Our Services
Periodontal treatment
Gum disease affects your oral health and your general wellbeing. Comprehensive periodontal treatment — from scaling and root planing to laser therapy — stops progression and rebuilds the foundation your teeth stand on.
The stages, and what each needs
Gingivitis — Early Stage
Gums become red, swollen, and bleed easily. Plaque buildup triggers the inflammation, but the underlying bone remains intact. Fully reversible with professional cleaning and improved home care.
Mild Periodontitis
Infection progresses below the gumline and early bone loss begins. Scaling and root planing removes bacterial deposits from root surfaces, and the disease can be halted here with good maintenance.
Moderate to Advanced Periodontitis
Deeper pockets, significant bone loss, gum recession, and tooth mobility. Treatment combines deep cleaning with laser therapy to decontaminate pockets, and sometimes surgical access. Lost bone does not return on its own, but progression can be stopped.
Why we take gum disease seriously
Periodontal disease is the leading cause of tooth loss in adults, and it usually progresses without pain. Most patients have no idea anything is wrong until teeth begin to move.
It is also linked to systemic health — cardiovascular disease, diabetes control, and inflammatory conditions all interact with chronic oral infection. Treating gums well is not only about keeping teeth.
How we treat it
Scaling & Root Planing
Non-surgical treatment, also called soft tissue management: cleaning bacterial deposits from the root surfaces inside the pockets, under local anaesthetic. Where treatment starts, and for most people where it finishes.
Laser Therapy
Around natural teeth, an adjunct — modest benefit at best and no substitute for cleaning the roots. Around implants it matters more, because steel instruments damage a titanium surface and a laser decontaminates without touching it.
Systemic Integration
Coordinating with your physician where diabetes or other conditions affect your periodontal response — because managing one without the other rarely works.
Maintenance
Usually every three months at first, because that is how quickly the bacteria return. The phase that determines whether the treatment holds — see periodontal maintenance.
Non-surgical first, surgical only where it is needed
Almost everyone starts non-surgically. You may hear it called soft tissue management, or non-surgical periodontal therapy — the same thing under three names. It means treating the disease by cleaning the root surfaces inside the pockets and getting the plaque control right, without lifting the gum.
That is our default, and we do not move past it unless the case clearly calls for it. The reason is not caution for its own sake. Non-surgical treatment resolves a large proportion of periodontitis on its own, it costs less, it carries no surgical recovery, and it leaves every option open. Surgery after soft tissue management is straightforward. There is no route back the other way.
What soft tissue management involves
- Charting first — pocket depths at six points around every tooth, bleeding recorded site by site, and radiographs for the bone level.
- Oral hygiene instruction aimed at the sites that are actually failing, usually with interdental brushes sized for your gaps rather than floss.
- Removal of the deposits above the gum line, and correction of the plaque traps — an overhanging filling, a rough crown margin.
- Subgingival instrumentation: cleaning the root surfaces inside the pockets under local anaesthetic, by hand, with ultrasonics, or both.
- Risk factor work, which for smoking and diabetes matters more than the instrumentation does.
- Re-measuring six to eight weeks later, because the numbers decide what happens next rather than the plan made at the start.
When surgery is indicated from the outset
Sometimes it is obvious before we start that cleaning blind will not reach the problem. The usual reasons:
- Pockets deep enough that no instrument reaches the bottom of them reliably — generally beyond about six millimetres, and more so on back teeth.
- Involvement of the space between the roots of a molar, which is shaped in a way that instruments cannot follow.
- A bone defect with the particular shape that responds to regenerative treatment, where grafting can rebuild attachment rather than simply halt the loss. That opportunity is worth taking when it exists.
- Anatomy that makes cleaning impossible without access — a deep groove on a root surface, for instance.
Even then, the first step of soft tissue management usually happens first, because operating on inflamed tissue in a mouth where the plaque control has not been established gives a worse result.
And when the re-evaluation shows most of the mouth has responded but two or three sites have not, surgery is targeted at those sites. It is not an all-or-nothing decision about the whole mouth.
The treatment runs in steps, and each one is checked
Periodontal treatment worldwide follows a stepwise approach set out by the European Federation of Periodontology in 2020. It matters that it is stepwise rather than a single procedure: each step is followed by re-measuring, and what happens next depends on what the numbers say rather than on what was planned at the start.
