Hygiene Treatment Plan

Scaling and root planing (SRP) is a deep cleaning procedure that goes well beyond a routine prophylaxis. Using ultrasonic scalers and hand instruments, we remove calculus (hardened plaque) and bacterial toxins from root surfaces below the gumline, surfaces a standard cleaning cannot reach. It is the evidence-based first-line treatment for Stage I through Stage IV periodontitis, confirmed by AAP clinical practice guidelines and multiple systematic reviews.

Arestin (CDT D4381) is covered by some plans but excluded by others. Delta Dental's table of allowances shows $52 per tooth, though specific plan coverage varies. Diode laser therapy (D4999, billed by report) has no standard carrier allowance and is often out-of-pocket. We check your specific plan before placing any treatment and are transparent about expected patient responsibility before proceeding.

Since 2018, the American Academy of Periodontology classifies periodontitis using a Stage/Grade system. Stage I (mild) means 1-2 mm of attachment loss. Stage II (moderate) means 3-4 mm. Stage III (severe) means 5+ mm with possible tooth mobility. Stage IV (very severe) includes functional compromise such as bite changes or tooth loss. Your hygienist determines your stage by measuring pocket depths at six sites per tooth, evaluating radiographic bone levels, and recording mobility.

OraCare uses activated chlorine dioxide (ClO2) rather than chlorhexidine gluconate (CHX). Both are broad-spectrum antimicrobials, but they work differently. CHX kills surface bacteria through cell membrane disruption. ClO2 is small enough to penetrate the polysaccharide matrix of established biofilm, the protective layer that shields bacteria from standard antiseptics. This makes OraCare particularly useful for patients with active disease who have already developed mature biofilm communities. Unlike CHX, OraCare does not cause tooth staining and is safe for long-term daily use.

Nightguards are primarily indicated for bruxism, not periodontitis. However, parafunctional grinding forces compound the bone loss already occurring in periodontal disease, the sustained compressive stress on teeth with compromised supporting bone accelerates mobility and recession. Protecting the dentition from occlusal trauma is an adjunctive benefit in bruxism patients who also have perio disease. For bruxism alone, hard acrylic guards reduce EMG activity in the masseter and temporalis muscles and prevent the enamel wear and tooth fractures that clenching otherwise produces.

Not necessarily. We provide comprehensive periodontal therapy in-house, including SRP, diode laser decontamination, and Arestin placement. For Stage III and Stage IV cases, we evaluate clinical response after active therapy and only co-manage or refer when surgical intervention such as osseous surgery or grafting appears necessary. Many Stage III and Stage IV patients achieve disease control non-surgically with aggressive multi-modal treatment and strict maintenance schedules.

Most patients who complete SRP transition to periodontal maintenance (D4910) on a three- or four-month recall schedule rather than the standard six-month prophylaxis schedule. At each maintenance visit we re-probe all sites, remove new deposits, and reassess whether active disease is controlled. The maintenance interval may be adjusted based on your tissue response, home care effectiveness, and systemic factors such as diabetes or smoking status.

Yes, for most patients. A 2014 Cochrane review of 56 randomized trials found oscillating-rotating electric toothbrushes reduce plaque by 21% and gingivitis by 11% more than manual brushing. The superiority is most pronounced at the gumline, exactly where periodontal disease begins. The built-in two-minute timer and pressure sensors on most models also prevent the overbrushing and gum abrasion that many patients cause with manual technique. Sonic models (Sonicare) perform comparably, with some studies showing an additional hydrodynamic disruption effect slightly beyond the brush head.