FAQ – common questions about periodontitis

The cost depends on the steps involved and on which teeth are affected, so it differs from patient to patient. Before treatment begins, the practice draws up a treatment and cost plan setting out the charges. It also shows which costs the statutory health insurer covers and which additional services you have to pay for yourself.

An implant can last many years – what matters is how healthy the surrounding tissue stays. Anyone who has had periodontitis carries a higher risk: the same bacteria can attack the tissue around an implant. This is known as peri-implantitis.

Periodontitis should therefore be fully treated before an implant is placed. After that, aftercare decides the outcome: regular check-ups, professional cleaning and careful oral hygiene at home. On those terms, implants remain a reliable solution even after periodontitis.

Follow your dentist's instructions closely. They will tell you exactly what to watch out for.

A single application of enamel matrix proteins is normally sufficient. The regenerative process they set in motion continues over a longer period – often for more than a year.

Consistent oral hygiene is the key. Your practitioner will tell you whether further rules apply in your case – cutting down on smoking or giving it up, for instance.

Periodontal disease is usually caused by bacteria that settle between tooth and gum and trigger an inflammation. Existing systemic conditions such as diabetes, stress or inadequate oral hygiene can also influence how the disease progresses.

The first signs of periodontal disease are red, swollen gums, bleeding gums, receding gums, pain in the teeth and gums, loosened teeth, a bad taste in the mouth and bad breath.

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Bleeding gums can be a sign of periodontal disease. If it happens regularly, for example when brushing, you should consult your dentist.

During the active phase of treatment your dentist sets the intervals between appointments; depending on the stage of the disease these can be close together. Even without periodontal disease you should attend a check-up once or twice a year.

Detected in time, the progress of periodontal disease and the loss of one or more teeth can be prevented in most cases. If a tooth is already damaged beyond saving, removal is often the only option.

Connections exist with diabetes mellitus in particular, where poorly controlled blood sugar is a risk factor. Caries, stress or a generally weakened immune system can also encourage periodontitis. Periodontitis is in turn considered a risk factor for heart disease, for the premature birth of underweight babies and for arthritis. Hormonal changes during pregnancy can likewise trigger periodontal disease.

Gingivitis can be treated by improved and consistent oral hygiene. If gum problems persist, a dentist should always be consulted.

Depending on how far the periodontal disease has advanced and on the wish to keep the affected tooth, a surgical procedure may be unavoidable. Your dentist will tell you whether it is necessary in your case.

Yes, periodontitis can be transmitted – for example by sharing a toothbrush or cutlery, or by moistening a dummy in your own mouth.

Recent studies have shown that tissue rebuilt with the help of enamel matrix proteins was still stable after five years.

In the worst case, untreated periodontal disease leads to the loss of the affected tooth or teeth.

The bacteria that trigger it can be transmitted, through saliva for example. Whether that turns into disease depends on the immune situation, oral hygiene and hereditary factors. Periodontitis is not contagious in the strict sense.

As a rule, no. That is its most dangerous property: the bone breaks down over years without pain to warn. It is often noticed only when teeth become loose or the gums visibly recede.

Partly. With certain defect shapes, regenerative procedures can rebuild bone and supporting tissue. Where the loss is horizontal across many teeth this is not possible; there the aim is to hold the situation stable.

With careful cleaning, usually within one to two weeks. If the bleeding lasts longer, the periodontium should be examined.

No, the opposite is right. The bleeding comes from the inflammation, not from the brushing. It is precisely the inflamed areas that need thorough but gentle cleaning.

No. Gingivitis can heal completely. If it persists over a long period, however, it can spread to the bone – and that step is no longer reversible.

Gingivitis affects only the gum and heals completely. Periodontitis has reached the bone; what is lost there does not return by itself.

Most commonly from middle age onwards, but there are also early and rapidly progressing forms in young people. What matters is not the age but how quickly the supporting tissue is lost.

A dentist with a declared focus or an additional qualification in periodontology. In Germany the term is not a protected specialist title; ask what kind of qualification is meant.

There is no general answer. In some people it remains gingivitis for years; in others the inflammation reaches the bone within months. Smoking, diabetes and a hereditary predisposition speed up the course.

By exposed tooth necks, teeth that look longer, persistent bad breath and later by teeth that move. The only reliable sign is the measurement of pocket depths at the practice.

Yes. In most people it can be brought to a standstill. What cannot be reversed is the bone loss that has already occurred – which is why every month of earlier treatment counts.

