— PERIODONTAL CARE — TORONTO
Gum Disease Treatment
in Toronto
Gum disease is the leading cause of tooth loss in adults — and one of the most undertreated conditions in dentistry. At Innova Dental, periodontal treatment ranges from non-surgical deep cleaning to guided tissue regeneration, matched to the stage and severity of disease.
GTR
Guided tissue regeneration available for advanced cases#1
Cause of adult tooth loss — largely preventable with early treatment3–4
Monthly maintenance intervals for periodontal patients— UNDERSTANDING GUM DISEASE
More Than
Bleeding Gums
Periodontal disease is a chronic bacterial infection of the structures that support your teeth — the gums, the periodontal ligament, and the underlying bone. It begins as gingivitis, a reversible inflammation of the gum tissue, and if left untreated progresses to periodontitis, where irreversible bone loss occurs around the roots of the teeth.
The progression is typically slow and largely painless, which is why patients often present late — sometimes with significant bone loss that could have been intercepted years earlier. Bleeding gums, gum recession, sensitivity, and loose teeth are among the signs that the disease has already advanced.
Beyond the mouth, periodontal disease has well-documented associations with cardiovascular disease, diabetes, adverse pregnancy outcomes, and respiratory conditions. Treating gum disease is not cosmetic — it is a meaningful health intervention.
SIGNS THAT WARRANT ASSESSMENT
Gums that bleed when brushing or flossing
Gum recession — teeth appearing longer than before
Persistent bad breath not explained by diet
Sensitivity along the gum line
Loose or shifting teeth
Visible tartar buildup at the gum line
HIGHER-RISK PATIENTS
Smokers and tobacco users
Patients with type 2 diabetes
Family history of gum disease
Medications causing gum changes or dry mouth
Dental implant patients — risk of peri-implantitis
Patients with a prior history of periodontal treatment
— STAGES OF DISEASE
Gingivitis, Periodontitis,
and Peri-Implantitis
Periodontal disease progresses through distinct stages. The appropriate treatment depends on which stage you are at and how rapidly the disease is advancing.
01Gingivitis
The earliest and only reversible stage. The gums are inflamed — typically red, swollen, and prone to bleeding — but no bone loss has occurred and the attachment of the gum to the tooth remains intact. Caused by bacterial plaque accumulating along the gum line. Fully reversible with professional cleaning and improved home care.
02Periodontitis
When gingivitis is not treated, infection progresses below the gum line, forming periodontal pockets where bacteria accumulate and attack the supporting bone and ligament. Bone loss is irreversible without surgical intervention. Classified by severity (Stages I–IV) and rate of progression (Grades A–C) under the 2018 classification system. Most patients present at Stage II or III before diagnosis.
03Peri-Implantitis
Periodontal disease affecting dental implants. Manifests as progressive bone loss around the implant fixture, driven by bacterial infection of the peri-implant tissues. More aggressive than periodontitis around natural teeth and, if untreated, can lead to implant failure. Patients with a history of gum disease have elevated risk and require regular implant monitoring.
— NON-SURGICAL TREATMENT
Scaling & Root Planing
Scaling and root planing is the first-line treatment for periodontitis. It is a non-surgical procedure performed under local anaesthesia, typically completed over one or two appointments depending on the extent of disease.
Scaling removes calculus (hardened tartar) and bacterial deposits from the tooth surface above and below the gum line, including within periodontal pockets. Root planing smooths the root surface to reduce bacterial adhesion and encourage the gum tissue to reattach. The combination disrupts the bacterial environment and halts disease progression in the majority of cases.
Following treatment, a reassessment at 6–8 weeks measures pocket depth response and determines whether further intervention is needed. Most patients then transition to a regular periodontal maintenance schedule.
WHAT TO EXPECT
Local anaesthetic administered — one or two quadrants per appointment
Mild sensitivity and gum tenderness for 2–5 days after each session
Soft diet and warm salt rinses recommended during recovery
Reassessment at 6–8 weeks to measure pocket depth response
Most patients see significant improvement in pocket depths and gum health
Ongoing periodontal maintenance every 3–4 months thereafter
Scaling and root planing is not a regular cleaning. It accesses below the gum line into periodontal pockets — areas a standard prophylaxis cannot reach. It is performed under local anaesthetic and takes significantly longer than a routine appointment.
