Sarasota’s gum disease specialists
Gum disease usually starts quietly, without pain, with gums that bleed a little when you brush, some redness you barely notice, and perhaps breath that doesn’t stay fresh as long as it used to. By the time you feel actual discomfort, the bacteria have often been at work for years, slowly destroying the bone and tissue that hold your teeth in place.
The good news is that gum disease is treatable at every stage. And at Misch Implant & Aesthetic Dentistry you won’t be referred out to a separate specialist’s office and left to coordinate your own care. Our board-certified periodontist, Dr. Maggie Misch-Haring, works alongside our oral surgeons and prosthodontists right here under one roof. Meaning, if your gum disease requires non-surgical therapy or advanced surgical intervention, we can diagnose it, treat it, and keep it under control, all in one place.
Gum disease, clinically known as periodontal disease, is an infection of the tissues that surround and support your teeth. It is caused by bacteria in plaque, that sticky film that constantly forms on your teeth and which, when not removed through regular brushing and flossing, hardens into tartar (calculus), which can only be removed by a dental professional. Thus, the bacteria in plaque and tartar produce toxins that irritate your gums and trigger an inflammatory response.
The earliest form of gum disease is gingivitis, which is inflammation of the gums without any bone loss. Signs include gums that bleed easily when you brush or floss, redness or swelling along the gum line, and occasional bad breath, and the critical thing to know about gingivitis is that it is completely reversible with professional treatment and improved home care, as no permanent damage has occurred yet.
If gingivitis isn't treated, it can progress to periodontitis, a more serious condition where the infection spreads below the gum line. In this case, bacteria create "pockets" between your teeth and gums while your body's inflammatory response starts destroying the bone and connective tissue that anchor your teeth. This damage is irreversible and teeth may become loose, shift position, or eventually need to be extracted.
In advanced cases bone loss becomes severe, pockets deepen dramatically and teeth may become so loose they need to be removed. At this stage, aggressive treatment is necessary to save remaining teeth and halt further destruction, and even at this point treatment can stabilize the disease, but the sooner we intervene, the more of your natural teeth and bone we can preserve.
Many people have gum disease without knowing it because the early stages are painless, so pay attention to these warning signs:
Healthy gums don't bleed, that is a fact. If you see pink in the sink after brushing or notice blood when you floss, that is inflammation, which is your body's response to bacterial infection. Therefore, don't dismiss this as "normal" because it is not.
Healthy gum tissue is pink and firm, so gums that appear red, swollen, or tender to the touch are signaling infection.
Chronic bad breath (halitosis) that doesn't improve with brushing can indicate bacteria thriving in deep periodontal pockets that you can't reach with a toothbrush.
If your teeth look longer than they used to or if you can see the roots of your teeth, your gums are receding. Although gum recession has multiple causes, periodontal disease is one of the most common.
Learn about gum grafting →
Teeth that feel loose, have shifted position, or bite together differently than before may indicate advanced bone loss from periodontal disease, and this is a serious sign that requires immediate attention.
Visible pus is a sign of active infection and needs immediate treatment.
Accurate diagnosis is the first step toward effective treatment, so when you come in for a periodontal evaluation, here’s what we assess:
We measure the depth of the spaces (pockets) between your gums and teeth using a periodontal probe, being that healthy pockets measure 1-3 millimeters while pockets of 4 millimeters or deeper indicate periodontal disease, and the deeper the pocket, the more advanced the condition.
Using digital X-rays and, when necessary, CBCT 3D imaging, we evaluate the bone levels around your teeth, which shows us exactly how much bone has been lost and helps us plan appropriate treatment.
Certain factors increase your risk of gum disease and affect how we approach treatment, including smoking, diabetes, genetics, certain medications, hormonal changes and systemic conditions. We'll discuss these factors and how they may influence your treatment plan.
Treatment depends on the severity of your condition, and for this reason, we always start with the least invasive approach and escalate only when necessary.
For mild to moderate periodontitis, the first line of treatment is scaling and root planing, often called “deep cleaning.” This non-surgical procedure removes plaque and tartar from tooth surfaces above and below the gum line, and then smooths the root surfaces to help gums reattach to the teeth.
Deep cleaning is typically performed over two appointments (one side of the mouth at a time) using local anesthesia for your comfort. Many patients see significant improvement from this treatment alone, with pockets shrinking and gum health restored.
In some cases, we enhance deep cleaning with locally applied antibiotics, like Arestin, which deliver medication directly into periodontal pockets to fight infection where it lives. Furthermore, we can also prescribe systemic antibiotics for more widespread infections.
When deep pockets persist despite non-surgical treatment, surgical intervention becomes necessary. During pocket reduction surgery, also called osseous surgery or flap surgery, Dr. Maggie folds back the gum tissue to access the root surfaces and underlying bone.
She also removes bacterial deposits and smooths damaged bone surfaces, eliminating the irregular contours where bacteria hide. Once this is done, the gums are then repositioned to fit more snugly around the teeth, reducing pocket depths.
