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Treatment protocols differ
significantly with Specific Plaque Hypothesis.
Diagnosis of periodontitis (the existence of the process of gum disease) is accomplished by of visual examination to detect signs of gingival inflammation, bleeding and damage to periodontal structures in the form of pockets around teeth and bone loss detected on radiographs.
Diagnosis of anaerobic infection assesses who needs treatment.
Treatment involves local debridement (scaling and root planing) followed by topical 0.5% iodine irrigation and/or systemic antibiotic treatment which helps select in favor of healthy bacteria and alters character of dental plaque to low risk profile. Recall the slide on infected vs. uninfected plaque.
Debridement (scaling and root planing) should always precede the prescription of antibiotics as has been demonstrated by studies. The only time I will prescribe antibiotics prior to scaling is when the patient has acute periodontal abscess and the antibiotics serve to reduce the chance for bacteremia and/or acute exacerbation of infection.
Infection control promotes excellent healing response and does not require surgery. Using these treatments virtually eliminates need for surgery. 33