General Dentistry · Periodontal Care · Last reviewed May 2026
Periodontitis: Stop the Bone Loss
Save Your Teeth.
Picasso Dental treats periodontitis in Vietnam with non-surgical deep cleaning, escalating to gum grafting (autograft or Alloderm) where indicated. Periodontitis is advanced gum disease that has already caused bone loss. Treatment manages it; treatment does not reverse it. Early intervention preserves teeth long-term.
What is Periodontitis?
Periodontitis is an advanced gum disease in which chronic plaque-driven inflammation has progressed beyond the gums to destroy the bone supporting the teeth. Pockets form between gum and root, harbouring bacteria that perpetuate the cycle of inflammation, attachment loss and bone destruction. Bone loss caused by periodontitis is permanent. Treatment focuses on halting progression, reducing pocket depths, and preserving the bone you still have.
Gingivitis vs Periodontitis
The two are not the same disease, and the distinction matters because one is fully reversible and the other is not. Diagnosis is decided after periodontal charting and X-rays, never from symptoms alone.
Gingivitis
Inflammation of the gums only. Bleeding when brushing or flossing, redness, mild swelling. No bone loss has occurred. Fully reversible with professional cleaning plus daily plaque control. The earliest stage, the cheapest to treat. See our gum treatment page for gingivitis pricing.
Periodontitis
Gingivitis that has progressed: bone loss has already occurred. Deeper pockets, attachment loss, eventual tooth mobility. Stoppable, not reversible. Requires ongoing 3-month maintenance for the life of the dentition. Without it, recurrence is the rule rather than the exception. This page covers periodontitis specifically.
Periodontitis Stages
The 2018 AAP/EFP classification stages periodontitis 4 based on percentage of bone loss, probing depths and tooth mobility. Stage drives treatment plan and prognosis.
Stage 1: Initial
Mild bone loss, less than 15%. Pockets typically 5mm. Manageable with non-surgical deep cleaning and 3-month maintenance. Best prognosis. Most patients stabilise here if treatment is started early.
Stage 2: Moderate
33% bone loss. Pockets 6mm. Treated with deep cleaning per quadrant or per jaw, sometimes with localised antibiotics for non-resolving sites. Good prognosis with disciplined maintenance.
Stage 3: Severe
More than 33% bone loss, pockets 6mm or deeper. Requires deep cleaning plus possible periodontal surgery (flap access, grafting). Tooth loss is possible despite treatment. Prognosis depends on remaining bone and patient compliance.
Stage 4: Advanced
Severe bone loss with significant tooth mobility, drifting, or already-lost teeth. May require extractions, surgical phases and prosthetic rehabilitation (implants, bridges, dentures). Specialist referral often warranted.
Why Picasso for Periodontitis
Probing-Depth Charting Before and After
Six-point pocket measurements around every tooth at baseline and again at the 6 week re-evaluation. The numbers tell you whether treatment worked. Without charting, periodontitis treatment is guesswork.
Ultrasonic Plus Manual Instrumentation
Ultrasonic scalers for bulk calculus removal, manual hand instruments for the fine root planing. Both are needed. Ultrasonic alone leaves residual deposits in the deepest pockets; manual alone is unnecessarily slow.
Escalation to Gum Grafting When Indicated
Where periodontitis has caused recession exposing root surfaces, soft-tissue grafting (autograft or Alloderm) rebuilds lost gum. We sequence grafting only after disease is controlled, never before.
3-Month Recall Protocol
Active periodontitis patients return every 3 months for maintenance, not 6. The interval is evidence-based: subgingival biofilm re-forms faster in periodontitis patients, and longer recalls correlate with disease recurrence.
No Overpromising of Regrowth
We do not market periodontitis treatment as a cure. Bone lost to periodontitis does not regrow predictably. Treatment halts active disease and reduces pocket depths. Anything more is sometimes possible in selected sites with regenerative grafting; it is not the rule.
