The first step in treating most forms of gum disease is scaling and root planing. During this treatment local anesthetic is usually used, but not all of the time.
The periodontist removes plaque and tarter under the gum line down to the bottom of each periodontal pocket. This treatment may be done over several visits, or one or two, depending on the patients needs. This is achieved with ultrasonic instraments and hand scalers.
The removal of such accretions from the tooth surface can leave the root surface rough and uneven. A rough surface will attract more bacteria. Therefore, the root surfaces of the teeth are smoothed with hand instraments (or planed). This allows the gum tissue to heal and reattach to the teeth.
Oral hygiene instructions are also reviewed at each visit.
Four to six weeks after healing, a periodontal re-evaluation is performed. This is essentially the same exam as the comprehensive periodontal evaluation. During this visit the periodontist is looking for a decrease in pocket depth and bleeding.
If the patients diagnosis was moderate or advanced periodontisis, a secondary treatment plan is formulated and reviewed. The patient can move on to the secondary treatment plan if the bleeding index is much lower than at the initial consult.
If the patients diagnosis was beginning periodontisis this may be the end of active therapy for this patient. During this re-evaluation, the recall interval is established for all patients. This is how often the patients should be seen for periodontal maintenance. Most times the recommendation is a 3 or 4 month recall.