Full periodontal assessment
Pocket depths are measured at six points on every tooth, bleeding and mobility are recorded and X-rays show the bone level. This gives a baseline against which every later visit is compared.
About this treatmentDental condition · Wimpole Street, Marylebone
Gum disease: how periodontitis destroys support, and how it is brought under control
Gum disease is the name most people use for periodontitis, the condition in which inflammation has spread beyond the gum into the bone and fibres that hold the teeth in place. It develops from untreated gingivitis, but not in everyone: susceptibility is partly inherited, and smokers and diabetics are at markedly higher risk. The process is slow, painless and destructive. Bacteria colonise the deepening gap between gum and root, the immune response meant to fight them dissolves bone in the process, and the tooth loses its foundation millimetre by millimetre over years. It remains the leading reason adults lose teeth. We want to be straightforward about what treatment can achieve. Bone that has gone does not regrow in any reliable way, so periodontitis is not reversed but stabilised: the infection is cleared, the pockets shrink, and with good maintenance most teeth can be kept for life. At Wimpole Street that stabilisation is a programme rather than a single appointment.
Recognising it
How it usually feels
Gums that bleed easily and have done for years
Long-standing bleeding suggests the inflammation has had time to move deeper.
Teeth that look longer, with dark triangles between them
Gum and bone have receded, exposing root and opening spaces.
Persistent bad breath or a foul taste
Bacteria deep in pockets produce sulphur compounds that brushing cannot reach.
Teeth that have shifted, spread out or feel slightly mobile
Reduced bone support lets them move under everyday forces.
Pus at the gum margin when pressed
An infected pocket discharging; sometimes a gum abscess forms.
A change in how your teeth meet
Drifting teeth alter the bite, which is often the first thing patients actually notice.
Behind the symptoms
What's going on
- 01
Plaque bacteria below the gum
Once a pocket forms, oxygen-hating bacteria that thrive in the depths take over. They release toxins and trigger an inflammatory response that, in susceptible people, breaks down the bone and ligament rather than simply fighting the bacteria off.
- 02
An over-reactive immune response
The damage in periodontitis is largely self-inflicted: it is the body’s own enzymes, released to attack bacteria, that dissolve bone. How aggressively an individual’s system responds is genetically influenced, which is why the disease runs in families.
- 03
Smoking
Smokers are several times more likely to develop periodontitis, lose more bone, respond less well to treatment and relapse faster. Nicotine restricts blood flow to the gum, masking the bleeding that would otherwise raise the alarm.
- 04
Diabetes and systemic health
High blood sugar impairs healing and amplifies inflammation, and the relationship runs both ways: untreated gum disease makes blood sugar harder to control. Cardiovascular disease, rheumatoid arthritis and some pregnancy complications are also associated with periodontitis.
- 05
Local factors that trap plaque
Tartar, overhanging fillings, deep grooves on roots, tightly crowded teeth and partial dentures all provide sheltered spots where bacteria mature undisturbed. Correcting these is part of treatment.
Before your appointment
What you can do today
- Clean between the teeth every day with interdental brushes sized so they fit snugly; in pockets, floss alone is not enough.
- Brush twice daily with the bristles angled into the gum line, ideally with an electric brush, for a full two minutes.
- If you smoke, seek support to stop; it is the single most effective change you can make to the outcome.
- Keep diabetes well controlled and let us know your latest HbA1c so we can gauge how your gums are likely to respond.
- Do not be put off by bleeding when you first clean thoroughly; it settles as the inflammation reduces.
- Note any teeth that feel different when biting and any changes in spacing to report at your assessment.
These are holding measures, not a substitute for an examination. Use any pain relief exactly as directed on the pack and check with a pharmacist if you take other medicines.
In the chair
How we treat it at Wimpole Street
Root surface debridement
Under local anaesthetic, the bacterial deposits and hardened tartar on the root surfaces inside each pocket are removed with fine ultrasonic and hand instruments, usually over two to four sessions.
