The gums – recall & periodontitis
Healthy gums are the foundation for healthy teeth. Periodontitis – inflammation of the tooth-supporting structures – is the most common cause of tooth loss in adults and is linked to cardiovascular disease, diabetes and other general health conditions.
Dr. Liane Kruse specialises in periodontology and supports you from diagnosis through to long-term aftercare (supportive periodontal therapy) in line with the current S3 clinical guideline.
- Periodontal screening index (PSI)
- Systematic periodontitis treatment
- Professional gum treatment (curettage)
- Antibiotic-supported therapy for severe periodontitis
- Supportive periodontal therapy (recall)
The silent disease
Periodontitis doesn't hurt for a long time. That's exactly what makes it so treacherous. While decay tends to announce itself early with a twinge or a knock, the breakdown of the tooth-supporting structures works away unnoticed for years. Many people only notice something when teeth start to loosen – by which point a substantial part of the bone that held them has already been lost. And lost bone does not grow back on its own.
The pattern is always similar: bacteria collect at the gum line and form a film. The gum becomes inflamed, bleeds when you brush and starts to recede. Pockets form between tooth and gum, where more bacteria settle in – places a toothbrush or floss can no longer reach. The body responds to the ongoing inflammation by breaking down bone.
This inflammation is not confined to the mouth. Studies show links between periodontitis and cardiovascular disease as well as diabetes – with the interaction running in both directions: poorly controlled diabetes promotes periodontitis, and treated periodontitis can help stabilise blood sugar levels. In pregnant women an increased risk of premature birth is also discussed. That is why we don't treat gums as a cosmetic matter.
How to recognise it
The earlier periodontitis is noticed, the easier it is to stop. Take these signs seriously:
Bleeding gums
Blood while brushing or flossing is not a sign that you're brushing too hard – almost always it's a sign of inflammation. Healthy gums don't bleed.
Red, swollen gums
Healthy gums are pale pink and sit firmly against the tooth. Dark red, puffy edges point to inflammation.
Bad breath
Persistent bad breath that brushing doesn't permanently fix can come from inflamed gum pockets.
Teeth that look longer
As gums recede, the tooth necks become exposed. Teeth look longer and often react more sensitively to cold.
Loosening teeth
A late sign. When teeth drift, loosen or the bite changes, bone loss is already advanced.
Higher risk
Smoking, diabetes, family history and stress all favour progression. In smokers, incidentally, the gums bleed less – which often means the disease stays undetected for longer.
How the treatment works
Systematic periodontitis therapy follows the current S3 clinical guideline and has been a statutory health insurance benefit under certain conditions since 2021.
- Screening (PSI). Using a blunt measuring probe we check the gum pockets. This doesn't hurt and takes a few minutes. The periodontal screening index shows whether, and how severely, disease is present.
- Detailed examination. If the suspicion is confirmed, we measure each tooth at several points and record bleeding points and looseness. X-rays show the bone level.
- Preparatory treatment and education. First, all deposits above the gumline are removed and oral hygiene is reviewed with you. This step determines the success of the actual therapy – without it, the bacteria come back.
- Cleaning the pockets. Under local anaesthetic, the root surfaces below the gumline are freed of deposits. This is done gently with hand and ultrasonic instruments.
- Checking the healing. After a few weeks we measure again. Usually the gums have calmed down noticeably and the pockets are shallower.
- Further measures if needed. If individual deep pockets remain, a minor surgical procedure or supporting antibiotic therapy can make sense. We decide this based on findings, not routinely.
- Supportive therapy (recall). The decisive phase: at fixed intervals, gum pockets are checked and cleaned. Without this aftercare the disease returns – with it, it can be kept permanently under control.