The Problem: Periodontitis, or gum disease, is a “polymicrobial” infection (“poly” – many; “microbial” – bacterial), which means it is caused by combinations of different types of bacteria. There are various forms of periodontitis, but all result from an interaction between bacteria and the body's immune (defense) system. Many of these bacteria are found in the biofilm (plaque) that collects on the teeth at the gum line, in the absence of effective daily oral hygiene. Bacteria migrate along the root surfaces upon which they calcify producing the hardened substance known as calculus or tartar. The inside lining of the gum tissues become inflamed and ulcerated in response to the presence of bacteria.

Thus in a susceptible individual, the resultant inflammatory response can cause destruction of the periodontal tissues and tooth-supporting bone — the ultimate consequence being tooth loss.

The Solution: The primary goal of periodontal (gum) treatment is to arrest the disease process. Treating gum disease is therefore aimed at controlling the cause. This is accomplished by what is known as “initial therapy” or “cause-related” therapy in which the affected root surfaces are cleaned and disinfected, allowing for the re-establishment of health. Susceptible individuals must also learn and be trained to remove bacterial biofilm to achieve optimum levels of daily oral hygiene. Once control of inflammation and infection has been established through initial therapy, secondary goals (in more advanced cases) may include surgical treatment, to assist in regenerating a healthy periodontal attachment to the teeth.

Treatment Techniques For Initial Therapy: The first phase of periodontal therapy consists of mechanical disruption of the biofilm. This requires clinical treatment to remove bacteria and calculus from the root surfaces of affected teeth. This treatment, known as “scaling and root planing” or “root debridement,” is traditionally carried out using hand instruments and/or ultrasonic (high frequency vibrational) instruments, both of which require a high degree of skill and tactile sensitivity. Non-surgical therapy is technique-sensitive and time-consuming. It was once considered necessary to remove the lining of “pockets” that form between inflamed gum tissue and teeth. However, research has shown that so long as bacteria can be effectively removed, the tissues can heal whether or not the pocket lining is removed with a procedure known as curettage.