— LONG-TERM MANAGEMENT
Periodontal Maintenance
Periodontal disease is a chronic condition — it cannot be cured, only controlled. Once active treatment is complete, regular periodontal maintenance appointments are essential to prevent recurrence and monitor for disease progression.
Periodontal maintenance differs from a standard hygiene appointment. It includes a full assessment of pocket depths at every visit, subgingival debridement of any areas showing signs of re-infection, plaque and oral hygiene review, and monitoring of any implants for peri-implant health.
The recommended interval is every 3 to 4 months — more frequent than standard 6-month recall, for good reason. Bacterial colonies in periodontal pockets re-establish within approximately 90 days. Consistent maintenance keeps the bacterial load below the threshold that triggers further bone loss.
WHAT MAINTENANCE INCLUDES
Full periodontal charting — pocket depths recorded at every visit
Bleeding on probing assessment — the key indicator of active inflammation
Subgingival debridement of any sites showing re-infection
Oral hygiene review and personalised home care guidance
Implant monitoring for peri-implant health where applicable
Radiographic review at appropriate intervals
Missing maintenance appointments significantly increases risk. Patients who complete active treatment but do not return for maintenance consistently show greater bone loss over time than those who maintain regular appointments. Maintenance is not optional — it is the treatment.
— SURGICAL TREATMENT
Guided Tissue Regeneration
In advanced periodontitis, significant bone loss has occurred around the roots of affected teeth. While scaling and root planing can halt disease progression, it cannot regenerate bone that has already been lost. Guided tissue regeneration (GTR) is a surgical procedure that attempts to do exactly that — stimulate regeneration of the periodontal attachment apparatus, including bone, cementum, and periodontal ligament.
The gum tissue is reflected to provide direct access to the root surface and the bone defect. The root is thoroughly cleaned and conditioned. A barrier membrane is placed over the defect to exclude fast-growing epithelial and connective tissue cells, allowing slower-growing periodontal ligament and bone-forming cells to repopulate the defect and regenerate the attachment.
Bone graft material may be placed within the defect alongside the membrane to provide scaffold support for regenerating tissue. The membrane and graft are covered with gum tissue, which is sutured closed.
GTR is indicated in specific defect configurations — particularly vertical (angular) bone defects and furcation involvement where the anatomy is favourable for regeneration. Not all bone defects are amenable to GTR; flat or horizontal defects have limited regenerative potential.
GTR AT A GLANCE
Performed under local anaesthesia; IV sedation available
Always preceded by a full course of non-surgical treatment
Healing: 6–9 months before regeneration can be assessed radiographically
Success depends on defect morphology, smoking status, and post-operative compliance
Smoking significantly impairs healing — cessation is strongly advised
Not appropriate for all defect types — assessment determines suitability
GTR is distinct from GBR (guided bone regeneration) used in implant site preparation. GTR aims to regenerate the periodontal ligament attachment around existing teeth. The principles are similar — barrier membranes, graft material — but the biological goal and the target tissue are different.
— SEDATION OPTIONS
Comfortable from
Start to Finish
Periodontal treatment — particularly scaling and root planing across multiple quadrants or guided tissue regeneration — can be uncomfortable for patients with dental anxiety. At Innova Dental, IV sedation is available for all periodontal procedures.
IV sedation produces a deeply relaxed, amnesic state. Most patients have little or no recollection of the procedure. You remain responsive but entirely comfortable throughout. A responsible adult must accompany you to and from the appointment.
Local Anaesthetic Only
Standard for scaling and root planing. The treatment area is completely numb. You are awake and aware but should feel no pain — only pressure and vibration from the instruments.
IV Sedation + Local Anaesthetic
Intravenous sedation administered and monitored by Dr. Cavus, who holds RCDSO certification as a moderate IV sedation provider. Produces deep, amnesic relaxation. Recommended for highly anxious patients and GTR procedures. Escort required.
— WHAT TO EXPECT
From Assessment
to Long-Term Control
Periodontal treatment at Innova Dental follows a structured, evidence-based sequence. Non-surgical treatment always precedes any surgical intervention. The response to non-surgical treatment determines whether surgery is warranted.
Long-term disease control requires ongoing commitment to maintenance — this is not a one-time treatment.
01 Periodontal Assessment
A full periodontal chart recording pocket depths, bleeding on probing, recession measurements, and furcation involvement is completed. Radiographs assess bone levels. This establishes a baseline and determines the stage and grade of disease — the foundation for treatment planning.
