Periodontitis is inflammation of the tissues that anchor the teeth: the ligament, the cementum on the root surface and the bone of the jaw. It begins where gingivitis leaves off, when the inflammation at the gum edge extends downwards and the fibres attaching gum to root are broken. A pocket forms, deepens, fills with bacteria that prefer the oxygen-poor environment, and the bone at its base is resorbed a fraction at a time. Most people notice nothing until a tooth loosens or a gap opens, by which point the process has usually been running for a decade or more. Dentists now classify periodontitis by stage, which describes how much damage has occurred, and grade, which estimates how quickly it is progressing given your age, smoking status and blood-sugar control. That classification shapes the plan: a stage one case in a non-smoker may need little more than thorough cleaning and good habits, while a stage three case in a smoker needs an intensive programme and lifelong vigilance. At Wimpole Street we chart every tooth, explain the stage and grade in plain terms, and set out exactly what stabilisation will take.
Gums that have bled on brushing for years
Long-standing inflammation that has had time to reach the bone.
Pockets you can feel with a fingernail beside a tooth
The gum has detached from the root and a gap has formed.
Exposed roots and longer-looking teeth
Gum and bone have receded together.
New spaces between the front teeth or teeth that have fanned out
Reduced support lets the lips and tongue drift the teeth.
A tooth or several that move slightly under pressure
Less than half of the original bone may remain.
A foul taste, bad breath or pus when the gum is pressed
Infected pockets discharging into the mouth.
Plaque left undisturbed for days organises into a complex film in which anaerobic species dominate. Below the gum, where brushing does not reach, this film sits against the root indefinitely and drives the inflammatory response.
The bone loss in periodontitis is caused by the body’s own enzymes and signalling molecules, not directly by the bacteria. Some people mount a far more destructive response to the same plaque, and this susceptibility is largely genetic.
Tobacco impairs the blood supply and immune function of the gum and is the strongest modifiable risk factor. Smokers lose bone faster, respond less well to treatment and relapse more often. Nicotine from any source appears to contribute.
Poorly controlled blood sugar increases inflammation and slows healing, so periodontitis is both more common and more severe. Treating the gums has been shown to improve glycaemic control slightly, and controlling diabetes improves the gum response.
Tartar, ledges on fillings and crowns, crowded teeth, open contacts that pack food and ill-fitting partial dentures all give plaque a foothold that ordinary cleaning cannot dislodge. Removing or correcting them is part of treatment.
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.
Depth, bleeding and recession are recorded at six sites on every tooth, mobility and furcation involvement noted and X-rays taken. From this we assign a stage and grade and a baseline to measure change against.
About this treatmentBefore any instrumentation we make sure your daily cleaning can maintain the result. Interdental brush sizes are fitted to each space and technique refined; this step alone reduces bleeding markedly.
About this treatmentUnder local anaesthetic, plaque and calculus are removed from the root surfaces within the pockets using ultrasonic and hand instruments, usually over two to four visits. This is the core of treatment.
About this treatmentThe pockets are re-measured once healing is complete. Sites that have closed to a maintainable depth go into maintenance; sites still deep and bleeding are identified for further treatment.
About this treatmentPersistent deep sites may be re-instrumented under direct vision with the gum lifted back, and in suitable bony defects a regenerative material can be placed to encourage new attachment. This is carried out or referred as appropriate.
About this treatmentMaintenance visits every three months in the first year, then at an interval set by your stability. Patients who attend maintenance keep far more teeth than those who do not.
About this treatmentA periodontal assessment at Wimpole Street with full charting and X-rays is expected to be £95. A non-surgical treatment course, including the debridement visits and the three-month re-assessment, is indicative from £850; the final fee reflects the number of teeth and pockets involved and is confirmed in writing before the first session.
Supportive care visits are from £89, or £142 with Airflow for stain removal. Surgical or regenerative treatment of residual sites is quoted per site after re-assessment. Where a tooth has lost too much support to be kept, extraction is from £250 and replacement options are planned once the remaining gums are stable.
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.
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.
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.