No. The probe is guided gently into the gum sulcus. Where the gum is severely inflamed it can be sensitive; the examination takes only a few minutes.

German statutory health insurers cover the assessment every two years as part of the routine check-up.

Code 3 stands for shallower, code 4 for deep periodontal pockets. Both mean treatment is required; with code 4 a detailed periodontal assessment follows, with measurements at every tooth.

The findings are recorded: pocket depths are measured at every tooth, the tendency to bleed is assessed and the medical history is taken. A conversation about smoking, existing conditions and home oral hygiene belongs to it.

Bring a list of your medication and mention any known conditions, particularly diabetes, cardiovascular disease and blood thinners. That affects the planning.

The cleaning itself takes one to two sessions, depending on the extent. Weeks lie between the steps in which the tissue heals. Reckon with several months overall – the aftercare then continues permanently.

Six sites are probed at every tooth: the depth of the periodontal pocket, bleeding on probing and the loss of attachment. Degrees of mobility are added, and radiographs where needed.

The probe measures the soft tissue. How much bone has actually been lost, and whether the loss is horizontal or funnel-shaped, is shown only by the radiograph – and that determines which procedures come into consideration.

A laboratory analysis of the bacteria from the pocket. It comes into consideration where the disease progresses despite good oral hygiene, or where a decision about accompanying antibiotics has to be made – not as a routine.

The root surfaces below the gum margin are freed of deposits and calculus – with hand instruments and ultrasound, under local anaesthetic. This is the core of periodontal treatment.

In the first few days the teeth can react sensitively to cold and heat, and the gums can ache slightly. Both subside. Exposed tooth necks sometimes stay sensitive for longer; varnishes and pastes help there.

The swelling subsides and the gum reattaches to the tooth. What was previously puffed up by the inflammation now visibly shrinks. That is a sign of healing, even if it is disconcerting at first.

With pocket depths up to about five millimetres, as a rule yes. If deeper pockets remain afterwards, a surgical step is considered.

Usually not. The mechanical cleaning is the treatment; an antibiotic is added only in certain cases, for instance in rapidly progressing forms. It never replaces the cleaning.

In the closed approach the cleaning is done without an incision, guided by touch. In the open approach the gum is folded back so that the root can be cleaned under direct view and the bone assessed.

When pockets remain after the non-surgical treatment that can neither be cleaned nor recede on their own. The procedure creates access and shapes the bone so that the site becomes maintainable again.

The wound closes within one to two weeks; sutures are usually removed after seven to ten days. Several months pass before the tissue has finally matured.

German statutory insurance covers the surgical step where it is justified after re-evaluation. Regenerative extras such as membranes or substitute materials often have to be paid privately – ask for that in writing beforehand.

Soft, lukewarm food for the first few days. Avoid anything hot, spicy, grainy and alcohol. Chew on the other side while the wound is still tender.

Not the wound itself at first. All other teeth continue to be brushed normally – especially now. For the wound area the practice provides a rinse or gel and says when brushing may resume.

If bleeding does not stop after ten minutes of pressure with a clean cloth, if swelling increases after the third day, with fever, or if the pain grows stronger rather than weaker.

With healthy gums, once or twice a year. After periodontal treatment more often – how often depends on the risk and is determined at the practice.

For the smooth surfaces, yes. No toothbrush reaches the spaces between the teeth and anything below the gum margin – and that is exactly where periodontitis begins.

Brush twice a day, clean between the teeth once a day, do not smoke, and have conditions such as diabetes well controlled. And keep the check-up appointments, even when nothing hurts.

It is a private service billed according to the work involved; the range is usually in the low three figures. Some insurers give a subsidy. Ask for the amount beforehand.

Usually not. With exposed tooth necks or inflamed gums it can be sensitive; say so, and the work will be gentler or done under local anaesthetic.

Only as white as they are without discolouration. Deposits from coffee, tea and tobacco are removed; the tooth's own colour does not change. That would require bleaching, which presupposes healthy gums.

The systematic periodontal treatment including preparatory steps, cleaning, re-evaluation and supportive aftercare, where the findings justify it. The application is made before treatment begins.

As a rule the professional cleaning outside the regulated aftercare, plus additional procedures such as regenerative materials, lasers or bacterial tests. These belong in a written cost plan beforehand.

The comparison is simple: the treatment costs once, a lost tooth costs many times that to replace – and permanently, since a restoration also has to be maintained and eventually renewed.

No. Receded gum does not return on its own. With a graft it can be rebuilt in many places – how completely depends on the tissue between the teeth.

