Oral Health›Dental visits and treatments

Gum Disease Treatment: What Happens at Each Stage

Treatment for gum disease moves in steps, from better cleaning and a professional clean to deep cleaning below the gumline, sometimes surgery, and lifelong maintenance. Here is what each step involves and how you may feel afterwards.

Updated September 2026·By the OHA editorial team·9 min read·How we write
Key takeaways
  • Treatment starts with better cleaning at home, help to stop smoking if you smoke, and a professional clean to remove plaque and tartar (hardened plaque).
  • For periodontitis, a deep clean below the gumline is usually done under local anaesthetic, often over more than one visit.
  • Afterwards your gums may shrink back and your teeth may feel sensitive. UK sources say this happens as the gums heal.
  • Gum surgery is only considered for pockets that remain after deep cleaning, and usually only when cleaning at home is very good.
  • Periodontitis needs lifelong care: regular reviews and cleans, often every 3 months at first, and careful cleaning every day.

Our guide to gum disease explains what gingivitis and periodontitis are and how to spot them. This article covers what happens next: the treatment steps, recovery and the care that follows. The NHS says how gum disease is treated depends on how severe it is.

Who will treat me?

The British Society of Periodontology (BSP), a UK professional society, says most cases can be successfully treated by your dentist, and that occasionally more complex treatment is needed. The Australian Dental Association says a dentist, dental hygienist or oral health therapist may clean your teeth.

You may be referred to a periodontist, a dentist who specialises in gum disease. The American Academy of Periodontology (AAP) says periodontists have three extra years of training after dental school, and that some general dentists treat less serious cases but refer more challenging ones. In the UK, the BSP says the usual route to a specialist is referral by your dentist, and that you can ask to be referred from the start.

Step 1: getting the basics right

The BSP's UK treatment guidelines set out four steps. The first covers understanding the disease, better cleaning, reducing risk factors such as smoking and poorly controlled diabetes, and a professional clean. For early gum disease, the NHS says your dentist will give you advice on keeping your teeth clean, such as using interdental brushes, advise you to stop smoking, and advise you to have your teeth cleaned by a hygienist.

A scale and polish removes plaque, tartar and debris from the tooth surface above the gumline, using ultrasonic (vibrating) and hand instruments, as University Hospitals of Leicester NHS Trust describes it (see dental check-ups). The same trust says bleeding gums are a sign the gums are not clean enough, and that with good cleaning the bleeding should stop within 2 weeks.

Step 2: deep cleaning below the gumline

If you have periodontitis, plaque and tartar sit in pockets (spaces) between the gums and the roots. Cleaning them out has several names: root surface debridement in the UK, scaling and root planing in the US, or simply a deep clean.

  • What happens. Leicester's leaflet says plaque, tartar and debris are removed from the root surface below the gumline with ultrasonic and hand instruments. The AAP adds that the root is smoothed to help stop plaque and bacterial toxins sticking to it.
  • Numbing. The BSP says it is best done under local anaesthetic (an injection that numbs the area while you stay awake) to avoid discomfort and allow thorough cleaning.
  • How long. Leicester says it can take up to 2 hours, often over 2 visits.

While you are numb, Leicester advises care with eating and drinking, as you can bite your lips and cheeks or burn your mouth.

How will my mouth feel afterwards?

The BSP lists changes you may notice as the gums heal and the pockets shrink:

  • teeth more sensitive to hot, cold or sweet food and drink
  • a higher chance of decay on the exposed roots
  • teeth that feel a little looser for a while
  • gums shrinking back, so the teeth look longer
  • small dark triangles between the teeth where gum has been lost

Leicester says this gum shrinkage is a sign the gums are becoming healthier. For sensitivity, it suggests rubbing a little fluoride toothpaste onto the sensitive roots, spitting out the excess and not rinsing; over several months the teeth should become less sensitive. See tooth sensitivity and receding gums.

Checking it has worked

The BSP guidelines say your gums should be re-checked about 3 months later. Pockets of 4 to 5 millimetres that remain may be cleaned again. For deep pockets of 6 millimetres or more, the guidelines suggest considering referral for surgery.

Antibiotics and antiseptic mouthwashes

The NHS says serious gum disease may need antibiotics. The US Centers for Disease Control and Prevention (CDC) lists prescribed medicine such as a mouth rinse, or medicine placed directly under the affected gums.

Antibiotics taken by mouth are not routine. In the BSP guidelines, the decision to add them is for practitioners accredited for more complex gum care. A 2020 Cochrane review of 45 studies involving 2,664 adults could not tell whether adding antibiotics to professional cleaning reduces gum disease in the long term, because confidence in the evidence was very low. The most common side effects reported were temporary stomach upsets, such as nausea, vomiting, diarrhoea or a metallic taste, and no studies looked at antibiotic resistance.

For antiseptic mouthwash, the UK's Delivering Better Oral Health guidance for dental teams, issued with NHS England, says there is high-certainty evidence that chlorhexidine reduces plaque and gum inflammation. Because longer use can stain teeth, change taste and make the mouth sore, it advises short-term use. See mouthwash: do you need it?

Step 3: gum surgery

Leicester's leaflet says that if pockets remain after deep cleaning, surgery lets the dentist reach the root surface directly, and is not normally considered unless your cleaning at home is excellent. Leeds Teaching Hospitals NHS Trust says it is done under local anaesthetic, you can go home straight afterwards, and it is not usually suitable if you smoke.

