Periodontitis can’t be fully reversed once bone loss has occurred, but it can be effectively treated and stabilized. The goal of treatment is to stop the disease from progressing, reduce pocket depth around your teeth, and in some cases regenerate lost bone. Nearly half of American adults over 30 have some form of periodontitis, and that number climbs to about 70% for adults over 65. The good news: a clear, well-established treatment path exists, and most people respond well to it.
What “Fixing” Periodontitis Actually Means
Periodontitis destroys the bone and connective tissue that hold your teeth in place. Unlike gingivitis, which is fully reversible, the bone loss from periodontitis doesn’t simply grow back on its own. Treatment focuses on halting the destruction, shrinking the infected pockets between your gums and teeth, and creating conditions where your body can heal. In certain cases, regenerative procedures can rebuild some of what was lost, but the realistic expectation for most people is long-term management and stability rather than a complete return to the original state.
Think of it like managing a chronic condition. Active treatment gets things under control, and ongoing maintenance keeps them there.
Scaling and Root Planing: The First Step
The foundation of periodontitis treatment is a deep cleaning called scaling and root planing. This goes well beyond a regular dental cleaning. Your dentist or hygienist uses instruments to remove bacterial plaque and hardened tarite (calculus) from below the gumline, then smooths the root surfaces so your gums can reattach more tightly to the tooth.
Clinical trials consistently show this works. Across multiple studies, scaling and root planing significantly reduced pocket depth and improved the attachment of gum tissue to the tooth compared to oral hygiene instruction alone. One large review of 11 trials found an average gain of about 0.5 mm in clinical attachment level measured at least six months after treatment. That may sound small, but in periodontal terms it represents meaningful disease stabilization. Studies also showed a significant decrease in the proportion of sites with deep pockets (greater than 4 or 5 mm), with the overall distribution shifting toward healthier, shallower depths.
The procedure is typically done in two to four visits, with local anesthesia to keep you comfortable. Your gums may feel tender for a few days afterward, and some sensitivity to hot or cold is normal as healing progresses.
Localized Antibiotics as an Add-On
For pockets that need extra help, your dentist may place a slow-release antibiotic directly into the space between gum and tooth after scaling and root planing. These tiny particles sit in the pocket and release medication over days, targeting the specific bacteria driving the infection.
Adding localized antibiotics to scaling and root planing reduces pocket depth, bleeding, and the number of deep pockets significantly more than deep cleaning alone. In one trial of 127 patients with moderate to advanced periodontitis, the combination treatment outperformed scaling and root planing on every clinical measure at 30 days. The improvements correlated directly with reductions in the most harmful periodontal bacteria.
The Re-Evaluation at 6 to 8 Weeks
About six to eight weeks after scaling and root planing, your dentist will reassess your gums. This re-evaluation checks for persistent inflammation, pocket depths that haven’t improved, continued attachment loss, recession, or worsening tooth mobility. It determines whether non-surgical treatment was enough or whether you need the next level of care.
The general guideline: pockets of 5 mm or less at re-evaluation can continue to be managed without surgery. Sites still measuring 6 mm or deeper will likely benefit from a surgical approach.
When Surgery Becomes Necessary
If deep pockets persist after non-surgical treatment, periodontal surgery gives your dentist direct access to clean infected root surfaces and reshape damaged bone. The most common type is flap surgery, where the gum tissue is gently lifted back, the underlying area is thoroughly cleaned, and the tissue is repositioned to fit more snugly around the teeth. This eliminates the deep pockets where bacteria thrive.
For teeth with significant bone loss, regenerative procedures can promote regrowth of lost bone, connective tissue, and the root-covering layer called cementum. Bone grafting materials are placed into the defect, sometimes combined with a barrier membrane that guides tissue to grow back in the right direction. This technique, called guided tissue regeneration, has shown clinical success in roughly 90% of vertical bone defects, with patients gaining several millimeters of attachment. Results are best in deep, narrow bone defects rather than broad, shallow ones.
Various graft materials produce similar outcomes. Your periodontist may use bone harvested from another site in your own mouth, processed donor bone, animal-derived material, or synthetic substitutes. The choice depends on the size and shape of the defect and your periodontist’s preference.
Laser Treatment: An Alternative Option
Laser-assisted periodontal treatment has gained popularity as a less invasive alternative to traditional surgery. The laser selectively removes diseased tissue and bacteria from the pocket while leaving healthy tissue intact, and it stimulates a blood clot that promotes healing.
In clinical comparisons, laser treatment reduced pocket depth by about 44% compared to 39.5% for scaling and root planing alone. Plaque levels dropped by nearly 97% with laser treatment versus 90% with deep cleaning, and bleeding decreased by about 93% versus 88%. However, these differences were not statistically significant. Both approaches produced excellent results at six weeks, and neither clearly outperformed the other by a meaningful margin.
Laser treatment tends to involve less post-operative discomfort and faster recovery. It can be a good option if you’re anxious about traditional surgery, though it may not be covered by all insurance plans.
Why Smoking Changes Everything
If you smoke, your treatment is significantly less likely to succeed long-term. A six-year study following patients after active periodontal therapy found that periodontitis recurred in 44% of nonsmokers, 68% of former smokers, and 80% of current smokers. Current smokers had nearly six times the odds of recurrence compared to nonsmokers.
Smoking restricts blood flow to the gums, slows healing, and weakens your immune response to the bacteria causing the disease. Quitting won’t erase past damage, but it dramatically improves your odds of keeping periodontitis stable after treatment. Former smokers still face elevated risk compared to people who never smoked, but their outcomes are substantially better than those who continue.
Long-Term Maintenance After Treatment
Periodontitis is a chronic condition, and active treatment is only the beginning. Without regular maintenance, the disease will almost certainly return. The American Academy of Periodontology recommends that most patients with a history of periodontitis start with cleanings every three months, with evidence that this frequency reduces the likelihood of disease progression compared to less frequent visits.
That said, there’s no single maintenance schedule that works for everyone. Published recommendations range from every two months to every six months, depending on how severe your disease was, how well you responded to treatment, and your individual risk factors. Your periodontist will tailor the interval based on how your gums look at each visit, and the schedule may loosen over time if things remain stable.
Between appointments, thorough daily cleaning at home is non-negotiable. Brushing twice a day, cleaning between teeth with floss or interdental brushes, and potentially using an antimicrobial rinse all help keep bacterial levels low enough that your immune system can manage what remains. Periodontitis started because bacterial buildup outpaced your body’s ability to fight it. Maintenance, both professional and at home, is how you keep that balance tipped in your favor.