​It is the branch of dentistry that examines the clinical and microscopic structure of the hard and soft tissues surrounding the teeth, diagnoses the diseases affecting these tissues, performs their treatment, and maintains the health achieved afterward. Gum disease is referred to as gingivitis in its early stage. 

The symptoms of gum disease include bleeding gums, red, swollen, tender gums that easily separate from the teeth, inflammatory discharge between the teeth and gums, loose or gradually separating teeth, and persistent bad breath. This stage of gum disease can be reversible. Sometimes, better oral hygiene and professional dental cleaning alone may be sufficient for treatment. Depending on the severity, a periodontist may recommend scaling and root planing in addition to dental cleaning. With special dental instruments, plaque and tartar are removed from the gum pocket. Afterward, the root surfaces are smoothed to ensure that the gums can adhere tightly to the tooth. In cases where this treatment is insufficient, gum surgery may be necessary. Gum diseases do not heal on their own with antibiotics, mouthwashes, vitamins, or similar treatments; they must be treated by a periodontist. Early diagnosis protects not only the gums but also the teeth. If not treated, these diseases can result in tooth loss. Since they usually progress without pain, gum diseases remain one of the leading causes of tooth loss today. Scientific evidence increasingly supports that the severity and extent of periodontal disease is a major risk factor for general health. To prevent gum disease, teeth should be brushed at least twice a day, dental floss should be used at least once daily, and dental checkups should be done every six months.

Dental plaque, the common enemy of teeth and gums, is a sticky, colorless bacterial layer that accumulates on the teeth and leads to cavities and gum diseases. Crowded teeth, decay, poorly made fillings and prostheses, mouth breathing, and dry mouth increase microbial dental plaque accumulation.

Dental plaque combines with sugars from food to form acids; these acids weaken the enamel over time and cause tooth decay.

Dental plaque is soft and can be easily removed by the patient. If not cleaned, it hardens due to calcium and phosphate ions in the saliva, forming tartar. Tartar can only be removed by a dentist. Tartar allows plaque to accumulate more easily on the teeth, contributing to gum disease. Therefore, having tartar cleaned is not harmful. Professional dental cleaning helps halt the progression of gum disease.

Another periodontal disease is periodontitis, an infection that affects the tissues surrounding and supporting the teeth. Periodontitis affects all age groups, including children, but is much more common in adults. Teeth without any cavities can still be lost due to this disease. Since it often progresses without pain, symptoms are difficult to notice, and patients typically seek treatment at an advanced stage.

Gingivitis
Gingivitis is the early stage of gum disease. It causes redness, swelling, and bleeding of the gums while brushing or using dental floss.

Healthy gums are pale pink, firmly attached to the tooth, and end in sharp edges. If plaque is not removed from the teeth, gum health deteriorates, causing the gums to turn red, swell, and lose their tight attachment to the tooth.

The earliest and most important sign of gum disease is bleeding while brushing or biting into hard foods. In this case, a periodontist should be consulted.

Periodontitis 
Gingivitis can be completely healed with proper dental treatment and good oral hygiene. However, if left untreated, it progresses into a more advanced form called periodontitis. In this condition, the fibers connecting the tooth root to the jawbone deteriorate, forming a gap called a “pocket” between the tooth and gum. This pocket collects more bacteria, toxins, and food debris. As the infection spreads deeper, bone supporting the tooth begins to deteriorate, eventually leading to tooth loss. Research shows that periodontal diseases account for 60–70% of tooth loss in adults.

Periodontitis can progress without visible symptoms. Therefore, regular dental checkups are crucial for early diagnosis.

Common signs of periodontitis include red and swollen gums, recession or enlargement of the gums, sensitivity, gum bleeding, exposed root surfaces, root caries, discharge from the gum pocket, spacing between teeth, tooth elongation, tooth movement, abscess formation, bad breath, and tooth loss. Early and moderate periodontitis is treated with non-surgical methods, while severe cases may require surgical intervention.

