Treatment of Periodontal Disease

Periodontal Scaling & Root Planing

The objective of scaling & root planing is to remove etiologic agents which cause inflammation to the gingival (gum) tissue and surrounding bone. Common etiologic agents removed by this conventional periodontal therapy include dental plaque and tartar (calculus).

These non-surgical procedures, which completely cleanse the periodontium, work very effectively for individuals suffering from gingivitis (mild gum inflammation) and moderate/severe periodontal disease.

Reasons for Scaling and Root Planing

Scaling and root planing can be used both as a preventative measure and as a stand-alone treatment. These procedures are performed as a preventative measure for a periodontitis sufferer.

Here are some reasons why these dental procedures may be necessary:

• Disease prevention: Oral bacteria which cause periodontal infections can travel via the bloodstream to other parts of the body. Research has linked lung infections and heart disease to periodontal bacteria. Scaling and root planing remove bacteria and can prevent periodontal disease from progressing.
• Tooth protection: When gum pockets exceed 3mm in depth, they house more dangerous bacteria. Chronic inflammation can lead to the destruction of tissue and bone, which may result in tooth loss.
• Aesthetic effects: This procedure removes tartar and plaque from teeth and below the gumline. Superficial stains may also be removed in the process.
• Better breath: Halitosis (bad breath) is often caused by food particles and bacteria, which are alleviated through cleaning procedures like scaling and root planing.

What Do Scaling and Root Planing Treatments Involve?

These treatments are only performed after a thorough examination. X-rays, visual assessments, and a diagnosis are made before starting. Depending on conditions, a local anesthetic may be used.

Scaling: Performed with special dental instruments, including ultrasonic scalers, this procedure removes plaque and tartar from crown and root surfaces. Irrigation may be used to deliver an antimicrobial agent below the gums.

Root Planing: This process removes cementum and dentin embedded with toxins and tartar. The root is smoothed to prevent future bacterial colonization and promote healing.

Antibiotics may be applied to soothe irritation and help the tissues heal. At a follow-up visit, the dentist checks gum healing. If pockets remain deeper than 3mm, more intensive treatments may be necessary.

Antibiotic Treatment

Periodontal disease is progressive and leads to inflammation and tooth loss if untreated. Antibiotics can be used alongside scaling, root planing, surgery, or as standalone treatments to reduce bacteria.

Antibiotics may be oral or topical. They’re effective in treating acute and chronic periodontal infections.

• Tetracycline antibiotics: These include tetracycline hydrochloride, doxycycline, and minocycline. They reduce inflammation and block collagenase (a tissue-destroying enzyme).
• Macrolide antibiotics: Effective at reducing inflammation and bacterial growth associated with periodontitis.
• Metronidazole: Often combined with amoxicillin or tetracycline to treat chronic or severe infections.
• Arestin®: A minocycline antibiotic in mini capsules, applied directly into gum pockets after scaling and root planing.

Visible improvements are often seen following antibiotic therapy. Your periodontist will recommend the best option for your condition.

Periodontal Surgery

Pocket reduction surgery—also known as gingivectomy, osseous surgery, or flap surgery—aims to access the tooth roots and remove bacteria and tartar.

Bacteria in plaque produce acids that cause tooth surface demineralization and contribute to gum disease. As infection spreads below the gumline, gum pockets form and deepen. This chronic inflammation destroys bone and tissue, potentially leading to tooth loss.

This surgery interrupts that cycle by cleaning out deep pockets and reducing their depth.

Bone Grafts and Guided Bone Regeneration (GBR)

Bone grafts are used during periodontal or implant surgery to support existing teeth or prepare sites for implants. These procedures restore stability and bone density in affected areas.

Ridge Preservation

Proper care of extraction sockets helps prevent bone loss and supports better cosmetic outcomes for tooth replacement. It maintains natural ridge shape and improves long-term success for implants or prosthetics.

Reasons for Pocket Reduction Surgery

Here are several key reasons why this procedure may be recommended:

• Reducing bacterial spread: Oral bacteria are linked to systemic conditions like heart disease, diabetes, and stroke. Reducing oral bacteria helps lower this risk.
• Halting bone loss: Inflammation causes the body to break down bone tissue. Reducing infection prevents further destruction and tooth mobility.
• Facilitating home care: Deep pockets are difficult to clean. Reducing pocket depth makes brushing and flossing more effective.
• Enhancing the smile: Treating gum disease improves the overall appearance of the smile and helps prevent aesthetic issues like gum recession or tooth loss.

What Does Pocket Reduction Surgery Involve?

The dentist will begin with x-rays and a thorough visual examination. Depending on the patient’s needs, the procedure may use local or general anesthesia.

The gums are gently pulled back, and calculus and bacteria are removed from the roots. Scaling and root planing smooth the root surfaces. An antimicrobial rinse is applied to promote healing. Finally, sutures are placed and typically left for 5–10 days.

Though gums may be tender following the procedure, patients typically experience reduced pocket depth and improved oral health.