The short answer
Periodontitis treatment in Germany is not one procedure but a sequence of appointments spread over months. It starts with a measuring appointment, where pocket depths around every tooth are recorded and X-rays show how much bone is left. Then comes a conversation about the findings and a practical hygiene session, followed by the central part: the cleaning of the root surfaces below the gum line, normally under local anaesthetic (Betäubung), across one or two longer appointments. A few months later everything is measured again to see what has responded — and from there the treatment moves into a structured maintenance programme that keeps the result stable. Most of it feels like a long, thorough cleaning rather than surgery, and nothing about it is rushed.
First, the thing nobody tells you: this is a course, not a visit
If you have booked because your gums bleed, you may be picturing a single appointment that fixes it. Reset that expectation early. Periodontitis therapy is closer to a course of physiotherapy than to a filling: an assessment, an active phase, a check on how the tissue responded, and a maintenance stage afterwards — the whole sequence is outlined on our Periodontitis treatment – service page (EN). The active part usually occupies a handful of appointments over a few weeks, with a gap of several months before the re-assessment.
That structure is deliberate. Gum tissue does not respond to instruments on the day; it responds over weeks, as inflammation subsides and the tissue tightens back onto the root. You cannot compress that, and a practice that promises to sort everything in one visit is promising something the biology will not deliver.
Appointment 1 — the measuring appointment
This is the quietest appointment and the most important one. A thin probe with millimetre markings is walked gently around each tooth, and numbers are called out to an assistant: two, three, three, five. Those numbers are the depths of the gaps between gum and tooth. Shallow readings are healthy. Deeper readings mean the attachment has been lost and bacteria have somewhere to live where no brush can reach.
Recorded alongside the depths:
- Bleeding on probing — the single most honest marker of active inflammation.
- Loose teeth — graded, not guessed.
- Gum recession — how far the gum has moved down the root.
- X-rays — showing the bone level around the roots, which the probe cannot see.
At the end you have a chart of your whole mouth and a classification of how far the disease has advanced and how quickly it is moving. Ask to see it — it is your own data, and the pattern is often startling in a useful way: three healthy quadrants and one bad one is a common picture, and it usually corresponds precisely to where flossing has never happened.
The gap: paperwork, and why it exists
Before the therapy itself starts, your dentist submits a plan to your health insurance fund, which approves it. It is an administrative step, not a clinical one, and you will simply be given your next appointment once it is done. The full mechanics of coverage, what is included and what sits outside, are explained separately in Does statutory health insurance pay for periodontitis treatment? (EN).
Use the waiting time well: whatever you change in your home routine now makes the real work easier when it starts.
Appointment 2 — the conversation and the hygiene session
This appointment surprises international patients most, because it looks like it is “just talking”. It is a defined part of the therapy, and it is the part that determines whether the result lasts.
Two things happen. First, you go through your own findings: which teeth are affected, what caused it, what the plan is, and which risk factors in your life are pushing the disease along — smoking above all, then poorly controlled diabetes, then stress and grinding.
Second, the practical work. Someone watches you clean, which is mildly embarrassing for about ninety seconds and then extremely useful. You will most likely be sized for interdental brushes (Interdentalbürsten) — several different sizes for different gaps, not one size for the whole mouth — and shown the angle that actually gets under the gum edge. Floss is fine where the gaps are tight; where periodontitis has already opened the spaces, brushes clean far better.
Be honest here about what you will realistically do. A routine you follow every night beats a perfect routine you abandon in a fortnight.
Appointment 3 (and often 4) — cleaning below the gum line
This is the core of the treatment, and the part people are nervous about, so here is what actually happens.
The area is numbed with local anaesthetic — usually one half or one quadrant of the mouth at a time, so you are not left with a completely numb face. Then, working pocket by pocket, the root surfaces are cleaned: ultrasonic instruments to break up and flush out deposits, fine hand instruments to feel along the root and remove what remains. The tip goes where the probe went, and the aim is a root surface that is smooth and free of biofilm, so the gum tissue has something clean to reattach to.
The week after
Expect the gums to be tender for a few days and to react to cold. Both settle. What often unsettles patients more is the change in appearance: as swelling goes down, the gum shrinks back slightly, teeth can look longer, and small triangular gaps appear between them. That is not damage — it is the swelling leaving. The gaps were always there, hidden under inflamed tissue, and now they need cleaning with an interdental brush.
Sensitivity to cold at the exposed root necks is common and usually fades over weeks. A toothpaste for sensitive teeth helps in the meantime, and a fluoride varnish can be applied if it does not settle.
