This is the first line of treatment for periodontitis. It’s essentially a careful, intensive cleaning of the tooth root surfaces below the gum line to remove plaque, tartar, and bacterial toxins from the pockets.

Usually, the dentist will numb the areas (often doing one quadrant or half the mouth at a time under local anesthesia) so they can comfortably clean deep under the gums.

They’ll use special instruments or ultrasonic scalers to scale (remove deposits) and plane (smooth) the root surfaces, because smooth surfaces are harder for bacteria to cling to. Sometimes antimicrobials (like chlorhexidine) or antibiotic gels are placed in pockets after cleaning. Scaling and root planing helps gums reattach to teeth somewhat as inflammation reduces, thus shrinking pocket depth.

A few months after scaling and root planing, you may be asked to go see the dentist as they’ll often re-probe the gums to see how they’ve improved. Many pockets may reduce in depth and bleeding should significantly reduce if home care and maintenance have been good. If there are stubborn areas with deep pockets still (typically >5-6mm) or areas that bleed persistently, further treatment might be considered.

After the deep cleaning, you will need more frequent cleanings – typically every 3 months – rather than the usual 6 months. These maintenance visits allow us to keep disease under control, cleaning in areas that you might have trouble reaching. Periodontal maintenance is critical to prevent recurrence; periodontitis can’t be cured per se, but it can be managed, like diabetes or hypertension, with ongoing care.

Areas that do not respond completely to initial therapy, or for certain cases of advanced disease, may need to refer to a periodontist (gum specialist) or perform further interventions such as:

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• Periodontal Surgery: This can include flap surgery where gums are gently reflected (lifted) to allow direct access to deep tartar for removal and then repositioning the gum, sometimes a bit lower to reduce pocket depth. It could also involve bone grafts or guided tissue regeneration if trying to regenerate some lost bone in specific defects.
   

• Laser Therapy: Some practices use lasers as an adjunct to help disinfect pockets and potentially aid in reducing bacteria and contaminated tissue.
   

• Local Antibiotic Delivery: In isolated sites, dentists can place tiny antibiotic chips or gels (like doxycycline gel or chlorhexidine chip) into a deep pocket after cleaning, which releases medication over time to kill bacteria.
   

• Extractions: If a tooth is so compromised by periodontal disease (very loose, hardly any bone support, causing repeated infection), it may be better to extract it. This can also help protect neighboring teeth from ongoing infection. Extractions are last-resort when a tooth can’t be saved.
   

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