The first step of treating periodontal disease is eliminating the causes that can be controlled. The bacteria of the mouth that is found in saliva forms a sticky film on the teeth and gums, plaque. Plaque is not only the primary cause of tooth decay but also periodontal inflammation and disorders. Tartar, also known as calculus, is formed when salts naturally found in saliva precipitate into the plaque. Another type of calculus, serumal calculus, forms under the gums from substances that naturally occur in some people’s blood. Both types of calculus are hard, rough substances that adhere tightly to the tooth.
Both tartar and plaque must be removed to have good periodontal and oral health. Removal of tartar requires a dental professional (hygienist or dentist) and the dental professional will teach the patient effective plaque removal techniques for everyday oral health maintenance. The following may be involved in non-surgical periodontal therapy:
- Education and demonstration of effective oral hygiene to remove surface plaque
- Scaling and root planing to remove calculus and deep plaque
- Creating an oral environment that makes plaque removal as easy as possible (can include replacing ill-fitting fillings that retain plaque)
- Bite adjustment
- Orthodontia for better tooth alignment
- Evaluation for extraction of any teeth with hopeless prognoses that are threatening other areas
After non-surgical treatment and sufficient healing time, the patient is re-evaluated to determine if further periodontal therapy is needed or if the patient is ready for maintenance. Different patients require different periodontal maintenance schedules, dependent on many factors. If the periodontal disease persists, further non-surgical treatment may need to be performed or a surgical treatment plan may need to be considered.