The main types described by Leeds and the AAP are:

  • Open flap surgery: the gum is folded back, the root is cleaned and the gum is stitched back in place.
  • Regenerative surgery: similar, but it aims to regrow some lost bone and gum attachment. Leeds says whether this is possible depends on the shape of the bone loss, and that some materials used come from animals, which you can discuss with your dentist.
  • Gum grafts: gum from the roof of the mouth covers exposed roots or strengthens thin gum (see receding gums).

Leeds says the appointment can take up to three hours, and suggests having someone collect you and avoiding vigorous exercise and alcohol for 24 hours. You may be asked not to brush the treated area until the stitches are out, and given chlorhexidine mouthwash instead. Common risks include pain, bleeding, swelling, bruising, gum recession, sensitivity that usually settles within weeks, and the surgery not working.

The NHS says some people with serious gum disease need some teeth removed. See replacing missing teeth.

Step 4: maintenance for life

Delivering Better Oral Health says periodontitis will come back and get worse without good plaque control, so ongoing supportive care is a long-term commitment.

How often you go back varies: every 3 to 12 months, tailored to you, in the BSP guidelines. The BSP patient leaflet and Leicester both say every 3 months is likely, at least at first.

On NHS charges in England, the NHS says scaling is usually Band 1 and extensive gum treatment may be Band 2; the NHS Business Services Authority says treatment such as root planing is always Band 2. See dental costs and help.

What you do at home

The BSP leaflet says treatment will not succeed without very good daily cleaning, which may take up to 20 minutes twice a day. The NHS advises:

  1. Brush with fluoride toothpaste at least twice a day. Spit, do not rinse.
  2. Clean between your teeth every day with floss or interdental brushes.
  3. Do not smoke.

The US National Institute of Dental and Craniofacial Research says tobacco can delay healing and make treatment less successful. Delivering Better Oral Health says people with diabetes are less likely to benefit from treatment if their diabetes is not well controlled. See how to brush your teeth, cleaning between your teeth, smoking, vaping and oral health and diabetes and oral health.

When to see a dentist
  • Your gums keep bleeding even though you are cleaning carefully.
  • Sensitivity after treatment is not settling over the following weeks.
  • A tooth feels looser, or a treated area gets more painful rather than less.
Get help urgently
  • Ask for an urgent dental appointment if you have gum disease with very sore and swollen gums, teeth becoming loose or falling out, ulcers or red patches in your mouth, or a lump in your mouth or on your lip (NHS advice).
  • Gum disease can lead to a dental abscess. The NHS says to call 999 or go to A&E if you are finding it hard to breathe, speak or swallow, have a swollen or painful eye or sudden problems with your eyesight, have a lot of swelling in your mouth, or are finding it hard to open your mouth. Outside the UK, call your local emergency number.

Frequently asked questions

Does deep cleaning hurt?

It is usually done with local anaesthetic, which the BSP says is to avoid discomfort. Sensitivity afterwards is common; see the fluoride toothpaste tip above.

Why do my teeth look longer after treatment?

As the inflammation settles, the gums can shrink back. Leicester says this is a sign your gums are becoming healthier. The BSP says small gaps between the teeth may show where gum has been lost.

Will the lost bone grow back?

Mostly not. Delivering Better Oral Health says bone loss from periodontitis is largely irreversible. The AAP and Leeds say regenerative surgery can regrow some lost bone in suitable cases, depending on the shape of the bone loss.

Sources

  1. Gum disease, NHS, accessed September 2026
  2. Dental abscess, NHS, accessed September 2026
  3. What is included in each NHS dental band charge, NHS, accessed September 2026
  4. What band of treatment is periodontal treatment?, NHS Business Services Authority, accessed September 2026
  5. Gum disease (leaflet 400), University Hospitals of Leicester NHS Trust, accessed September 2026
  6. Periodontal surgery, Leeds Teaching Hospitals NHS Trust, accessed September 2026
  7. Delivering better oral health, chapter 5: periodontal diseases, Department of Health and Social Care and NHS England, accessed September 2026
  8. Delivering better oral health, chapter 2: summary guidance tables for dental teams, Department of Health and Social Care and NHS England, accessed September 2026
  9. Patient FAQs: periodontal disease and treatment, British Society of Periodontology and Implant Dentistry, accessed September 2026
  10. Periodontal information leaflet and consent form, British Society of Periodontology and Implant Dentistry, accessed September 2026
  11. BSP UK clinical practice guidelines for the treatment of periodontal diseases (flowchart), British Society of Periodontology and Implant Dentistry, accessed September 2026
  12. Professional teeth cleaning (factsheet), Australian Dental Association, accessed September 2026
  13. Non-surgical treatments, American Academy of Periodontology, accessed September 2026
  14. Surgical periodontal procedures, American Academy of Periodontology, accessed September 2026
  15. What is a periodontist?, American Academy of Periodontology, accessed September 2026
  16. Periodontal (gum) disease, NIH National Institute of Dental and Craniofacial Research, accessed September 2026
  17. Periodontal (gum) disease, Centers for Disease Control and Prevention, accessed September 2026
  18. What are the benefits and risks of using antibiotics as well as cleaning by a dental care professional to treat gum disease?, Cochrane (Khattri and others, 2020), accessed September 2026

This article is general information about oral health. It is not a diagnosis or a substitute for advice from a dentist or doctor who knows your situation. If you have pain, swelling, bleeding that does not settle, or a problem that is getting worse, see a dental professional. In an emergency, contact your local emergency service.

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