Bleeding, by contrast, should get better, not worse. Gums that still bleed at every brush three weeks later are a reason to ring us rather than to wait for the next scheduled visit.
The re-assessment, a few months later
After the tissue has had time to respond, everything is measured again — the same probe, the same points, the same chart. Now the comparison tells the story: pockets that were five or six millimetres and have come down, bleeding that has stopped, areas that stayed stubborn.
Three outcomes are possible, and all three are normal:
1. The mouth has settled. Most sites shallow and quiet. You move straight into the maintenance programme. 2. A few sites are still deep. Very common, particularly on the back teeth and between roots, where instruments reach worst. Those specific sites are addressed further, not the whole mouth again. 3. Response is limited overall. Then the honest question is what is driving it — smoking, blood sugar, an unreachable defect, or a home routine that has not changed. That conversation is more useful than another round of instruments.
If a site needs surgery
Surgical treatment is the exception rather than the rule, and it applies to defined areas that stayed deep. Under local anaesthetic, the gum is lifted a few millimetres so the root and the bone defect can be cleaned under direct vision — often, in our practice, using the microscope. The tissue is put back and secured with fine sutures, which are removed after about a week.
It is a smaller event than it sounds. People generally expect something dramatic and report afterwards that it was easier than the first deep clean.
The maintenance years — where the result is actually kept
After the active phase the treatment does not end; it changes gear. You enter a structured aftercare programme with appointments at intervals set by how severe your case was, running over a period of years. Each visit re-measures the pockets, removes deposits above and below the gum line where needed, and checks your technique.
This is not an upsell. Long-term stability in periodontitis correlates with regular maintenance more reliably than with anything done in the active phase — the disease is chronic, the bacteria come back, and the interval between professional visits is what keeps them at a level your body can handle.
What is normal after treatment — and when to contact us
Special situations worth flagging in advance
If you smoke, say so plainly rather than diplomatically. Nicotine narrows the small vessels in the gums, so smokers often bleed less and look healthier at the probe while losing more bone underneath. It changes how your results are interpreted, and stopping improves the response measurably.
If you have diabetes, bring your latest HbA1c: blood sugar and gum inflammation influence each other in both directions. If you are pregnant, treatment is not something to postpone out of caution — inflamed gums are common in pregnancy — but do tell us the trimester so appointments can be planned sensibly.
If you are an anxious patient, say it at booking, not in the chair. Longer appointments can be split, and sedation and laughing gas (Lachgas) are available.
If you are new to Germany, the sequence above is probably unfamiliar, and the vocabulary certainly is. English is one of our working languages, which for a treatment made of this many separate steps matters more than it does for a single filling — see English-Speaking Dentist in NRW. Expat patients from Düsseldorf, Cologne and Bonn regularly travel the 20 to 30 minutes to Wuppertal for exactly that reason.
For the active phase, typically three to four: measuring, the conversation and hygiene session, and one or two cleaning appointments. Add the re-assessment a few months later, and then maintenance visits at intervals set by the severity of your case. The whole active sequence usually spans a few weeks; the pathway as a whole runs for years, at a much lower intensity.
The cleaning itself is carried out under local anaesthetic, so the usual experience is pressure and vibration rather than pain. Afterwards, tenderness for a few days and cold sensitivity for some weeks are common. If you feel anything sharp during the session, say so — topping up the anaesthetic is routine.
Yes, in almost all cases. You will be numb for a few hours and your gums will be tender that evening. Plan the appointment so you are not giving a presentation immediately afterwards, and avoid very hot food and alcohol on the day.
Because the swelling has gone. Inflamed gum is puffed up and sits higher on the tooth; once the inflammation settles, the tissue tightens and returns to the level the underlying bone supports. It looks like loss, but it is the tissue telling the truth — and the exposed spaces now need cleaning between the teeth.
Sometimes, partly. When looseness is caused by swelling and inflamed fibres, teeth often tighten noticeably once the tissue settles. Where the bone around the root has genuinely been lost, some mobility usually remains, and a splint may be an option. Firmness is assessed at the re-assessment, not on the day of treatment.
Periodontitis treatment is a sequence you walk through, not an event you survive: measure, plan, clean, wait, measure again, then maintain. The active phase is a few appointments under anaesthetic and feels like a long, meticulous cleaning. The part that decides the long-term outcome is quieter — the interdental brush every evening, and the maintenance appointments you keep. If you know what each step is for, the whole thing becomes considerably less daunting.
Zahnarztpraxis Tsypin · Wuppertal. This article was medically reviewed and is provided for information; it does not replace an examination. Updated August 2026.
