What Gum Disease Actually Does – & How Treatment Helps Your Body Rebuild

Maybe there’s some bleeding when you brush. Some tenderness. Maybe a comment at a cleaning that things aren’t quite where they should be.

What’s harder to see is what’s happening underneath.

Because gum disease isn’t just about the gums. All of the periodontium is involved. That’s the clinical name for all the tissues that surround your teeth and the reason gum disease is also called periodontal disease. Along with the gums, it includes the periodontal ligament – a network of tiny fibers that acts a bit like a suspension system, holding each tooth in place – and the alveolar bone that the teeth sit in, which provides the foundation for it all.

When gum disease is in an early stage – what’s called gingivitis – those below-the-gum tissues tend to be okay. You might notice that your gums appear red and puffy. There may be some bleeding. But there’s no permanent tissue damage. The disease is rather easily reversible.

It’s a different story if the condition worsens into periodontitis. At that point, you’re no longer dealing with just surface irritation. You’re dealing with a chronic bacterial biofilm that triggers an ongoing inflammatory response below the gumline. The body responds with inflammation, and over time, this process starts to break down the very structures that support the teeth.

The ligament fibers can start to weaken. The attachment between the teeth and gums becomes less stable. The supporting bone can slowly break down and be lost.

This doesn’t usually happen all at once. In fact, for a long time, you may not feel or notice anything particularly wrong at all. So the turning point often comes as a surprise.

A routine visit becomes a longer conversation. Your dentist explains how the pockets around your teeth have deepened. Words like “bone loss” enter the picture. Sometimes, the talk can turn to the need to extract some teeth in order to protect the rest.

If you’re thinking of “gum disease” as something that only involves the gums, this last point can be hard to make sense of. But when the structures that support a tooth have become deeply damaged, the tooth itself can become unstable in its socket. In advanced cases, that instability affects more than just the one tooth. It can place ongoing stress on the surrounding tissues and teeth.

With this in mind, the two-part goal of periodontal therapy becomes clearer: treat the bacterial infection and give the tissues a fighting chance to heal. Not only do we want to clean the area but, ideally, leave behind conditions that give the body something to work with.

This is where different treatment approaches can start to matter.

The standard treatment for gum disease is a procedure called scaling and root planing (SRP) and is often referred to as a “deep cleaning.” It involves carefully removing buildup and bacterial deposits from tooth roots and smoothing the surface so surrounding tissue can reattach more effectively. The ultimate goal is to reduce inflammation and create conditions in which the periodontal tissues can start to heal and restore stability to the teeth.

SRP has a long and successful track record, and it remains an important option. Add laser therapy to the mix, though, and some extra benefits may emerge.

This was most recently suggested by a meta-analysis that just dropped, comparing laser-assisted treatment with SRP alone. The research team found modest improvement in things like pocket depth and attachment levels, particularly in the short-term. “Overall,” they wrote, laser-assisted periodontal therapy should be viewed as a potentially useful adjunctive approach in selected cases…

What is it about the use of laser energy that changes the body’s response?

A randomized, single-blinded clinical trial from last year compared three approaches – SRP, low level laser therapy (LLLT), and a procedure called LANAP – with respect to clinical, biochemical, and radiographic (x-ray) outcomes.

All three groups benefited from treatment, which is what you’d expect when an infection is brought under control. No statistically significant differences were seen among biochemical markers either.

But when it came to treating deeper pockets, both laser groups showed greater reductions in pocket depth and gains in attachment levels than the deep cleaning group. And the biggest difference was seen via imaging:

Radiographically, although bone filling was observed across all test groups, only [the LANAP group] demonstrated a statistically significant difference compared to the control group.

That would be the SRP group.

This is kind of a big deal because, for a long time, it was thought that once alveolar bone loss had happened, it wouldn’t come back on its own. Treatment focused on stabilizing what remained and, in some cases, rebuilding lost structure through grafting.

Studies like this one suggest that, under the right conditions, the body may be capable of far more than just holding the line.

LANAP – a procedure we do here in our office – uses an Nd:YAG laser to selectively remove diseased tissue while preserving as much of the surrounding structure as possible. (“Nd:YAG” is much easier to say than its full name, “neodymium-doped yttrium aluminum garnet,” -which refers to the crystal that produces this particular wavelength of light.) But it also appears to support the formation of a stable clot and create an environment that encourages the kind of cellular activity involved in tissue repair.

In short, it helps create the conditions under which recovery happens. It supports the body’s natural healing response.

Because even in more advanced cases, the body isn’t passive. Given the right conditions, it can stabilize. It can adapt.

In some situations, it can even begin to rebuild aspects of what’s been lost.