This procedure creates an environment that is easier to keep clean and allows us to halt the progression of bone loss, is performed under local anesthesia, and we offer sedation options for patient comfort.
In some cases, we can actually regenerate bone that has been lost to periodontal disease using bone grafts, membranes, and tissue-stimulating proteins, encouraging your body to rebuild part of the supporting structure around your teeth. This is particularly valuable when periodontitis has created deep angular defects in the bone.
When gum recession has exposed tooth roots, whether from periodontal disease or other causes, soft tissue grafting can cover the exposed areas, protect the roots against decay and sensitivity, and restore a more natural gum line appearance.
Successfully treating gum disease is only half the battle, since periodontal disease is a chronic condition and ongoing maintenance is essential to prevent recurrence.
Patients who have been treated for periodontal disease need professional cleanings more frequently than the standard twice-a-year schedule, and we typically recommend periodontal maintenance every three to four months. These specialized cleanings go deeper than a routine prophylaxis, monitoring pocket depths and removing bacterial deposits before they can cause new damage.
Learn more about periodontal maintenance →
Your daily habits also matter a lot, and for this reason, we will work with you to develop an effective home care routine, including proper brushing technique, flossing or interdental cleaning, and any specialized tools that might help you keep your mouth healthy between visits.
If you smoke, quitting is the single most important thing you can do for your periodontal health, and if you have diabetes, maintaining good blood sugar control helps your body fight infection. We will discuss any modifiable risk factors and how addressing them can improve your outcomes.
Treatment depends on the severity of your condition, and for this reason, we always start with the least invasive approach and escalate only when necessary.
Dr. Maggie Misch-Haring is a board-certified periodontist with specialized training in the diagnosis and treatment of periodontal disease, having completed a three-year residency in periodontics beyond dental school, focusing exclusively on the treatment of gum disease, bone regeneration, and soft tissue surgery. When your gum disease requires more than basic care, you are seeing a specialist, not a general dentist working outside their primary training.
Here is what happens at most practices: your general dentist diagnoses gum disease, refers you to a periodontist across town, you get treated and then are sent back to your general dentist, and if you need implants to replace teeth lost to periodontal disease, you are referred out again. At Misch, Dr. Maggie works alongside oral surgeons and prosthodontists in the same office and treatment planning happens collaboratively, meaning that if periodontal treatment reveals that a tooth cannot be saved, we can discuss implant placement in the same consultation. It’s that simple: efficient, coordinated, and nothing falls through the cracks.
At Misch Implant & Aesthetic Dentistry we use state-of-the-art technology: We have CBCT 3D imaging for precise diagnosis of bone loss, ultrasonic scalers for thorough cleaning, and advanced regenerative materials for bone and tissue grafting. Technology does not replace skill and experience, but it enhances what a skilled clinician can accomplish.
Periodontal procedures have a reputation for being uncomfortable, but they don’t have to be. With patient well-being in mind, we offer sedation options ranging from nitrous oxide to IV sedation, ensuring you are comfortable throughout your treatment. In the end, many patients tell us their experience was much easier than they expected.
It is natural to have questions about diagnosis and treatment, so below we answer the most common questions so you feel fully informed and secure about your oral health.
Gingivitis (early gum disease) is completely reversible with professional treatment and good home care, while periodontitis (advanced gum disease) can be controlled and stabilized, although the bone loss it causes is permanent. That is why early intervention is so important, since the sooner we treat gum disease, the more of your natural bone structure we can preserve.
It depends on severity. Scaling and root planing typically require two appointments of 60 to 90 minutes each, while surgical procedures vary in length depending on how many areas are being treated. After initial treatment, you will need periodontal maintenance every 3-4 months indefinitely.
Surgery is performed under local anesthesia, so you will not feel pain during the procedure. Afterward, you can expect some discomfort for several days, which is managed with pain medication, with most patients reporting that recovery is more manageable than they imagined. Furthermore, we have sedation options available for patients who suffer from anxiety.
Many dental insurance plans cover periodontal treatment, often at 50 to 80% after the deductible, although coverage varies significantly between plans. As a fee-for-service practice, we provide detailed treatment estimates and superbills for insurance reimbursement, and our team can help you understand your coverage before treatment begins.
Yes. Research has linked periodontal disease to an increased risk of heart disease, stroke, diabetes complications, respiratory infections, and adverse pregnancy outcomes, as the bacteria and inflammation associated with gum disease can affect your entire body. Therefore, caring for and treating periodontal disease is not just about saving your teeth, but about protecting your overall health.
Periodontal disease is the leading cause of tooth loss in adults, but it doesn’t have to be. With proper treatment and ongoing maintenance, most people are able to keep their natural teeth for life, even after a diagnosis of gum disease.
If you are experiencing any signs of gum disease or if it has been a while since your last periodontal evaluation, don’t wait, as the sooner we detect and treat it, the better your outcomes will be.
