Periodontal Therapy

Periodontal Health and Disease

Periodontal health describes the condition of the supporting tissues of the teeth, including the gingiva, periodontal ligament, and alveolar bone. It is distinct from the health of the teeth themselves; teeth may appear structurally intact while the underlying support has already been compromised.

Changes in periodontal health are typically gradual and asymptomatic, with clinical signs often emerging after significant tissue loss has occurred. In more advanced stages, disease is defined by irreversible loss of supporting bone, accompanied by inflammation, gingival recession, and, in some cases, tooth mobility or loss. Tooth loss is not an inevitable consequence of aging, but rather the result of a pathologic process affecting the supporting structures.

ANNUAL EVALUATION

  • Comprehensive periodontal examination

  • Radiographic assessment of alveolar bone levels

  • Clinical evaluation of gingival tissue, inflammatory status, and occlusion

  • Individualized risk assessment

  • Salivary diagnostics (if indicated)

TREATMENT

Treatment is individualized and guided by the patient’s periodontal status:

  • Mechanical debridement to disrupt and remove subgingival biofilm and calculus

  • Salivary diagnostics and targeted pharmacologic agents to assess and modulate the microbial environment

  • Periodontal maintenance at intervals to maintain disease stability

Understanding Preventive and Periodontal Treatment

Dental cleanings are not uniform procedures. The type of care recommended is determined by the condition of the supporting tissues rather than by routine:

  • Indicated for patients with periodontal health.
    Bacterial deposits are confined above or slightly below the gumline, and the supporting bone remains intact. Treatment is preventive in nature—focused on maintaining stability and preventing disease onset.

  • Indicated when there is evidence of periodontal disease. Clinical finding include increased probing depths, radiographic bone loss, and bleeding on probing. In this setting, bacteria extend into deeper subgingival environments that cannot be managed with routine cleaning. Treatment is directed at decontaminating root surfaces and disrupting the microbial biofilm within these areas to control infection and halt progression.

  • Indicated following treatment of periodontal disease. One bone loss has occurred, the condition is managed rather than reversed. Periodontal maintenance is a specialized, ongoing therapy designed to preserve stability by targeting areas of prior involvement at regular intervals. It differs from prophylaxis in both scope and intent, reflecting the long-term nature of periodontal disease management.

Important Considerations

Those experiencing gingival recession (whether related to periodontal disease or not) may develop tooth sensitivity due to exposed root surfaces. In these cases, dental whitening should be approached with caution, as it may exacerbate sensitivity. Once periodontal disease is stabilized, bone and soft tissue grafting may be considered to help restore coverage and mitigate sensitivity.