Specialist Referral When Needed
Picasso does not have a registered periodontist. Cases needing surgical bone grafting in periodontal defects, guided tissue regeneration or rare aggressive periodontitis are referred to a hospital-based maxillofacial or periodontal specialist. We are transparent about scope.
Periodontitis Pricing
Per-tooth, per-quadrant or per-jaw pricing depending on disease extent and number of affected sites. Quoted in writing after periodontal charting and X-rays, never on the phone.
Full pricing for deep cleaning, maintenance recalls, gum grafting and surgical phases is published on our cost guide.
How Deep Cleaning Works
Five steps from charting to re-probing. Most cases stabilise after the non-surgical phase plus disciplined maintenance.
Charting + X-Ray
Six-point pocket-depth charting per tooth, bleeding-on-probing index, recession measurements, X-ray review to confirm bone loss pattern.
Day 1 · 60 minUltrasonic Deep Scaling
Where pockets exceed 5mm, ultrasonic scaling under local anaesthetic removes subgingival calculus and biofilm from root surfaces.
Per quadrantManual Root Planing
Hand instruments smooth and detoxify root surfaces inside the pockets, removing residual deposits the ultrasonic cannot reach.
Same visitPolishing
Soft-tissue management, polishing, plaque-control instruction with interdental brushes calibrated to your pocket depths.
Same visitReview at 6 Weeks
Pockets re-charted. Resolved cases enter the 3-month maintenance phase. Non-resolving sites are escalated to surgical access or referral.
Week 6Symptoms of Periodontitis
If you recognise more than two of these, book a periodontal charting appointment. Symptoms alone do not diagnose; pocket measurements and X-rays do.
Persistent Bleeding
Gums bleed when brushing or flossing and the bleeding does not stop after a week or two of careful hygiene. Bleeding is the most reliable early sign of inflammation reaching the bone.
Gum Recession
Visible exposure of root surface. The gum line has retreated apically, often with sensitivity to cold. Recession can be from periodontitis, over-aggressive brushing, or thin biotype.
Longer-Looking Teeth
Teeth appear longer than they used to in photographs, the classic visual of periodontal recession exposing more crown and root.
Pus from the Gum
Pus discharge from the gum margin, often when pressing on the gum, indicates active periodontal infection. Requires urgent assessment.
Loose Teeth
Mobility you can feel with your tongue or fingers. Mobility means significant bone loss has already occurred. Severely mobile teeth may not be saveable.
Bad Breath That Won't Go Away
Persistent halitosis that does not resolve with brushing, flossing or mouthwash. Subgingival bacterial activity in deep pockets is a common cause.
Food Impaction
Food repeatedly trapping in gaps between teeth or under the gum. Bone loss between teeth opens spaces (black triangles) that catch food.
Sensitivity from Exposed Roots
Sharp, brief pain to cold air, water or sweet foods on the exposed root surface. Roots are not protected by enamel and respond strongly to thermal change.
Risk Factors
Some you can change, some you cannot. We ask about all of them during charting because they shape both treatment plan and realistic prognosis.
Smoking
The single biggest modifiable risk factor. Smokers have roughly twice the failure rate after periodontal therapy. Reducing or quitting measurably improves outcomes within months.
Uncontrolled Diabetes
Hyperglycaemia drives gum inflammation and impairs healing. Patients with HbA1c above 7% respond significantly worse to treatment. We ask for diabetic control before elective surgical phases.
Family History
Aggressive periodontitis is partly genetic. A parent or sibling who lost teeth in their 30s or 40s to gum disease is a useful risk signal even if your hygiene is excellent.
Age
Periodontitis prevalence rises sharply with age. The CDC's NHANES data shows roughly 47% of US adults aged 30 plus have some form of periodontitis. Vietnamese epidemiology follows a similar pattern.
Hormonal Changes
Pregnancy, puberty and menopause can amplify gum inflammation in patients who already have a plaque problem. Hormones do not cause periodontitis, but they exaggerate its expression.
Certain Medications
Calcium-channel blockers, anti-epileptics (phenytoin) and ciclosporin can cause gum overgrowth that traps plaque. Disclose all medications during your medical history.