02 Active Treatment — Scaling & Root Planing
Performed under local anaesthesia, typically over one to two appointments depending on the extent of disease. Each appointment addresses one or two quadrants. The subgingival environment is thoroughly debrided and root surfaces smoothed to reduce bacterial adhesion and promote healing.
03 Reassessment at 6–8 Weeks
Pocket depths are re-measured and the response to non-surgical treatment is evaluated. This determines whether healing is adequate or whether surgical intervention — such as guided tissue regeneration — is warranted for specific sites that have not responded sufficiently.
04 Surgical Treatment if Indicated (GTR)
For sites with advanced bone loss that are amenable to regeneration, guided tissue regeneration is planned as a separate surgical appointment. GTR is never the first treatment — it follows a full course of non-surgical therapy and a confirmed inadequate response at specific sites.
05 Periodontal Maintenance — Every 3–4 Months
Long-term control requires regular maintenance every 3 to 4 months. These appointments are not optional — they are the ongoing treatment that prevents recurrence. Pocket depths are recorded at every visit, and any sites showing re-infection are addressed before the disease can progress.
ABOUT GUM DISEASE TREATMENT
Gum disease — clinically termed periodontal disease — is a chronic bacterial infection affecting the supporting structures of the teeth, including the gums, periodontal ligament, and alveolar bone. It progresses from gingivitis (reversible gum inflammation with no bone loss) to periodontitis (irreversible bone loss around tooth roots) and is the leading cause of tooth loss in adults. Treatment depends on disease severity and includes scaling and root planing (non-surgical deep cleaning below the gum line), periodontal maintenance (regular 3–4 monthly appointments to prevent recurrence and monitor disease), and guided tissue regeneration (GTR — a surgical procedure using barrier membranes and bone graft material to stimulate regeneration of lost periodontal attachment in favourable defect configurations). Peri-implantitis — an equivalent condition affecting dental implants — requires the same structured treatment approach. Periodontal disease is treated by dentists and periodontists.— FAQ
Gum Disease
Questions
Questions about your specific situation are best answered at an assessment, where your pocket depths and radiographs can be reviewed directly.
-
Gingivitis — the earliest stage — is fully reversible with professional cleaning and improved home care. Periodontitis, once established, is not reversible. Bone loss that has occurred cannot be regained without surgical intervention, and even then, regeneration is partial. What treatment achieves is disease control — halting further progression and maintaining the remaining attachment. GTR can recover some lost bone in specific defect configurations.
-
Active gum disease must be treated and controlled before implant placement. Uncontrolled periodontal disease significantly increases the risk of peri-implantitis — a serious infection around implants that can lead to implant failure. Once disease is stable and well-maintained, implants are a viable option and can be planned as part of a comprehensive treatment sequence.
-
Most patients who have been treated for periodontitis require maintenance every 3 to 4 months. This interval is based on the biology of bacterial recolonization — colonies re-establish in periodontal pockets within approximately 90 days of disruption. Standard 6-month recall is not sufficient for periodontal patients and consistently produces worse long-term outcomes compared to 3-monthly maintenance.
-
The procedure is performed under local anaesthesia — you should feel pressure but not pain during the appointment. Post-operative sensitivity and gum tenderness are normal for 2 to 5 days and are managed with over-the-counter analgesics. Teeth may feel more sensitive to temperature briefly following treatment as the gums begin to tighten and reattach.
-
A standard prophylaxis (regular cleaning) removes plaque and calculus from tooth surfaces above the gum line and in the shallow sulcus around healthy gums. Scaling and root planing goes below the gum line into periodontal pockets, cleaning root surfaces that a standard cleaning cannot reach. It is performed under local anaesthetic and typically takes significantly longer than a routine appointment.
-
Yes. There is well-established evidence linking periodontal disease to cardiovascular disease, type 2 diabetes (bidirectional relationship — each worsens the other), adverse pregnancy outcomes including preterm birth and low birth weight, and respiratory conditions. The mechanism involves systemic spread of periodontal bacteria and the chronic inflammatory burden of untreated disease. Treating gum disease has meaningful systemic health benefits beyond the mouth.
— BOOK AN ASSESSMENT
Gum Disease Is Manageable —
With the Right Treatment
If you have been told you have gum disease, or if you have noticed bleeding, recession, or sensitivity along the gum line, an assessment will clarify the stage of disease and what treatment is needed. Early intervention makes a significant difference.