Gum disease first: before Turkey teeth or implants

An implant is more exposed than a tooth

Peri-implantitis is inflammation around an implant, and it destroys the bone holding the implant in place. Often the first sign is bleeding when you brush, or gum drawn back far enough to show metal, and by then some bone has usually gone. The reason is the missing ligament: a natural tooth hangs from one, with its own blood supply; an implant, by contrast, sits straight against bone, so infection can travel along it faster and with little pain. A 2017 World Workshop review found strong evidence of higher risk with a history of periodontitis, poor plaque control or no regular maintenance after treatment.

Deep pockets around your remaining teeth also act as a reservoir for the bacteria behind peri-implantitis. The 2023 guideline from the European Federation of Periodontology (EFP) says prevention should start when implants are planned and carry on afterwards as supportive care, so the months between the two stays of dental implants in Turkey are part of that care.

Signs the disease is still active

Whatever you were told years ago, these suggest the disease is still active: gums that bleed when you brush or floss, most days and in more than one place; teeth that have started to drift or feel loose; a bad taste or bad breath that returns however well you clean. These signs only point the way; a pocket chart and X-rays of the bone levels settle it, and a clinic abroad should ask to see both before planning. Very sore, swollen gums or a loosening tooth need an urgent dental appointment, which NHS 111 can find in England; a swelling that spreads towards the eye or neck, grows fast or reaches under the tongue, or comes with a high temperature or trouble swallowing, needs A&E or an emergency department straight away, and difficulty breathing or confusion means calling 999 (911 in North America, 000 in Australia, 111 in New Zealand) instead of driving yourself (what happens if it goes wrong).

What treating the gums first means in practice

In the UK the starting point is the Basic Periodontal Examination, or BPE. The dentist divides the mouth into six sections, probes the teeth in each and records the worst finding as a code from 0 to 4. Under the British Society of Periodontology’s 2019 guidance, 0 means shallow pockets with no tartar or bleeding, 1 means bleeding on probing, 2 adds tartar or an overhanging filling edge, 3 means a pocket of 3.5–5.5 mm and 4 a deeper one; an asterisk marks furcation involvement, where bone has been lost between the roots of a back tooth. The guidance describes the BPE as a screening tool that should not be used for diagnosis. A 4 anywhere calls for a six-point pocket chart of the whole mouth, a 3 for charting of that section after the first round of cleaning, and both for X-rays; only charts taken before and after treatment show how the gums responded.

Treatment then usually runs like this:

1. Cleaning habits and risk factors, including smoking and blood sugar where they apply.
2. Deep cleaning below the gum line, often over several appointments with local anaesthetic.
3. A pause of several weeks while the tissue settles.
4. Reassessment with a new pocket chart, and further treatment where pockets remain deep, sometimes from a specialist periodontist.
5. Tooth-by-tooth decisions, then the plan, made with the gums stable.

A plan drawn up while everything is inflamed tends to write off teeth that could have been kept; drawn up at step five, it starts from the gums as they will be. Gum treatment in Turkey deals with where it can be done and the maintenance after.

Receding gums are a separate question

Gums that have drawn back can be the mark of disease treated years ago, or of thin tissue, hard brushing or a heavy bite. The pocket chart shows whether any of it is active now. Recession still limits where a crown or veneer edge can sit, and that side of it belongs to thin gums and recession risk.

Smoking and diabetes change the picture

Smokers’ gums bleed less, muting the main early warning of disease (smoking and implants). Smoking and diabetes are both recognised risk factors for periodontitis, and the EFP’s 2020 guideline makes tackling them part of the first step of gum treatment. Around implants the 2017 review called the data on either inconclusive; even so, clinics ask about both. Poorly controlled diabetes and active gum disease feed each other, so a clinic should want your recent blood sugar results; well-controlled diabetes on its own is not a reason to refuse implants. What to bring is listed in diabetes and dental treatment abroad.

Gums and Turkey teeth, four answers

Can Turkey teeth fix gum disease?

No. Crowns and veneers, the work behind what people mean by Turkey teeth, cover the visible teeth and do nothing for the pockets, the bacteria in them or bone already lost. Fitted over inflamed gums, they can hide the problem while the disease carries on underneath. Gum treatment comes first, and the cleaning that keeps the gums stable carries on afterwards.

Can you have implants if you have had periodontitis?

Often, yes, as long as the disease has been treated, your dentist has recorded it as stable and you keep up maintenance afterwards. The history still raises the risk of peri-implantitis, so expect closer reviews for as long as you have the implants.

Do veneers make gum disease worse?

They can, depending on where their edges sit and how they are made: a smooth edge on healthy gum need not cause trouble. A bulky or overhanging edge, or one pushed under swollen gum, gives plaque a ledge to collect on; the BPE records an overhang that traps plaque as a code 2.

How long after gum treatment can veneers or implants go ahead?

There is no fixed number of weeks. No work should go ahead unless your dentist has recorded the gums as stable, usually at a re-examination some weeks after the deep cleaning. Pockets still deep at that point mean more treatment first.

If you are planning to travel for the work

A tooth that cannot be saved can often come out early in gum treatment, so its socket heals while the rest of the mouth settles. The implant waits for the endpoint: the EFP’s 2023 guideline recommends treating the gums until no pocket deeper than 4 mm bleeds on probing and none reaches 6 mm, with maintenance under way, before an implant goes in. After that, whether an implant goes in on the day of an extraction depends on the socket: no active infection, enough bone, a stable site.

The deep cleaning usually fits into a week. The reassessment comes some weeks later, once the tissue has settled, and that time is spent at home. Two arrangements work.

• Gum treatment at home, the rest abroad. The NHS provides clinically necessary treatment to keep gums healthy, so this part often falls within it. Ask for the pocket charts from before and after, and send both on.
• Two trips. Gum treatment and any extractions on the first, timed so the flight home respects the wait in flying after dental surgery; the rest on the second, once a reassessment has recorded the gums as stable.

A single-trip quote that lists a deep clean on the first day and preparation or surgery a few days later has left out the reassessment. When a plan arrives, look for your pocket depths, a named person doing the maintenance afterwards and a line timing gum treatment against any preparation or surgery. If any of the three is missing, ask how the plan accounts for your gums before anything is booked. How to brief a clinic covers the first message, and a second opinion from a UK dentist a local reading of the plan. Where active disease and a fixed holiday date cannot be reconciled, read when not to travel for dental work before paying a deposit.

The next step takes one message to your own practice: “I’d like a copy of my BPE scores and my last gum chart, please.” Ask for the date they were recorded and any X-rays taken with them (in the US or Canada, ask for the periodontal chart instead of BPE scores), and attach all of it to your first email to each clinic.

Sources

• British Society of Periodontology. Basic Periodontal Examination (BPE) guidelines. 2019.
• NHS. Gum disease. 2026.
• NHS. Dental services available on the NHS. 2025.
• Sanz M, et al. Treatment of stage I–III periodontitis: the EFP S3 level clinical practice guideline. Journal of Clinical Periodontology. 2020.
• Herrera D, et al. Prevention and treatment of peri-implant diseases: the EFP S3 level clinical practice guideline. Journal of Clinical Periodontology. 2023.
• Schwarz F, et al. Peri-implantitis. Journal of Clinical Periodontology. 2018.