What Is Periodontal Disease and How Do You Treat It?

How Gum Disease Starts and Progresses.

Gum disease begins with plaque, the soft bacterial film that forms on teeth throughout the day. When plaque is not removed by brushing and flossing within 24 hours, it hardens into calculus (tartar). Calculus cannot be removed by any home tool; only professional scaling instruments remove it.

At the gum line, calculus releases bacterial toxins continuously. The body's immune system responds by sending inflammatory signals to the area. That inflammation is what causes the first visible sign of gum disease: gingivitis, where gums become red, swollen, and bleed easily. At this stage, no bone has been lost. Gingivitis is fully reversible with a professional cleaning followed by consistent home care. See our gum treatment page for how each stage is treated.

If gingivitis goes untreated, the infection spreads below the gum line. The gum tissue begins to detach from the tooth, forming a pocket where bacteria accumulate out of reach of any brush or floss. This is periodontitis. The same immune response that was trying to fight the infection begins destroying the supporting bone around the tooth root. Pockets deepen, bone recedes, and teeth begin to loosen. By the time teeth are visibly shifting, significant bone has already been lost permanently.

Warning Signs Most People Miss.

Periodontal disease is frequently painless until it reaches an advanced stage. By the time patients notice loose teeth, significant bone loss has already occurred. The earlier warning signs are easy to dismiss:

1. Bleeding gums when brushing or flossing. Many patients assume this is normal or caused by brushing too hard. Healthy gums do not bleed. Bleeding is the most common early sign of gingivitis and should prompt a dental appointment if it persists beyond two weeks of correct brushing technique.
2. Persistent bad breath. Bacteria in deep periodontal pockets produce volatile sulphur compounds. If bad breath persists despite good oral hygiene, the likely source is subgingival bacteria that home care cannot reach.
3. Gums pulling away from teeth. Gum recession exposes root surfaces and makes teeth appear longer. It is a visible sign that infection has been present below the gum line for some time.
4. Sensitivity to cold or pressure. Exposed root surfaces are more sensitive than enamel-covered crowns. Pressure sensitivity can also indicate inflammation in the periodontal ligament around the root.
5. Teeth that feel loose or have shifted position. This indicates significant bone loss and requires urgent evaluation. A tooth that has moved has done so because the bone holding it is gone.
6. Pus between the tooth and gum. A periodontal abscess is an acute infection requiring same-day treatment. It will not resolve without drainage and antibiotics.

The Systemic Health Connection: Beyond Your Mouth.

One of the most significant developments in periodontal research over the past two decades is the evidence linking gum disease to serious health conditions throughout the body. Bacteria from infected periodontal pockets enter the bloodstream through damaged gum tissue, triggering systemic inflammation.

Heart disease

Multiple studies have identified periodontal bacteria in arterial plaques of patients with cardiovascular disease. The systemic inflammation from chronic gum infection contributes to the inflammatory cascade that drives atherosclerosis. Treating periodontal disease measurably reduces CRP, a key marker of cardiovascular inflammation, within months of completing treatment.

Diabetes

The relationship between diabetes and periodontal disease is bidirectional. Poorly controlled blood sugar impairs immune function, making gum infections more severe and healing slower. Conversely, active periodontal infection raises systemic inflammation, making blood sugar harder to control. Treating gum disease improves glycaemic control without changes to medication in multiple clinical studies.

Pregnancy

Pregnant women with active periodontal disease have a significantly elevated risk of preterm birth and low-birth-weight babies. Hormonal changes during pregnancy also accelerate gum disease progression in women who already have calculus buildup. Periodontal evaluation and treatment during pregnancy is safe and recommended.

"Had a very mad flair up of my gingivitis. Shot them a message on WhatsApp and they got me an appointment in 2 hours. The practice is modern, clean, and professional. Much nicer than my dentist back in Oregon."

Pete Nazelrod · Hanoi Old Quarter branch · Google review

Who Is Most at Risk.

Smokers present a particular diagnostic challenge: tobacco suppresses the inflammatory response, which means smokers' gums bleed less even when disease is severe. The bleeding that normally alerts patients and dentists to a problem is masked. Smokers should not interpret the absence of bleeding as a sign of healthy gums.