Step one: the things that decide whether the rest works
This comes first for a reason, and skipping it is why treatment sometimes disappoints. It covers getting the plaque control right — which usually means interdental brushes rather than floss, in a size chosen for your gaps — cleaning off what is above the gum line, removing the plaque traps that make cleaning impossible, and addressing risk factors.
Two of those matter more than the rest. Stopping smoking changes the outlook more than any instrument we own. And where there is diabetes, getting blood sugar under control is part of the periodontal treatment, not a separate medical matter — the two conditions feed each other.
Step two: cleaning below the gum line
This is the part most people mean by a deep cleaning. Properly, it is subgingival instrumentation: removing bacterial deposits from the root surfaces inside the pockets, using hand instruments, ultrasonics or both.
What it is like: local anaesthetic, so it should not hurt at the time. Usually done in sections over more than one visit, though it can be done in fewer, longer appointments if you would rather get it over with. Afterwards the gums are tender for a few days and teeth are often sensitive to cold for a few weeks as the swelling settles and root surfaces that were covered by inflamed tissue become exposed. That sensitivity usually fades.
Re-evaluating, about six to eight weeks later
The gums are re-measured once they have healed enough for the reading to mean something. This appointment is not a formality — it decides everything that follows.
What we are looking for is a mouth with no pockets of 4 mm or more that still bleed, and no deep pockets left over. Bleeding on probing at under a tenth of sites is the figure the guideline uses. A pocket that is shallow and does not bleed is a pocket that has stopped losing bone.
Step three: dealing with what did not respond
Some sites will not close, usually the deepest ones and those on multi-rooted back teeth. This is the point at which surgery enters the conversation for the minority who need it, and it is targeted at those sites rather than the whole mouth.
- Moderate pockets that still bleed are often re-instrumented — the same treatment again, more thoroughly, now that the inflammation around them has settled and access is better.
- Deep pockets that remain may need surgical access, which means lifting the gum to clean root surfaces that cannot be reached blind, then replacing it.
- Some defects of a particular shape can be treated regeneratively, using grafting material or biological agents to encourage the attachment to rebuild. This works in selected sites, not everywhere, and we will say which.
- Occasionally a tooth is not worth treating further. That decision is made with you, and planned together with what replaces it rather than separately — see loose teeth.
Step four: maintenance, which does not end
Once the mouth is stable it goes onto a supportive schedule, usually every three months at first, with the interval set by risk and reassessed each visit. This is the step that determines whether the first three hold. It has its own page: periodontal maintenance.
About lasers, antibiotics and the things sold as extras
Two different questions get asked as one here, and they have different answers. Around natural teeth, a laser is an adjunct. Around implants, the instrument choice is constrained by the surface itself, which changes the argument.
Around natural teeth
Used alongside thorough instrumentation, the evidence shows modest benefit at best, and nothing that substitutes for the cleaning. If anyone offers you laser treatment instead of instrumentation on your own teeth, that is not a choice the evidence supports. The thing that decides the outcome is unglamorous: how thoroughly the roots were cleaned, and how well the plaque is controlled between appointments.
Around implants, which is a different problem
A steel curette is the right tool on a root surface and the wrong one on titanium. It scratches the implant, and a scratched surface holds more plaque than the one it replaced — so the instrument meant to solve the problem leaves the site worse. That constraint is why implant decontamination uses titanium or plastic instruments, air-polishing with fine glycine powder, titanium brushes, and lasers, rather than the instruments used on teeth.
The published picture is better here than around teeth, on one outcome in particular. A 2025 review pooling fifteen randomised trials — 540 patients and 658 implants — found Er:YAG laser reduced bleeding on probing by 35.6% and pocket depth by 0.65 mm, and mechanical debridement combined with an Er,Cr:YSGG laser reduced bleeding by 47.3% and pocket depth by 1.23 mm. The American Academy of Periodontology's own review found much the same: a 21% greater reduction in bleeding when a laser was added to non-surgical treatment.
Two honest limits on that. Neither review found lasers superior to careful mechanical debridement overall, and no modality in any of them prevented bone loss around the implant. In surgical treatment specifically, adding an Er:YAG laser has not been shown to improve pocket depth at all. What the evidence supports is inflammation — bleeding, redness, the soft tissue around the implant — not a claim about saving bone.
The laser matters most in implant cases, because we do not want aggressive instrumentation anywhere near an implant surface. Being able to decontaminate the sulcus or the pocket around an implant without touching the titanium is genuinely useful. In my experience there is a real benefit in holding back inflammation around implants and stopping early peri-implant problems from progressing.
