgical options come into play.
Flap Surgery
In traditional flap surgery (also called osseous surgery), a periodontist cuts the gum tissue to fold it back, gaining direct access to the infected bone and deep pockets underneath. They remove bacteria, smooth damaged bone surfaces, and then suture the gums back into a tighter, healthier position around the teeth. Recovery typically takes one to two weeks, with some swelling and discomfort in the first few days.
Bone Grafting
When periodontal disease has destroyed the bone supporting your teeth, a bone graft can help rebuild what was lost. The graft material acts as a scaffold, encouraging your body to regenerate new bone in the area. Several types of graft material exist: bone harvested from another area of your own body, donor bone from a licensed tissue bank, animal-derived bone (commonly from cows), or synthetic lab-made substitutes. Your periodontist will choose the type based on the size and location of the bone defect. Bone grafts are often performed at the same time as flap surgery.
Laser Treatment
A newer alternative to traditional surgery is the Laser Assisted New Attachment Procedure, or LANAP. Instead of cutting gum tissue with a scalpel, a specialized laser targets and removes diseased tissue while leaving healthy tissue intact. The laser can distinguish between the two because diseased tissue is darker in color. It also kills bacteria in the treatment area and stimulates the growth of new gum and bone tissue.
The main advantage for patients is recovery. Without incisions and sutures, healing tends to be faster and less painful. The laser also encourages healthy gum tissue to reattach to the bone, which is the “new attachment” the procedure is named for. Not every dental office offers LANAP, and it may not be appropriate for all cases, so it’s worth asking your periodontist whether you’re a candidate.
What You Do at Home Matters Enormously
Professional treatment controls the acute infection, but what you do between appointments determines whether the disease stays in remission. The single most important habit is cleaning between your teeth daily. A University at Buffalo review of the evidence found that interdental brushes and water flossers outperformed other tools at reducing gum inflammation. Both should be used alongside regular toothbrushing.
Interdental brushes are small, bristled picks that slide between teeth to physically scrub the surfaces your toothbrush misses. They come in different sizes, and your dentist can recommend the right fit for your gaps. Water flossers use a pressurized stream of water to flush debris and bacteria from pockets and tight spaces. They’re especially helpful if you have dexterity issues that make string floss difficult, or if your pockets are still slightly deeper than ideal.
As for toothbrushes, electric models are popular, but research shows they’re no more effective at reducing plaque and gum inflammation than a manual toothbrush used properly. The technique matters more than the tool. Brush twice a day for two minutes, angling the bristles toward your gumline at about 45 degrees.
The Maintenance Schedule After Treatment
Periodontal disease can be treated but not cured in the traditional sense. The bacteria responsible never fully disappear, which means ongoing professional maintenance is essential to prevent relapse. For most people with a history of periodontitis, that means dental cleanings every three to four months rather than the standard six-month schedule. This tighter interval continues for the life of the affected teeth or for as long as you remain at elevated risk of further bone loss.
At each maintenance visit, your dental team will measure pocket depths, check for bleeding, and remove any new buildup of tartar below the gumline. If everything stays stable over time, and you have no additional risk factors like smoking or diabetes, your interval may eventually stretch to every six months. On the other hand, people who respond poorly to treatment or who smoke may need cleanings as often as every two months until stability is achieved.
If signs of active disease return at any point, you go back into active treatment rather than continuing on the maintenance track. Periodontal care is a long-term commitment, not a one-time fix.
Why Treatment Benefits More Than Your Mouth
Periodontal disease drives chronic, low-grade inflammation throughout the body. Treating it doesn’t just protect your teeth. One clinical trial found that people who received deep cleaning had significant reductions in C-reactive protein, a key marker of systemic inflammation, at both three and six months after treatment. Elevated C-reactive protein is linked to increased risk of heart disease, stroke, and complications from conditions like diabetes and metabolic syndrome.
The connection runs both directions. Uncontrolled diabetes makes periodontal disease harder to treat, and active periodontal disease makes blood sugar harder to control. Addressing the gum infection can break that cycle, which is why many physicians now coordinate with dental teams when managing patients with overlapping conditions. Smoking is the other major accelerator. It impairs blood flow to the gums, slows healing after procedures, and significantly increases the risk of disease progression even with treatment.