Book a periodontal assessment →

How We Diagnose Periodontal Disease.

The diagnostic process at any Picasso Dental branch is systematic and takes place in a single appointment.

Periodontal probing is the primary diagnostic tool. A thin graduated probe is gently inserted between the tooth and gum at six points around every tooth. Healthy gums have pockets of 1 to 3mm. Pockets of 4mm or more indicate periodontitis. Pockets of 6mm or more indicate severe disease. All measurements are recorded so future appointments can track whether the disease is progressing or stable.

Bleeding on probing is recorded alongside pocket depths. Bleeding when the probe touches the pocket base indicates active inflammation. A healthy site does not bleed on probing.

X-rays show bone levels around the roots. Healthy bone fills to within 1 to 2mm of the enamel-root junction. Bone loss that appears as a gap on the X-ray tells us how far the disease has progressed and which teeth are at risk.

CBCT scanning gives a three-dimensional view of bone levels, root anatomy, and furcation involvement (bone loss between the roots of multi-rooted teeth). It is particularly useful for complex cases and for planning surgical treatment.

How We Treat Periodontal Disease at Every Stage.

Gingivitis: professional cleaning plus home care correction

A thorough scale and polish removes all calculus above and just below the gum line. We review brushing technique and interdental cleaning, correcting any gaps in home care. For most patients with pure gingivitis, this single appointment combined with improved daily cleaning resolves the condition within 2 to 4 weeks. Gum bleeding stops, the tissue firms up, and pocket depths return to normal.

Moderate periodontitis: scaling and root planing

For pockets of 4mm or deeper, a standard scale and polish cannot reach the calculus on the root surface. Scaling and root planing (SRP) is performed under local anaesthesia. We use ultrasonic instruments and hand curettes to clean calculus from the root surface down to the base of the pocket, and smooth the root so gum tissue can reattach. A full mouth is typically treated in two sessions, two quadrants per visit, one to two weeks apart. Post-treatment soreness lasts 3 to 5 days. Pocket depths are re-evaluated 6 to 8 weeks after SRP to confirm healing.

Severe periodontitis: periodontal surgery

When pockets remain 6mm or deeper after SRP, or when furcation involvement prevents instruments from reaching all affected root surfaces, surgical access is required. The gum tissue is temporarily reflected away from the root, allowing direct vision and instrumentation of the entire root surface and the underlying bone. Bone defects can sometimes be grafted during surgery to encourage regeneration.

Periodontal abscess: same-day drainage

An abscess is an acute bacterial infection forming a pocket of pus within the periodontal tissues. It causes rapid swelling, severe pain, and sometimes fever. It requires immediate drainage, irrigation of the pocket, and antibiotics. This is a dental emergency that should not wait for a scheduled appointment.

"I went today and 2 weeks ago for a deep cleaning. The dentist Dr Ngoc Jade was simply great and did an amazing job. She is very friendly and caring for the patient. The cleaning was perfect and the service was excellent."

Arn · HCMC Thao Dien branch · Google review

After Treatment: Maintenance Is the Treatment.

Active periodontal treatment removes the current infection. It does not eliminate the underlying susceptibility. Bacteria begin repopulating treated pockets within 3 months. The evidence is consistent: patients who maintain 3-month recall appointments after completing SRP have significantly lower rates of disease recurrence and tooth loss than those who return to 6-month or annual visits.

Maintenance appointments are shorter than initial treatment, typically 45 to 60 minutes, but they include full probing to check pocket depths, targeted cleaning of any sites that have not fully resolved, and reinforcement of home care technique. If a pocket begins to deepen again, it is caught at 3 months when intervention is simple, rather than at 12 months when the disease has progressed.

For international patients who cannot return to Vietnam every 3 months, the treating dentist provides a written home care protocol and coordinates with a local periodontist in the patient's home country for interim maintenance visits.

"Came here for a dental cleaning based on several people recommending Picasso on FB groups. Once I got there, they checked my teeth and told me my cleaning would cost 300k. Lasted 15 minutes and it did feel thorough."

Briana Le · HCMC Thao Dien branch · Google review