About this treatmentRe-evaluation at eight to twelve weeks
Pockets are measured again once the gum has healed. Most shrink markedly; sites that remain deep are identified for further treatment rather than assumed to be fine.
About this treatmentTreatment of persistent sites
Deep residual pockets may be re-treated, or in selected cases referred for periodontal surgery to access the root and, where the defect suits it, encourage some bone regeneration.
About this treatmentSupportive maintenance
Three-monthly hygiene visits for at least the first year, then adjusted to your stability. This phase is where the long-term success of periodontal treatment is actually decided.
About this treatmentManaging the consequences
Loose teeth may be splinted, drifted teeth can be realigned once the disease is stable, and teeth that cannot be saved are replaced with implants, bridges or dentures.
About this treatmentFees
Costs to expect
A full periodontal assessment with charting and X-rays at Wimpole Street is expected to be £95. A course of periodontal treatment, covering the debridement sessions and the re-evaluation, is indicative from £850, with the exact fee depending on how many teeth and how many deep pockets are involved.
Supportive hygiene visits afterwards are from £89 each, usually every three months to begin with. Where surgery or specialist referral is needed for stubborn sites, that is quoted separately, as is any replacement of teeth that cannot be kept. We set out the whole programme and its cost in writing at the outset so that there are no surprises midway.
Figures are indicative prices for Wimpole Street and are confirmed in a written plan once a dentist has examined you. Fees match our South Kensington and St Paul's clinics.
Don't wait if
When to see a dentist
- Your gums have bled on brushing for months or years.
- Teeth appear longer, or gaps have opened between them.
- A tooth feels loose or has moved position.
- You have persistent bad breath despite good brushing.
- There is pus, swelling or a recurring boil on the gum.
- You are diabetic or a smoker and have not had your gums measured recently.
FAQ
Common questions
In most cases, no. Treatment stops further loss and lets the gum reattach more tightly to the root, which reduces pocket depth, but the bone height stays where it is. Regenerative surgery can rebuild bone in certain narrow, well-contained defects, and we will tell you honestly whether any of your sites qualify.
That the pockets have reduced to a depth you can keep clean, bleeding on probing is minimal, and the bone level on X-ray is unchanged from one year to the next. Stabilised periodontitis needs lifelong maintenance, but stabilised teeth routinely last for decades.
Treating the whole mouth thoroughly under anaesthetic takes several hours, and splitting it into quadrants or halves is more comfortable and allows more careful work. Healing then takes two to three months before pockets can be reliably re-measured, which is why the re-evaluation is scheduled well after the last session.
Often, for a few weeks. As the swollen gum shrinks back, root surfaces that were covered by inflamed tissue are exposed to cold. A sensitive toothpaste, fluoride varnish and time usually resolve it. The shrinkage also means teeth look longer, which is the trade-off for healthy gum.
Rarely, and never on their own. Bacteria in a pocket live in a protective film that antibiotics penetrate poorly, so mechanical removal is what works. A short course is occasionally used alongside debridement in aggressive or rapidly progressing cases, or for an acute abscess.
Marylebone, W1
Wimpole Street opens 1 October 2026
Leave your details and we will be in touch when the Marylebone diary opens. If the problem cannot wait, the same clinicians are already seeing patients in South Kensington and at St Paul's.
Related conditions
Opening 1 October 2026
Wimpole Street is not yet seeing patients. Until then, please book or call our South Kensington clinic on 020 7183 2362 or our St Paul's clinic on 020 7183 3709. Questions about the new clinic: wimpolestreet@md.co.uk.
Until we open
Need an appointment before 1 October 2026?
The same clinical team already works from two other Medical & Dental clinics. Book at either one now and, if you prefer, move your ongoing care to Wimpole Street once the doors open.
South Kensington
- 20 Old Brompton Road, London SW7 3DL
- Open seven days a week
- 020 7183 2362
St Paul's, City of London
- 5 Ave Maria Lane, London EC4M 7AQ
- Open Monday to Friday
- 020 7183 3709
