When the gums have to be treated

If the gum findings show pockets deeper than 3.5 millimetres, the field of prevention ends and a course of treatment begins. Since 2021 it has been governed by a directive of its own and is covered by the statutory health insurer — not as a tooth cleaning but as a course of services in its own right, over about two years.

The difference matters, because patients often hear that they need “a tooth cleaning for the gums” and then pay for it themselves. Where periodontitis has been established, that is not the case.

The course at a glance

1. Findings. Complete measurement of all pockets, X-ray images, assessment of bone loss and tooth mobility. From this follows how far the disease has advanced and how quickly it is progressing.
2. Explanatory and therapy consultation. A service of its own with an appointment of its own. Causes and risk factors are discussed — above all smoking and uncontrolled diabetes — and what oral hygiene has to achieve.
3. Instruction in oral hygiene. Practical, on your own teeth, with a selection of suitable aids. This step decides more about the outcome than any other.
4. Cleaning of the root surfaces. The pockets are cleaned and the root surfaces smoothed, usually under local anaesthetic, in one or two sessions.
5. Follow-up examination after about three to six months. Measurements are taken again: where have the pockets become shallower, where not?
6. Surgical procedure — only if individual pockets have remained deep. The gum is then detached, the site cleaned openly and sutured again.
7. Supportive periodontal therapy over two years, at set intervals depending on severity — once a year in milder cases, up to four times a year in severe ones.

The follow-up care is the treatment

That is the sentence that matters. Periodontitis is not curable in the sense of being “over”; it is treatable and then manageable. The bone that has been lost does not come back. What the treatment achieves is a halt — and that halt only holds as long as the follow-up care continues.

At every follow-up appointment, measurements are taken again, cleaning is done where necessary, and oral hygiene is discussed. Studies consistently show the same picture: patients in regular follow-up care lose considerably fewer teeth over the years than those who do not come back after the treatment. Anyone who lets the appointments lapse loses within a few years what the treatment achieved.

After the two years, the insurer's course of services ends. The follow-up care does not end — it is then usually continued as professional tooth cleaning, and that is the moment at which it becomes a private service.

What you contribute yourself

• The Clean the interdental spaces daily. Without this step the treatment cannot be held — that is where the plaque sits that rebuilds the pockets.
• Stop smoking or at least reduce it considerably. It is the strongest risk factor you can influence and at the same time it worsens the outcome of the treatment.
• With diabetes, pay attention to control. The interaction runs in both directions: poorly controlled blood sugar worsens the gums, treated gums improve blood sugar values.
• Keep the follow-up appointments, even when nothing hurts. That nothing hurts is the normal case with periodontitis, not the signal to relax.