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Periodontal Therapy

What is periodontal therapy?

Periodontal disease known as Periodontitis or Gum disease, is the #1 cause of adult tooth loss in the United States.
On average, 50% of American adults between the age of 30 and 90 suffer from bleeding gums.

Some people have a higher risk of getting periodontal disease. Gum disease is particularly prevalent in smokers, people with systemic diseases (poorly controlled diabetes mellitus), stress or some people are genetically predisposed to developing this disease.

Periodontitis can occur in people of any age: children, adolescents and adults.

Pain usually is not a symptom of periodontitis. This absence of pain may explain why periodontitis is often advanced before the patient seeks treatment and why a patient may avoid treatment even after receiving a diagnosis of periodontitis.

There is relationship between periodontal disease and:

  • an increased risk of heart attack or stroke
  • an increased risk of delivering preterm, low birth weight babies
  • difficulty controlling blood sugar levels in people with diabetes

At Dr Kakos’ Office periodontal screening examination is an efficient information – gathering process used to determine the periodontal health status of the patient. We gather the detailed data needed to make a periodontal diagnosis:  pockets depth, bleeding, teeth mobility, furcation involvement, gum appearance, x-rays evaluation, and presence of deposits above and below gumline. We also review, very carefully, the medical and dental history for each patient. Then we develop dental hygiene treatment plan for patient based on the data we collected during examination.


Early stage of Periodontal Disease is called Gingivitis.

This initial stage is usually characterized by presence of inflammation of the gums around teeth, slight redness or swelling, bleeding gums due to bacteria and plaque build up. Gingivitis is usually painless and reversible with professional cleaning that removes all the plaque and tartar (hardened plaque) to reduce bacteria and its byproducts. This type of periodontal treatment will stop inflammation and reverse infection from progressing any further.

To treat gingivitis we perform cleaning with ultrasonic and hand instruments. This procedure requires two appointments: first appointment involves teeth scaling and second appointment: gums re-evaluation, final scaling and teeth polishing. Usually professional cleaning and good home care are enough to restore healthy gums.


Untreated gingivitis may progress to more severe form of gum disease, called Periodontits (periodontal disease, gum disease).

Periodontal Disease

Periodontal disease occurs when inflammation spreads to the tissue that supports the teeth: bone, PDL ligaments and tooth sockets.  Gum tissue have a red/blue color.  There is pronounced bleeding, gum swelling, puffiness, sensitivity and tender spots.  X-rays present slight to severe bone loss, depends of the severity of disease. Loss of support causes the teeth to become loose. More severe stages of periodontal disease may eventually lead to tooth loss. This process is caused by body’s immune system response to the bacteria, toxins and deposit accumulation in supporting structures.

Active Periodontal Disease. Visible tartar deposit surrounding teeth

Active Periodontal Disease. Visible tartar deposit surrounding teeth

Arrested Periodontal Disease. Stars indicate areas of recession.

Arrested Periodontal Disease. Stars indicate areas of recession.

To treat periodontal disease we use a “deep – cleaning” procedure known as a Scaling and Root Paining (SRP) in conjunction with Dental Diode Laser treatment and antibiotic treatment.

  • Scaling and root planning (SRP) involves the removal of calculus, bacterial plaque, bacterial toxins and diseased cementum (the outer covering of the root surface).  The purpose of this procedure is to shrink periodontal pockets and reduce infection to a level more manageable by individual immune system. We use ultrasonic instrument and we follow – up with special hand instruments to scrape away bacterial deposits above and below gumline. A combination of both techniques is our preferred approach. Full mouth Scaling and Root Planing w/ Laser treatment requires at least 4 appointments: One quadrant per appointment.
  • Laser Assisted Periodontal Therapy. The greatest opportunity to return tissue to a healthy state is Soft Tissue Laser. The goal is to decrease number of periodontal pathogens and to eliminate the diseased or granulation tissue of all of the teeth being treated.  This treatment is used in addition to conventional scaling and root planning.
    The diode dental laser energy is attracted to melanin, water , and to a small extend, hemoglobin- three components of inflamed, diseased tissue. Diode laser energy is thermal and actually vaporizes the targeted diseased tissue.
    The dental laser provides simultaneous coagulation of blood vessels, providing an optimal environment for fast healing. When used in conjunction with SRP therapy, is documented to be far more effective over the long term than scaling and root planning alone.
    Laser-assisted periodontal therapy also has an added benefit of minimal, if any, postoperative discomfort reported by patients.  Those hygienists who use the laser observe greater pocket reduction and better long-term tissue stability.
  • Arestin can be used as part of a comprehensive treatment plan for patient with gum disease. It is an antibiotic placed directly in the infected “pockets” in patient’s gum. It might be applied right after scaling and root planning (SRP) to kill harmful bacteria left behind and to help protect the area from further damage.
Arrestin application

Arrestin application


Surgical Periodontal TherapyAs the severity of periodontitis increases, it becomes more likely that some periodontal surgery will be needed to bring the tissue under control. Patients that require surgical intervention are seen by Dr J. Micaletti at our office.


We focus our treatments on maintenance appointments.  The goal of this stage of treatment is to prevent recurrence of periodontal disease by removing the bacterial microflora from the root surfaces within the pockets on a regular basis. If you’ve had periodontal disease and it has been treated, you may need professional cleaning more frequently.

It takes about three months before the pathogenic bacteria recolonize again in the pocket.  The inflammation may recur and some of the pockets may deepen again. That’s why the maintenance appointments should occur before the inflammation re-appears, because of the risk of continued bone loss and connective tissue attachment. An appointment for re-evaluation should be scheduled for 4 to 6 weeks after completion of deep cleaning. If there are still unhealthy sites present that exhibit signs of inflammation, bleeding or continued loss of attachment additional localized deep cleaning, laser therapy, periodontal maintenance or periodontal surgery may be recommended.

Regular maintenance, patient motivation and proper oral hygiene following professional treatment for gingivitis or periodontal disease are essential to fight the effects of these diseases and to make treatment successful.