Plaque accumulates in the areas where the teeth meet the gums, causing inflammation. The earliest signs are bleeding while toothbrushing, and redness. However, no pain is felt. The next stage is swelling of the gum. This is called Gingivitis. Gradually the gum becomes detached from the enamel exposing the root and causing a pocket, which fills with plaque. Eventually the pocket becomes deeper until inflammation reaches the bone, which is then slowly destroyed. The bone can then be destroyed to such an extent that the tooth becomes loose and may even fall out. This is called Periodontitis.

Treatment of gingivitis and periodontitis: To prevent this regular six monthly check up, scaling, polishing is required. In case disease has progressed gum treatments are available for removing pockets and also for reshaping gums

In flap surgery, under local anesthesia, small incisions are made in the gum, so that it can be lifted back to expose the tooth and bone. The entire area is carefully cleaned and all tarter and infected granulation tissue are removed and the bone is examined. Because periodontal disease causes bone loss, often the bone will need to be re-contoured in order for the gum to heal properly.

When the procedure is done, the gums are sutured in to place on top of the bone.

The entire flap procedure typically requires from 1 to 3 hours to perform with only two quadrants of the mouth being addressed in a single visit. The sutures will remain in place for approximately one week, and a patient will likely be given a prescription for pain medication and antibiotics.

It is very important for you to keep your mouth as clean as possible while the surgical site is healing. This means you should brush and floss the rest of your mouth normally. If the surgical site is not covered by a periodontal pack (A type of dental ‘band–aid'), you can use a toothbrush to gently remove plaque from the teeth. Mouth rinses containing chlorhexidine are commonly prescribed following periodontal surgery. Although these rinses do not remove plaque from the teeth, they kill the bacteria and help your mouth heal. Post-surgical swelling is also possible, and this can be minimized by applying an ice pack to the outside of your face in the treated area.

Initially after surgery, there may be some bleeding, swelling and risk of infection. Long term, there is likely to be gum recession, sensitivity to hot and cold, and an increased risk of root cavities.