Gum Health Before Bonding: Why Stable Gums Come First
This page is for anyone considering composite bonding who has gum problems or has had gum disease. At Deepcar Dental Care, gum disease and tooth decay are treated before composite bonding. The page covers why healthy gums matter for composite, how gum health is checked, gum recession, and the treatment order.
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Clinically reviewed by Dr Ibraheem Ijaz, dentist · GDC 301711
Medical disclaimer: This page is for general information only. It does not replace an examination or treatment by a dentist.
Dr Ibraheem Ijaz, principal dentist at Deepcar Dental Care, reviewed this page. He is a General Dental Practitioner, GDC 301711.
Why does gum health come before composite bonding?
Two findings on restorations in general, set out below, bear on gum health. Inadequate restoration edges, or edges placed within the gum's attachment, can be associated with gum inflammation, and blood contamination can weaken composite's bond to dentine. The main composite bonding page explains the treatment itself.
The 2017 World Workshop on gum disease classification defines periodontal health as the absence of clinically detectable inflammation, and bases its definitions of gum health and gingivitis mainly on bleeding on probing, meaning whether the gum bleeds when it is probed. European Federation of Periodontology (EFP) guidance (2020) notes that periodontitis negatively affects chewing function and aesthetics. After gum disease treatment, the same EFP guidance defines a stable periodontitis patient by bleeding on probing at under 10% of sites, probing depths of 4 mm or less, and no 4 mm sites that bleed.
The edge of a restoration, its margin, matters too. EFP guidance says plaque-retentive factors, linked to tooth shape or, more often, to inadequate restorative margins, are often associated with gum inflammation or attachment loss. A World Workshop review (Ercoli and Caton, 2018) reports that margins placed within the gum's attachment to the tooth can be associated with inflammation and, potentially, recession, while margins in the shallow gum crevice do not cause gingivitis if plaque control and periodic maintenance are kept up. It calls the evidence in several areas not conclusive, and covers restorations in general, not bonding alone.
The background to a 2021 Cochrane review on isolating teeth during restorative treatment notes that effective control of moisture and microbes is necessary for the success of restoration procedures. A 2024 scoping review (Chen and colleagues) found that blood contamination adversely affected bond strength between resin composite and dentine, the layer beneath the enamel.
What do bleeding or swollen gums mean before cosmetic treatment?
Bleeding, swollen or sore gums are symptoms of gum disease, which the NHS says is important to get checked by a dentist. NHS guidance says to see a dentist if:
- your gums bleed when you brush your teeth or eat hard foods
- your gums are painful and swollen
- you have bad breath
- your child has sore, bleeding gums
NHS guidance says to ask for an urgent dentist appointment if you or your child has gum disease and other symptoms such as very sore and swollen gums, teeth becoming loose or falling out, ulcers or red patches in your mouth, or a lump in your mouth or on your lip. If you do not have a dentist or cannot get an emergency appointment, call 111.
The NHS toothache page says to go to A&E if you have toothache and the area around your eye or your neck is swollen, or swelling in your mouth or neck is making it difficult to breathe, swallow or speak. Do not drive yourself: ask someone to drive you, or call 999 for an ambulance.
Our page on gums that bleed during cleaning explains what bleeding when brushing can mean.
How is gum health checked?
In general, gum health is checked by probing around the gums for bleeding and pockets, a Leeds Teaching Hospitals NHS Trust leaflet explains.
Our gum disease page explains how gum disease develops and how it is staged.
If you are considering composite bonding, book an appointment online or call 0114 288 2121.
Is gum disease treated before composite bonding at Deepcar Dental Care?
Yes. At Deepcar Dental Care, gum disease and tooth decay are treated first, before composite bonding.
Gum disease treatment at Deepcar Dental Care includes non-surgical periodontal therapy, often called deep cleaning. The dental hygiene section, which covers hygiene appointments and gum treatment at the practice, sets out what each involves.
What is known about gum recession and composite bonding?
Restorations near the gum line might increase the risk of gum recession, as might inadequate oral hygiene and orthodontic treatment, a 2018 review found. The review, by Cortellini and Bissada for the World Workshop, says the root surface that recession exposes is frequently associated with impaired appearance, sensitivity, and decay or other lesions near the gum line. It describes recession and restorations in general, not composite bonding specifically.
Gum treatment can change the gum line too. The Leeds Teaching Hospitals leaflet explains that as gums become healthier, swelling reduces and the gums may shrink, so you might notice new spaces between the teeth or teeth that look longer. As the gums shrink, teeth may become sensitive to hot, cold or sweet things; this often gets better after a few weeks, but a sensitive toothpaste might be needed. Why gaps between teeth form is covered on its own page.
Gum recession treatment is offered at Deepcar Dental Care, and our page on receding gums and what can be done covers causes and options. Black triangle closure, for dark gaps between teeth near the gum line, is also offered, and the page on closing black triangles with composite explains it.
What order does treatment follow before composite bonding at Deepcar Dental Care?
Before composite bonding at Deepcar Dental Care, gum disease and tooth decay are treated first. Crowding can be addressed with aligners first, and bonding is ideally done once aligner treatment has finished. Whitening can be done first, and whitening before bonding is optional, not required.
A mock-up is offered before you commit to composite bonding. Bonding after braces or aligners is covered in planning bonding after orthodontic treatment.
Frequently asked questions
What happens if you have gum disease and want composite bonding?
At Deepcar Dental Care, gum disease is treated first, before composite bonding. The 2017 World Workshop consensus says clinical gum health can be restored following treatment of gingivitis and periodontitis. It adds that a treated and stable periodontitis patient with current gum health remains at increased risk of it returning, and must be closely monitored.
Is a hygiene visit part of composite bonding at Deepcar Dental Care?
Yes. At Deepcar Dental Care, a hygiene visit before treatment is included in composite bonding treatment. Separately, a hygiene appointment can be booked online through the booking portal, without registering as a patient. The NHS advises regular dental check-ups even if you do not have any problems.
How often are gums checked after gum disease treatment?
At Deepcar Dental Care, the recall interval is 3 to 6 months after treated gum disease, and 6 months with healthy gums. European Federation of Periodontology guidance says treated, stable periodontitis patients remain at increased risk of it returning, so if gum inflammation is present, measures to control it should be put in place.
Does smoking affect gum health before cosmetic treatment?
Yes, smoking affects both gum disease and its treatment. The Leeds Teaching Hospitals leaflet says that in smokers, gum disease is more likely to get worse and at a faster rate, treatment is less likely to work, and it is more likely to come back. Smoking cessation advice is available at Deepcar Dental Care.
Does gum health matter for teeth whitening as well?
Yes. At Deepcar Dental Care, teeth whitening is not suitable with active decay or gum disease, and a hygiene visit beforehand is recommended. If you are planning both treatments, whitening can be done before composite bonding, and whitening first is optional.
Book a consultation.
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Contact Deepcar Dental Care through the online booking portal or on 0114 288 2121, 8am to 8pm, Monday to Sunday. Patients describe their visits in our patient reviews.
Other suitability questions for composite bonding are among the options in this section.
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