Initial Periodontal Sanative Therapy

The initial-first phase in the treatment of periodontal disease typically involves Sanative Therapy; a meticulous below the gum line cleaning that may include scaling, root planning, soft tissue curettage and dental prophylaxis. The objective of these non-surgical procedures is to remove the etiologic agents, bacterial plaque and tartar (calculus) that cause periodontal infection and disease.

Although the above procedures are essential for patients with periodontal disease to begin the healing process, scaling, root planning and prophylaxis are also employed as preventative measures (Periodontal Supportive Maintenance Care), to maintain our patients long term oral-periodontal health.

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The Importance of a Thorough Periodontal Examination

A thorough examination of the mouth is critical to define your future care needs. Dr. Novack’s comprehensive examination, along with his Periodontal FAQ page, will include a determination of the amount of plaque and tartar present, the degree of periodontal infection, the depth of the pockets, assessment as to whether infection has spread to involve the supporting structures of your teeth, (periodontal fibres and bone) along with X-ray analysis. The results of Dr. Novack’s assessment of your case documentation will define the extent of Initial Periodontal Sanative Therapy that you will require and thereafter, what further care may be needed. Dr. Novack either personally or in collaboration with his expertly trained hygienist will perform Initial Periodontal Sanative Therapy (scaling, root planning, soft tissue curettage and prophylaxis).

Dependent upon the severity of your condition, the extent and spread of infection in your gums, the amount of tartar present the depth of the gum pockets, Dr. Novack may recommend local anesthesia when performing Initial Periodontal Sanative Therapy procedure. Our office philosophy requires patient treatment be performed in a caring, compassionate and pain free manner.


Scaling:  This procedure involves the meticulous removal of plaque and calcified bacterial products (tartar or calculus) attached to the crowns and roots of the teeth.  Typically, an ultrasonic scaler is used first to dislodge the large deposits and debris both above and below the gum line while rinsing the area with a stream of water.  This is then followed by fine hand instruments that slip under the gum tissue to remove the remaining calcified deposits from the pocket area to complete the scaling process. 

Root Planning:  After all calculus or as much as can be reached has been removed, light strokes with fine scaling instruments (curettes) are used to remove a thin layer of the diseased root surface. Research has established that disease causing (pathogenic) bacteria and the poisons (toxins) they produce stick to and infect the tooth root surfaces and must be removed. A clean smooth root surface is required for the gum tissue to heal against. In addition, definitive root planning creates a glassy smooth surface that is then more difficult for bacteria to easily colonize in future.

Soft Tissue Curettage:  This step involves removal of the infected gum tissue within the inner lining of the periodontal pocket.  Soft tissue curettage promotes more rapid and thorough healing to occur.

Polish (Prophylaxis):  After scaling, root planning and curettage have been completed, your teeth will be polished to remove all stain and soft bacteria (plaque).  This procedure is generally repeated at each Initial Sanative Therapy appointment to maximize your healing response to the treatment.

Dependant upon the extent and severity of your condition, Dr. Novack may recommend antimicrobial agents, mouth rinses or other medication to control the growth of bacteria and improve your healing response.


Does it Hurt?During:  No. Our patients comfort is of paramount concern. A local anesthetic injection to numb teeth and gums is routinely employed during Initial Sanative Therapy.  Our patients thus find these procedures painless.

After:  The day of treatment, you will likely find your gum somewhat tender.  If home care instruments (below) are followed, this tenderness will resolve within 48 hours. If needed, a medication for discomfort will be prescribed.

Sensitive Teeth:  It is not uncommon to experience thermal sensitivity, especially to cold following Initial Sanative Therapy.  Keeping the area very clean by diligently brushing and flossing twice daily will decrease your sensitivity.  Should problems persist, please inform Dr. Novack or our hygienist Bonnie. At your next appointment, we would be glad to provide you with a desensitizing treatment.

Bleeding:  Slight bleeding is normal for up to a week to ten days following treatment.  Generally, should bleeding persist beyond that point, this indicates that the patient has not performed adequate home care.  Bacteria and infection re-establish quickly.  Even though the area may be tender, be vigorous with your twice daily home care.  If at all concerned, or if bleeding continues, please call our office.

Recession:  The goal of scaling, root planning and soft tissue curettage is to improve the health of your gum tissues.  Gums that are swollen, inflamed and infected are diseased.  With treatment coupled with your diligent home care, the swelling in your gums will shrink and the gums firm up. You may notice that the roots of your teeth may be more exposed and that there may be increased spacing between your teeth with healing. This is a normal and positive sign that healing has occurred.

Mobility:  It is not uncommon to experience a slight to moderate increase in tooth mobility initially following treatment.  Mobility is due to minor stretching of the gum tissue during the removal of debris and infection within the pockets.  Mobility is typically not a cause for concern as your teeth should tighten over time. Please be diligent with your daily personal care (brushing and flossing) to hasten your teeth firming up.