More on peri-implantitis and how it is treated, and on laser dentistry generally.
Antibiotics
Systemic antibiotics are not routine. The guideline reserves them for particular situations — generally younger patients with rapidly progressing disease — rather than as a standard addition, because the benefit in ordinary cases is small and antibiotic resistance is not a small problem. Locally applied antimicrobials have a narrower role, in individual stubborn sites.
What treatment can and cannot achieve
It can stop the bone loss. It can shrink pockets so they become cleanable. It can take away the bleeding, the odour and the taste. In a mouth caught before things move, it can keep teeth that looked doubtful for decades.
It cannot regrow bone that has gone, except in a minority of sites with the right shape for regenerative techniques. It cannot make receded gums come back. And it cannot work on its own — the appointments interrupt the bacteria, and what you do daily decides how fast they rebuild.
Two things to expect that surprise people. Teeth can look longer after treatment, because the swelling that was propping the gum up has gone down; the gum has not receded further, it has stopped being inflamed. And small gaps can open between teeth for the same reason. Both are signs of healing, which does not make them welcome.
Gum treatment runs in three parts
Periodontitis is a chronic condition, so the course does not finish — it changes shape. Knowing which part you are in makes the rest of it make sense.
1. Gum disease
The condition itself — what it is, what you would notice, and what decides how serious it is.
You are here
2. Periodontal treatment
The active course. Cleaning below the gum line, re-measuring, and treating whatever has not responded.
3. Periodontal maintenance
What follows, indefinitely. Usually every three months, because that is how fast the bacteria return.
What gum treatment costs
Gum treatment is charged by time, at the Ontario Dental Association's suggested fees, and the fees are the same for every patient. Scaling and root planing are each $75 for one 15-minute unit, $144 for two and $202 for three, and $34 for a half unit.
How many units you need depends on how many teeth are involved and how deep the pockets are, which is one reason treatment is often split over more than one visit. We measure first, and you receive a written, itemised estimate before treatment begins. Maintenance visits afterwards are charged the same way. The Canadian Dental Care Plan covers gum treatment, with a co-payment that depends on your family income.
Common questions
Will I need gum surgery?+
Most people do not. We start with soft tissue management — the non-surgical treatment — in almost every case, and a large proportion of periodontitis resolves with it. Surgery is considered when the re-evaluation shows particular sites have not responded, or where it is clear from the outset that the pockets are too deep to clean blind. Even then it is usually aimed at a few sites rather than the whole mouth.
What is soft tissue management?+
Another name for non-surgical periodontal therapy: treating gum disease by cleaning the root surfaces inside the pockets and establishing plaque control, without lifting the gum. It is where treatment starts, and for most patients it is where it finishes.
Does deep cleaning hurt?+
It is done under local anaesthetic, so it should not hurt at the time. Afterwards the gums are tender for a few days, and teeth are often sensitive to cold for a few weeks while the inflammation settles and root surfaces adjust. A sensitive toothpaste helps, and the sensitivity usually fades.
How many appointments will it take?+
Usually the mouth is treated in sections over two to four visits, then re-measured about six to eight weeks later. What happens after that depends on the readings — some mouths are stable and move straight to maintenance, others need particular sites re-treated.
Is scaling and root planing the same as periodontal maintenance?+
No. Scaling and root planing is the active treatment, done once the diagnosis is made, usually with anaesthetic and in sections. Maintenance is the ongoing care afterwards, which continues indefinitely. One is the course; the other is keeping the result.
Will laser treatment mean I can avoid the deep cleaning?+
No, and we would not offer it that way. The evidence for lasers as an addition to thorough mechanical cleaning shows modest benefit at best, and none as a replacement for it. The cleaning is what removes the deposits.
Why do my teeth look longer since the treatment?+
Because the swelling has gone down. Inflamed gum sits higher than healthy gum, so treating the inflammation reveals where the gum line actually is. It looks like recession and it is mostly not — though where genuine recession causes problems, gum grafting is an option.
What happens if I do not treat it?+
The bone loss continues, at whatever rate your grade suggests. Pockets deepen, which makes them harder to clean, which accelerates the process. Teeth loosen once enough support has gone. None of that is fast, and none of it is inevitable if it is treated.
Ready to get started?
Book a gum assessment. Pocket depths and bone levels measured properly, then a plan. Call (905) 479-7777.