Periodontal disease is one of the most widespread health issues worldwide, and its effects on systemic health are well established. These infections not only affect the oral cavity but also impact general health when bacteria enter the bloodstream. Recent studies show associations between gum inflammation and systemic diseases such as diabetes, cardiovascular diseases, atherosclerosis, respiratory diseases, low birth weight in infants, and preterm birth. Therefore, oral tissues must be viewed as an integral part of the body.

TREATMENT OF GUM DISEASES
Periodontal diseases are largely preventable and controllable. The most important step is ensuring that the patient learns to maintain effective and regular plaque control. In early gum disease, plaque and tartar are removed from the gum pocket using special dental instruments. Scaling and root planing may also be recommended. When this is insufficient, gum surgery may be necessary. Gum diseases do not heal on their own with antibiotics, mouthwash, or vitamins. They must be treated by a periodontist. Early diagnosis protects both gums and teeth. If systemic diseases exist, medical consultation may be needed before treatment.

During initial treatment, old or overhanging fillings must be corrected, decayed teeth should be restored, ill-fitting prostheses adjusted, and hopeless teeth extracted to reduce bacterial retention areas.

After periodontal treatment, regular dental checkups are necessary to maintain plaque control and remove new tartar buildup. No treatment is as effective as the patient maintaining proper daily oral hygiene.

Mechanical and surgical periodontal treatments, combined with effective plaque control, are usually sufficient. However, in some cases, despite ideal hygiene, periodontal destruction continues. In such cases, antibiotic therapy in addition to conventional treatment may be beneficial. Moreover, antibiotics may be required for patients with uncontrolled diabetes, endocarditis, organ transplants, coronary bypass, heart valve replacement, or other high-risk groups. However, antibiotics are not required in most gingivitis and periodontitis cases. Unnecessary and incorrect antibiotic use leads to serious antibiotic resistance, creating risks for individuals and society.

GUM RECESSION
Various factors contribute to gum recession, including anatomical factors, irritative factors, and gum inflammation/periodontal disease. Anatomical factors include muscle attachments, root morphology, malocclusion, and misaligned teeth. Irritative factors include trauma, improper brushing, brushing duration and frequency, abnormal orthodontic forces, plaque and tartar, harmful habits (toothpicks, biting nails or pens), and faulty restorations or prostheses. Symptoms associated with gum recession include:

• Root/tooth sensitivity,
• Root caries,
• Esthetic concerns,
• Fear of tooth loss,
• Pulpal problems.

As a result of gum recession, the clinical crown length increases. Patients—especially in the front region—may feel like their teeth have become longer, creating esthetic concerns. For many individuals, this esthetic issue is more important than sensitivity or root decay.

Treatment focuses on eliminating the underlying cause. If necessary, surgical procedures may be applied to cover the recession. For example, if improper brushing or habits caused the recession, these factors must be corrected. If periodontal disease is the cause, it must be controlled to prevent progression. In cases that cannot be treated surgically, restorative procedures such as fillings or crowns may be used.

FACTORS CAUSING GUM DISEASE
Although bacterial plaque is the main cause of periodontal disease, smoking, systemic diseases, medications, stress, and nutrition can also affect gum health. During dental treatments, any systemic disease must be disclosed to prevent complications.

Smoking 
In addition to its well-known harms, smoking significantly increases the risk of periodontal disease. Studies show that smokers have more tartar buildup, deeper gum pockets, and greater loss of supporting tissues. Chemicals in tobacco and heat exposure can mask signs of inflammation, such as bleeding. Because gums may not bleed even when inflamed, smokers often do not notice periodontal disease.

Adolescence, Pregnancy, and Menopause
Hormonal changes during these periods affect many tissues in the body, including gum tissues. As a result, the gums respond more intensely to bacteria. Therefore, brushing and flossing must be done carefully during these times.

Systemic Diseases
Systemic diseases such as diabetes and immune-related disorders affect the severity and treatment response of periodontitis.

Diseases that weaken the immune system—such as leukemia and AIDS—can worsen gum conditions. Such individuals are highly prone to infections, making gum disease more severe and harder to control.