Brush:  Day 1- Run your tooth brush under warm water to soften the bristles. Then brush as you have been instructed but use less pressure. After the first 24 hours, return to a normal brushing pressure.Floss:  Be sure to floss twice daily. It is important to start the same day as your Initial Periodontal Sanative Therapy appointment.

Rinse:  You may rinse with ½ teaspoon of salt in a glass of warm water up to four times a day for the first 48 hours.  You should however avoid over the counter mouthwashes that contain alcohol.


The extent and severity of the infection and inflammation present, the amount of plaque and calculus above and below the gum line, the depths of the pockets and your own tolerance to dental procedures will all impact on the number of appointments you may require to complete Initial Periodontal Sanative Therapy. Dr. Novack’s goal is always to minimize numbers of appointments, time off from work and cost while expediting completion of patient care.

The ongoing removal of plaque and calculus from below the gum line represents an essential component in maintaining in periodontal health for your life time. Once the disease process has been controlled, generally your whole mouth can be cleaned and polished in a one hour appointment.  To maintain your periodontal health, scaling, root planning and dental prophylaxis should be repeated every three months.


Initial Periodontal Sanative therapy represents treatment critical to begin the healing process for your gums.  Calculus and plaque infect the gums and keep periodontal disease active.  Healing can only start in a clean mouth.  If bone and gum disease is slight to moderate, scaling, root planning, soft tissue curettage and prophylaxis may be all that are required to control the disease process.  If your disease is more advanced, Initial Periodontal Sanative Therapy will start the healing process, but may not be sufficient to return you to health.  After completion of all Initial Sanative Therapy appointments, a four to six week period for healing is generally allotted.  Dr. Novack will then evaluate your level of healing and disease control.  At this re-evaluation appointment, Dr. Novack will determine if additional treatment is required to control active disease in your mouth and return you to maintainable health.

When deep pockets remain between the teeth and gums, the complete professional removal of all plaque and tartar is unpredictable. Patients can only essentially clean above the gum line. Consequently, surgery may be needed to restore you to maintainable periodontal health.

Benefits of Initial Periodontal Sanative Therapy

Initial Periodontal Sanative Therapy has been shown to provide many oral health benefits. First and foremost, Initial Periodontal Sanative Therapy helps to bring the bacterial infection that has spread into your gums and potentially jaw bone under some measure of control.

Research has established that the bacteria that cause periodontal infections can travel through the blood stream and affect other areas of the body placing you at increased risk of in particular heart and respiratory diseases. The goal of Periodontal Sanative Therapy is to remove the bacteria that cause infection. As gum – periodontal pockets deepen beyond 3 mm, your health risks increase. In deeper pockets, more bacteria especially those known to cause disease are able to colonize. Eventually, a chronic inflammatory response is elicited that results in the permanent destruction of your gums and supporting jaw bone. Over time, untreated disease can lead to bone and tooth loss. Periodontal Sanative Therapy can help save your teeth. Finally, Periodontal Sanative Therapy contributes to a more aesthetically pleasing smile and improves bad breath (halitosis). Superficial stains on your teeth will also be removed adding an extra bonus to the procedures.

Teeth Polishing – Prophylaxis

Dental prophylaxis represents an above the gum line treatment to thoroughly clean and polish the teeth.  Prophylaxis is an effective adjunctive procedure to help keep the oral cavity healthier. The benefits include:

-Reducing Gingivitis. Prophylaxis represents an important treatment to control the progression of gingivitis. Once bacterial infection spreads below the gum line and has caused permanent destruction of the tooth supporting fibres and bone (periodontitis), more extensive treatments are required to bring the infection under control. There is no substitute for early disease prevention.

Plaque removal. Tartar (also referred to as calculus) and plaque buildup both above and below the gum line cause serious periodontal infection. Unfortunately, even with proper twice daily brushing and flossing, it is not always possible to personally remove all debris, bacteria and deposits even above the gum line. Specialized dental equipment and experience are required to detect and remove damaging tartar buildups.

A healthier looking smile. Stained and yellowed teeth can dramatically decrease the esthetics of a smile.  Prophylaxis is an effective treatment to rid your teeth of these unsightly stains. 

Fresher breath. Bad breath (halitosis) is generally indicative of advancing periodontal disease. A combination of rotting food particles and bacterial infection that has spread below the gum line to cause jaw bone death tend to be the primary factors that contribute to bad breath.  The ongoing removal of plaque, calculus and bacteria by our professional staff can reduce infection and thus noticeably improve halitosis.

Prophylaxis can be performed at our office or by your general dentist. Dependent upon the severity of your condition, it may be beneficial to have your Periodontal Supportive Maintenance Care (cleanings) performed by Dr. Novack who is more familiar with the full scope of your periodontal disease. It should be noted that gum disease cannot be completely reversed, but prophylaxis is one of the tools Dr. Novack utilizes to effectively halt its progress.