The American Academy treatment guidelines stress that the least invasive and most cost-effective treatment should be utilized to obtain periodontal health. For less extensive periodontal disease periodontal health can be achieved through non-surgical treatments alone, however, with more severe disease or if health is not obtained after non-surgical therapy, surgery may be indicated to prevent further loss of bone and or teeth. Scaling and root planing is a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins. Scaling and root planing is sometimes followed by adjunctive therapy such as local delivery antimicrobials, systemic antibiotics, and host modulation, as needed on a case-by-case basis.
For many patients, further active treatment is not needed after scaling and root planing. However, the vast majority of patients will require ongoing maintenance therapy to sustain health.