Scaling and root planing Most periodontal lesions will respond to scaling and root planing. This difficult to perform procedure reduces edema, inflammation and probing pocket depths. It accomplishes this desired clinical outcome by physically removing plaque, calculus and other pocket contents. The routine use of systemic chemotherapeutic adjuncts is not recommended because its use will only suppress the etiologic agents, lead to adverse side effects and the development of resistant strains. Adjunctive local antimicrobials are often used at this time with varying degrees of success.
Chlorhexidine rinses twice a day are excellent ways to help the patient control plaque.
Oral hygiene instructions Oral hygiene instructions are paramount for the long-term reduction of plaque and the maintenance of the clinical status of the patient. Failure to properly insure that the patient has the appropriate tools to control plaque will lead to the perpetuation or initiation of periodontitis. Elimination of local factors Elimination of local factors other than plaque and calculus that may contribute to periodontal destruction should be performed as part of initial therapy. Consultation with the patient's physician is often indicated.