Stages of Periodontal Disease

Gingivitis – Gingivitis is the first stage of periodontal disease. Plaque and its toxin by-products cause your gums to become red and swollen, and to bleed.

Periodontitis – Plaque hardens into calculus (tartar). As calculus and plaque continue to build up, your gums begin to recede away from your teeth. Deeper pockets form between your gums and teeth and become filled with bacteria and pus. Your gums will become very irritated, inflamed, and bleed easily. Slight to moderate bone loss could occur.

Advanced Gum Disease – Your teeth lose more support as your gums, bone, and periodontal ligament continue to be destroyed. Unless treated, the affected teeth will become very loose and may be lost. Moderate to severe bone loss may occur.

Are Your Gums Healthy

How Healthy Are Your Gums?

The first signs of periodontal disease are inflamed gums that bleed easily. If you’re experiencing these symptoms, or if you don’t have a diligent daily dental hygiene routine that includes regular dental check-ups, plan a visit to Top Down Dental in San Jose/Los Gatos.

During a periodontal examination, Dr. Nancy Nehawandian will diagnose the health of your gums and jaw bones. Using a periodontal probe (small dental instrument) she’ll gently measure the sulcus (pocket or space) between your teeth and gums. A healthy pocket is 3 mm deep (or less) and does not bleed. By noting the depth of your pockets, the presence of bleeding and inflammation, and the stability of your teeth, she will make a diagnosis and get you on a treatment plan that’s suited to the severity of your condition.

Get The Gum Disease Treatment You Need

To treat periodontal disease, Top Down Dental in Los Gatos uses special periodontal program called Laser Assisted Gum Therapy (LAPT) for our San Jose area patients. This program requires four or more appointments consisting of the following treatments:

Bacterial Testing

According to the American Academy of Periodontology, up to 30% of the general population may be genetically susceptible to gum disease. Despite diligent dental hygiene habits, if you are one of these people you may be six times more likely to develop periodontal disease. The bacterial test provides information on the species and number of microorganisms in your mouth. If needed, Dr. Nancy Nehawandian will prescribe antibiotics.

Full Mouth Disinfection

The staff at Top Down Dental will perform a cleaning and thorough disinfection of your mouth including your cheeks, tongue and palate.

Scaling and Root Planing

This is a careful cleaning of your teeth to remove plaque and calculus [tartar] from deep periodontal pockets, and smooth your affected teeth’s roots to remove bacterial toxins.

Laser Therapy

A Diode laser generates a tiny beam of concentrated light energy, killing bacteria, sterilizing the inflamed areas, and removing diseased tissue.


A powder form of antibiotics, it is placed into deep, infected pockets to reduce bacteria.

Ozone Therapy

Ozone is an unstable form of oxygen that can penetrate into infected tissue to kill damaging bacteria.

Home Care

A medicated mouth rinse, a water pick, or an electric tooth brush may be recommended to help minimize and control your infection and promote healing.


Straight teeth are less likely to accumulate harmful bacteria and are easier to clean. Orthodontic treatments like Invisalign may lower your risk of gum disease by 50%.

Periodontal Surgery

For very serious cases of gum disease, we may refer you to a periodontist (specialist focusing on the gums and bones) for surgical treatment.

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Perio Protect ®

Perio Protect ® uses a custom, flexible tray to deliver medications that help us better manage your gum disease. You put medication in the tray, then slip it over your teeth. The comfortable tray holds medication under your gums long enough to significantly reduce the amount of disease-causing bacteria so your gum disease heals better and faster. As an added benefit, you may notice whiter teeth and fresher breath.

Once your periodontal treatment has been completed, Dr. Nehawandian recommends that you return to Top Down Dental every 2 to 3 months, to keep active periodontal conditions under control. At these appointments, the depth of your pockets will be carefully evaluated to ensure they are healthy. Plaque and calculus that is difficult for you to get rid of on a daily basis will be removed from above and below the gum line.

Full mouth laser maintenance may be recommended every 9 – 12 months to reduce bacterial and inflammation. Laser therapy can also boost your immune response, reduce the severity of further disease processes, and improve overall health.

Find a San Jose Dentist You Can Trust

Good oral hygiene practices and active maintenance visits are essential in maintaining your health. San Jose dentist Dr. Nancy Nehawandian is committed to your oral and overall health. You can trust Top Down Dental in Los Gatos to help you get your periodontal disease under control. Call our office today at (408) 354-5600 or use our online contact form.