Is periodontitis curable?

No. Periodontitis is a chronic disease. It can be stopped and controlled, but not cured once and for all. Bone already lost does not come back. That is why the 2-year UPT (supportive periodontal therapy) is crucial. Without it, 60-80% of patients relapse within 5 years.

No. AIT (anti-infective therapy) is performed under local anaesthesia (Articain), pain-free. It takes 1-2 hours, working quadrant by quadrant with Gracey curettes and ultrasonics. Mild sensitivity for 2-3 days afterwards. A check-up follows one week later with instructions.

How often is UPT needed?

Per EFP 2017 classification. Grade A (low risk): every 6 months. Grade B (moderate): 4 months. Grade C (high, smokers, diabetics): every 3 months. For 2 years after PAR therapy, GKV covers UPT 100%. After 2 years, continue as PZR (80-120 €).

What is the PAR-Richtlinie 2021?

The PAR-Richtlinie is a G-BA guideline effective 1 July 2021 that completely rewrote periodontitis care in Germany. GKV now covers: Befundaufnahme (PSI + X-ray), AIT (anti-infective therapy), CPT (surgery if needed), UPT (2 years of supportive care) at 100%. Before 2021, patients paid out of pocket.

How much does periodontitis treatment cost in Hamburg?

With an eGK: 0 € (full coverage including 2-year UPT). Uninsured or private: Befund + X-ray 80-150 €, AIT 4 quadrants 400-800 €, CPT surgery 150-400 € per quadrant, UPT per visit 80-150 €. Bone regeneration surgery (Emdogain): 500-1500 € per tooth, partially covered by GKV.

Can teeth be saved with Stage III-IV periodontitis?

Depends on the state. Stage III: pockets 4-6 mm, bone loss 33-50%, often 80-90% of teeth can be saved. Stage IV: pockets 6+ mm, bone loss 50%+, tooth mobility grade 2-3, prognosis depends on response. Cochrane 2024: with Grade C plus smoking and diabetes, up to 30% of teeth must be extracted within 5-10 years.

Does periodontitis treatment help with diabetes?

Yes. DGZMK study 2023: successful PAR therapy lowers HbA1c in diabetics by 0.3-0.5%, comparable to a second antidiabetic drug. Periodontitis increases systemic inflammation and worsens glucose control. Gum therapy in diabetics is both dentistry and internal medicine.

Periodontitis Treatment in Germany: New Rules Since 2021

Thomas, 52, came to me complaining that his «teeth wobble». A smoker for 20 years, hadn't been to a dentist for 5 years. On probing: pocket depths 6-7 mm, BOP 60%, early bone loss 30% on X-ray. Textbook Stage III Grade C periodontitis. «Doctor, is this treatable?» I explained: «Yes. In 2021 Germany completely rewrote the PAR-Richtlinie. GKV now covers the full course and 2 years of maintenance, free of charge. Before that, patients like you paid 2000-3500 € privately». Four months later, Thomas's BOP was 12%, pockets 3-4 mm, the teeth held. The bone didn't return, but the disease stopped.

Periodontitis (Parodontitis) is a chronic bacterial gum infection causing bone loss and risk of tooth loss. In Germany 50% of 35-44 year-olds and 65% of those over 65 are affected (DMS-V). It is the leading cause of adult tooth loss, not caries. In this article: the new 2021 protocol (PAR-Richtlinie), what GKV covers, what it costs without insurance, and why 16 years of practice have convinced me that even Stage III periodontitis can be stopped if you come in time.

What Changed on 1 July 2021

The new PAR-Richtlinie (Guideline for Systematic Treatment of Periodontitis) came into force, issued by the Gemeinsamer Bundesausschuss (G-BA). Based on the 2018 Chicago Classification, it maps the entire journey from screening to long-term maintenance for the first time.

The New Classification System

Severity (Stage I,IV):

Stage I: Mild, attachment loss ≤2 mm. Stage II: Moderate, pockets ≤5 mm, no tooth loss. Stage III: Severe, vertical bone loss. Stage IV: Very severe, tooth mobility, functional impairment.

Rate of Progression (Grade A,C):

Grade A: Slow, no risk factors. Grade B: Moderate. Grade C: Rapid, risk factors present (smoking, diabetes).

PSI. Screening for Everyone

The Periodontal Screening Index (PSI) should be performed at least annually. PSI score 3,4 indicates full periodontal assessment and systematic therapy are needed.

Treatment Steps Under the New Guideline

AIT. Anti-Infective Therapy

Professional removal of plaque and calculus. above and below the gumline (Scaling and Root Planing). Under local anaesthesia, split across multiple sessions. Covered by GKV.

Reevaluation

8,12 weeks after AIT: repeat pocket measurements. Persistent deep pockets may require periodontal surgery. also covered by GKV when indicated.

UPT. Supportive Periodontal Therapy

The key innovation: structured maintenance for two years after active treatment. GKV covers appointments every 3,6 months. Before 2021, UPT was not a GKV benefit. Now it is.

Important prerequisite

Prior approval from the health insurer (Genehmigung) is required before treatment begins. Without it, costs are not reimbursed.

Red flags: when to see a dentist urgently

Periodontitis is painless in the early stages. Here are 5 signs that should bring you in within 2-3 weeks.

1. Bleeding gums every day

Blood on the brush for 2+ weeks is not «pressing too hard». It is gingivitis or early periodontitis. In 90% of cases it can be stopped with one PZR and better hygiene.

2. Persistent bad breath

Halitosis that lingers despite brushing, tongue scraping, and mouthwash often signals active periodontitis. Bacteria in pockets produce VSC (volatile sulphur compounds).

3. «Longer» teeth

Teeth look longer than before. Not imagination, but real gum recession. A classic mid-to-severe periodontitis sign.

4. Tooth mobility

If a tooth wobbles under tongue pressure, that is Stage III or IV. Urgent. Without treatment the tooth can be lost in 6-24 months.

5. Pus or metallic taste

A persistent unpleasant taste often indicates an active abscess in a pocket. Call 116 117 or your dentist within 24 hours.

What to do at home during treatment

PAR therapy only works in combination with home hygiene. Without it, relapse is guaranteed.

Brush twice a day, Bass technique

Electric brush in «sensitive» mode or manual with soft bristles. 2 minutes, short vibrating strokes at 45° to the gumline. Longer is not better; technique is.

Interdental brushes every evening

Not floss but interdental brushes. Cochrane 2019: 30% more effective than floss. ISO size 0-4 depending on gap, the dentist sizes them during UPT. Dinner, brushing, interdental brushes, bed.

CHX 0.1% short course

Two weeks after AIT, 1-minute rinse once daily. Not longer: brown staining, microbiome impact. Curasept ADS or Meridol med are best for extended use.

Quit smoking

Smoking is the #1 risk factor. Smokers lose teeth 4-7 times more often. After 5 years smoke-free, your risk drops back to non-smoker levels. Hamburg Suchtberatung offers free support.

Diabetes control

HbA1c should be below 7%. Uncontrolled diabetes makes PAR therapy fail. Before AIT, ask your GP to optimise glycaemic control. It's their domain too.

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