Diabetes
Diabetes is a disease characterized by hyperglycemia caused by the absence, deficiency, or ineffectiveness of insulin. A typical oral change seen in diabetic patients is dry mouth. Increased glucose levels in saliva and gums negatively affect the oral bacteria population.

Diabetic patients are more susceptible to infections; therefore, periodontal disease develops more easily and causes more destruction. Uncontrolled diabetes accelerates and increases the severity of periodontal damage. Periodontal disease is considered both a risk factor for diabetes and a complication that worsens metabolic control.

Diabetic patients must maintain good oral hygiene and receive regular dental checkups. Untreated dental problems may increase blood sugar levels.

Medications
Some medications adversely affect oral tissues, including birth control pills, antidepressants, certain heart medications, immunosuppressants, epilepsy drugs, and corticosteroid sprays used for asthma. In such cases, dental and medical consultation is necessary.

Birth control pills may exaggerate gum inflammation. Studies show that the duration of pill use correlates with increased inflammation.

Stress
Research shows that stress is also a risk factor for periodontal disease. Stress weakens the immune system, making it harder to fight infections.

Poor Nutrition 
Poor nutrition weakens the immune system, making it harder to fight infections. Gum inflammation becomes more severe when nutrition is inadequate.

BAD BREATH (HALITOSIS)
Bad breath may result from poor oral hygiene, advanced gum disease, cavities, or partially erupted wisdom teeth. It may also indicate systemic diseases requiring medical evaluation. However, it is mostly caused by oral issues. Treatment focuses on the underlying cause.

Bad breath affects a large portion of society and leads to social and psychological discomfort. Causes include:

• Poor oral hygiene or advanced gum disease,
• Certain foods and drinks (garlic, onion),
• Smoking or medications that cause dry mouth,
• Systemic diseases such as diabetes, stomach issues, liver diseases, throat infections, or sinusitis,
• Faulty restorations and food trap areas,
• Vitamin or mineral deficiencies, such as A, B12, iron, or zinc, leading to mucosal fissures that harbor food debris.

Treatment includes professional dental cleaning, oral hygiene training, and referral to medical specialists when necessary.

DENTAL SCALING
Is dental scaling painful?

Dental scaling is generally painless. It is one of the simplest and least painful dental procedures. Local anesthesia is usually not required. However, for patients with low pain tolerance or severe gum recession, anesthesia may be applied to eliminate sensitivity.

Does scaling damage teeth?

No. Scaling removes plaque and tartar—not tooth structure. Instruments used do not scratch or damage the tooth surface.

Does scaling cause bleeding?

Minor bleeding during scaling is normal. Patients usually do not notice it. In advanced gum disease, bleeding may be slightly increased but never like surgical bleeding.

What happens if I skip scaling?

Tartar is the main cause of all gum diseases. Dental scaling is essential for oral health. During regular 6-month dental checkups, tartar in hard-to-reach areas is removed by the dentist. This is completely harmless. If tartar formation is not excessive, scaling should be done according to your dentist’s recommendation.

Should scaling be done before fillings?

Yes. Scaling and gum treatment should be done before fillings, prostheses, implants, and other treatments.

Does tartar re-form after scaling?

If tartar forms rapidly after cleaning, your brushing technique should be reviewed. Preventing tartar formation is your responsibility. Proper brushing and interdental cleaning ensure healthy gums.

What if my tartar forms too frequently?

Frequent tartar formation indicates poor oral hygiene. Relying solely on your dentist to clean tartar and neglecting oral care leads to rapid buildup after each cleaning. The goal is not to frequently remove tartar but to prevent its formation.

Will I have gaps between my teeth after scaling?

In mouths with excessive tartar, cleaning may reveal gaps or cause sensitivity. Patients may misunderstand this as damage caused by scaling, which is incorrect. These issues occur due to delayed treatment.

Remember: scaling is a treatment, not a cosmetic procedure. Not removing tartar leads to gum disease, gum recession, bad breath, and eventually tooth loss.​

​Our Physicians