Poor Oral Hygiene
Inadequate plaque control allows the bacterial biofilm responsible for periodontitis to mature and colonise subgingival spaces. The bedrock risk factor; the one most under your control.
Stress
Chronic stress correlates with worse periodontal outcomes through behavioural pathways (worse hygiene, more smoking) and direct immune effects. Less actionable but worth naming.
What Treatment Cannot Do
Honest version. Treatment manages periodontitis. Treatment does not cure it. We tell you this before you commit, not after.
It Will Not Regrow Bone
Deep cleaning halts active disease and reduces pocket depths as inflammation resolves, but the bone you have already lost does not grow back in most cases. Aim is preservation of remaining bone, not restoration.
It Will Not Save Every Tooth
Severely mobile teeth (Grade 3) with most of their bone support gone often cannot be saved long-term despite treatment. We tell you honestly when extraction plus an implant is the better long-term answer.
It Is Not a One-Time Fix
Without 3-month maintenance recalls, recurrence is the rule rather than the exception. Periodontitis is controlled, not cured. The active phase is weeks; the maintenance phase is the rest of your life.
Regenerative Grafting Is Selective
Bone regeneration is sometimes possible with surgical bone grafting in specific defect shapes (intrabony, contained), placed by a periodontal specialist. It is not a default offer; we refer when the defect anatomy makes it worth the cost.
Aftercare and Maintenance
3-Month Recall Standard
Active periodontitis patients return every 3 months for maintenance scaling and re-charting, not the 6-month interval used for healthy patients. Subgingival biofilm re-forms faster in periodontitis patients, and longer intervals correlate with attachment loss.
Maintenance scaling is priced by extent; see our cost guide.
Home Care Is Mandatory
Interdental brushes sized to each gap, not floss alone, the spaces left after pocket reduction are too wide for floss to clean effectively.
Smoking cessation or reduction strongly recommended. Heavy smokers respond markedly worse to treatment regardless of how good the clinical work is.
Diabetic control if relevant. HbA1c under 7% is the practical target before elective surgical phases.
Risks & Honest Tradeoffs
Periodontitis treatment is among the most evidence-based procedures in dentistry. Here is what can go wrong and how we minimise the avoidable.
Post-Treatment Sensitivity
Exposed root surfaces react to thermal change for the first weeks after deep cleaning. Manage with desensitising toothpaste (potassium nitrate or stannous fluoride). Usually resolves within a month.
Gum Shrinkage
Inflamed gum tissue shrinks as the inflammation resolves, exposing more root surface. Cosmetically visible in front teeth (longer-looking teeth, black triangles). The visible change is the inflammation leaving, not the treatment damaging anything.
Some Teeth Still Lost
Despite optimal treatment, teeth with severe pre-existing bone loss may still be lost over the following years. We give honest tooth-by-tooth prognoses at the re-evaluation visit so you can plan.
Bacteraemia Risk
Deep scaling produces transient bacteraemia. In immunocompromised patients or those with specific cardiac conditions, antibiotic prophylaxis may be indicated. Disclose your medical history fully.
Smokers Respond Worse
Smokers show roughly twice the failure rate after periodontal therapy and significantly higher recession after deep cleaning. We do not refuse care to smokers; we change the prognosis they should expect.
What We Will Tell You No To
Cosmetic gum surgery on diseased gums, we treat the disease first. Heroic salvage of a Grade 3 mobile tooth with hopeless bone support, when extraction plus an implant is the better long-term answer. We say no when no is the right answer.
Your Periodontal Team
General dentists at Picasso deliver non-surgical periodontitis therapy and routine surgical phases. Picasso does not have a registered periodontist; complex regenerative cases are referred transparently.
Dr. Thao Tran
General Dentist
Periodontitis treatment, scaling and root planing, periodontal pocket therapy, periodontal maintenance.
Dr. Nhung Duong
General Dentist
Periodontal pocket therapy, gingival flap surgery, operculectomy, risk-factor counselling.
