Diagnosis and Nonsurgical Treatment of Periodontitis: Pragmatic Utilization of Contemporary Knowledge.

Before initiating therapy for patients with periodontitis, clinicians need to consider diagnostic issues in light of current knowledge regarding a number of factors, including the etiology of periodontal diseases, patterns of periodontal disease progression, interpretations of bleeding on probing, hypermobility, radiographs, and probing assessments. Scaling and root planing to reduce biofilms and the bacterial challenge is an effective mode of therapy for treating many cases of periodontitis. Subsequent to tooth instrumentation, signs of gingival inflammation are reduced, and the magnitude of probing depth reductions and clinical attachment gains are related to initial pocket depths. Root debridement can be accomplished with manual instrumentation or power devices (eg, ultrasonic) in one quadrant at a time or via full-mouth debridement. Root planing should be limited to areas that are inflamed or have calculus to avoid removal of cementum and inducing root sensitivity. Endotoxins can be decreased through washing or use of an ultrasonic device. Periodic professional maintenance visits should be based on the patient's periodontal status and his or her ability to comply with maintenance protocols. Practical application of current concepts with respect to the diagnosis and treatment of periodontitis enhances periodontal therapy. [ABSTRACT FROM AUTHOR]