Usually from the patient's own palate. Alternatively there are substitute materials that the body replaces with its own tissue during healing, which avoids the second wound.

As a rule no. Gum reconstruction is mostly regarded as aesthetically motivated and billed privately. With pronounced functional impairment that can differ – the practice clarifies this beforehand.

No. The tissue between the teeth is decisive. Where it is intact (Miller I and II), complete coverage can be expected. Where it is lost, only partial coverage remains.

The wound heals in one to two weeks. Several months pass before colour and shape have evened out – do not judge the result after a fortnight.

Yes, if the cause remains. Brushing too hard, an unfavourable tooth position or untreated inflammation lead to renewed recession. That is why coverage always includes the question of where it came from.

Colloquially yes, technically no. “Periodontosis” once described recession without inflammation. Almost always, however, there is inflammation – and that is called periodontitis. The term periodontosis is regarded as obsolete today.

Because it has become established. Findings and treatment plans today say periodontitis, with stage and grade. When you hear “periodontosis”, the same thing is almost always meant.

An organised community of bacteria that attaches to the tooth surface with a protective layer of its own. Within that layer the bacteria are largely shielded from rinses and antibiotics.

It reaches the surface of the biofilm, not its interior. A biofilm has to be disrupted mechanically – by brush, interdental brush or the instruments at the practice. Rinses are a supplement, not a substitute.

Recolonisation begins within hours; after one to two days the biofilm is organised again. That is why doing it daily matters more than the thoroughness of any single cleaning.

Usually 45 to 60 minutes, depending on the dentition and the extent of the deposits.

The cleaning slightly roughens the surface, and bacteria settle faster on rough spots. Polishing smooths it and thereby delays the next deposit.

After the fluoride varnish you should wait about an hour so that it can take effect. After that there is no restriction; it is better to avoid strongly coloured drinks on the first day.

Many German statutory insurers give a subsidy or reimburse part of it through bonus programmes. The amount differs from insurer to insurer – ask there before you make the appointment.

Billing follows the work involved: number of teeth, amount and hardness of the deposits, methods used. A dentition with few teeth and little calculus costs less than a complete one with firm deposits.

No. During supportive periodontal therapy the aftercare is covered by statutory insurance as long as it runs within the defined framework. Afterwards it becomes a private service again.

To bring the inflammation to a standstill, to reduce the pockets far enough that they can be cleaned, and to keep the tooth. A dentition as before the disease is not the aim and usually not possible.

By pocket depths that are lower at re-measurement and above all by probing that no longer bleeds. The absence of bleeding is regarded as the best sign of a stable situation.

That depends on the findings. Severely loosened teeth with far-advanced bone loss sometimes cannot be kept. The treatment plan states in advance which teeth are regarded as questionable.

With funnel-shaped bone defects bounded by several walls. Where the bone loss is horizontal across many teeth, rebuilding is not possible.

Depending on the defect: membranes, bone substitute material or enamel matrix proteins, alone or combined. What makes sense in an individual case is decided by the shape of the defect – not by a wish for the newest material.

A gain in attachment is well documented for suitable defects, but not guaranteed. Smoking, inadequate oral hygiene and persisting inflammation markedly worsen the prospects.

As a reference on treatments, procedures and terms that come up in connection with the periodontium – from prevention through paediatric dentistry to aesthetics.

No. The texts explain what exists and what matters. Which treatment is right in your case can only be said after an examination.

From the patient's own bone, from human donor bone supplied by a tissue bank, from animal material or from purely synthetic substances. All are remodelled or resorbed by the body over months.

Donor and animal materials go through standardised processing and sterilisation and are subject to medicinal-product or medical-device supervision. Ask the practice which material is planned – its origin belongs in the consultation.

In periodontal surgery usually not. Substitute materials and membranes are mostly regarded as a private extra and therefore belong in a written cost plan beforehand.

The work is done under loupes or an operating microscope with finer instruments and thinner suture material. The incisions are smaller and the tissue is stretched less.

Smaller wounds and more precise wound edges favour healing; swelling and discomfort are usually less. A better result is therefore more likely, but not guaranteed – oral hygiene and giving up smoking weigh more heavily.

Not when used correctly. The powder is decisive: for the periodontal pocket and exposed roots, fine glycine-based powders are used, which are considerably softer than classic sodium bicarbonate.

With acute respiratory inflammation, with certain conditions requiring a low-salt diet and with open wounds in the treatment area. Mention existing conditions before the session.