Dr. Emily Nguyen
Founding Clinical Director
Treatment planning oversight, second opinions on advanced cases, specialist referral coordination.
Cases requiring complex regenerative surgery (guided tissue regeneration, surgical bone grafting in periodontal defects, aggressive periodontitis) are referred to a hospital-based maxillofacial or periodontal specialist. We are transparent about scope of practice.
Common Questions
How do I know if I have periodontitis or just gingivitis?
Gingivitis is gum inflammation only: bleeding, redness, mild swelling, but no bone loss. Periodontitis is gingivitis that has progressed to destroy the bone supporting the teeth. The only way to tell them apart is six-point periodontal pocket charting plus X-rays. Pockets deeper than 4mm and visible bone loss on radiographs confirm periodontitis. Gingivitis is fully reversible. Periodontitis is not.
Will my gums grow back?
No. Gum tissue and bone lost to periodontitis do not regrow on their own. Deep cleaning halts the active disease and reduces pocket depths as inflammation resolves, but the underlying bone loss is permanent. In selected defect shapes, regenerative bone grafting (referred to a specialist) can rebuild some bone, but this is not the rule. Aim is preservation of remaining bone, not restoration.
Can I save loose teeth?
Sometimes. Mildly mobile teeth with adequate remaining bone often stabilise after non-surgical therapy, splinting and disciplined maintenance. Severely loose teeth (Grade 3 mobility) with most of their bone support gone usually cannot be saved long-term, and we will tell you honestly when extraction plus an implant is the better answer than heroic salvage. See our dental implants page for replacement options.
Do I need antibiotics?
Most periodontitis cases are treated with scaling and root planing alone, antibiotics do not replace mechanical debridement. Localised antibiotics or short systemic courses are sometimes added for aggressive periodontitis, non-resolving deep pockets, or acute infection. We do not prescribe antibiotics routinely; the evidence does not support it.
Why every 3 months instead of 6?
Periodontitis patients re-form subgingival plaque biofilm faster than healthy patients. Studies show that maintenance intervals longer than 3 months are associated with attachment loss and disease recurrence in active periodontitis cases. The 3-month recall is the evidence-based standard. Healthy patients without periodontitis can safely attend every 6 months.
Can I get implants if I have periodontitis?
Yes, but periodontitis must be controlled first. Active gum disease is associated with significantly higher implant failure and peri-implantitis rates. We resolve the periodontal infection, re-evaluate, and only place implants once pocket depths and bleeding have stabilised. Implants placed into a diseased mouth fail at unacceptable rates. See our dental implants page.
Is periodontitis hereditary?
Partly. Aggressive periodontitis has a documented familial pattern, and some patients carry genetic susceptibility regardless of how well they brush. Most periodontitis is multifactorial: genetics plus plaque, smoking, diabetes and age. A family history of early tooth loss is a useful risk signal we ask about during charting.
Will quitting smoking help?
Yes, significantly. Smoking is the single biggest modifiable risk factor for periodontitis. Smokers have roughly twice the failure rate after periodontal therapy and respond markedly worse to deep cleaning. Quitting (or even reducing to under 10 cigarettes a day) measurably improves outcomes within months. We counsel cessation before any surgical or grafting phase.
How do I prevent it from coming back?
Three things: 3-month maintenance recalls without skipping, daily interdental brushing (not just floss, the gaps are too wide once pockets have formed), and control of risk factors (smoking, diabetes). Without disciplined maintenance, recurrence is the rule rather than the exception. Periodontitis is controlled, not cured.
When do you refer to a specialist?
Picasso does not have a registered periodontist. Cases requiring complex regenerative surgery, guided tissue regeneration, surgical bone grafting in periodontal defects, or rare aggressive periodontitis presentations are referred to a hospital-based maxillofacial or periodontal specialist. We tell you transparently when your case exceeds what general practice should manage.
Start Here
Stop the Bone Loss.
Save the Teeth You Have.
Book a free consultation. We will perform full periodontal charting, X-ray review, stage your case honestly, and quote in writing before any treatment is booked. Early intervention preserves teeth long-term.