Some people mistakenly think that treatment in a periodontist's office always involves surgery.  In its earlier stages, periodontal disease actually responds quite favorably to non-surgical periodontal therapy. Surgical intervention is only necessary to treat the more advanced stages of periodontal destruction. In fact, surgery is reserved for those situations in which nonsurgical therapies have failed to achieve the desired clinical outcome and there is a need to gain access to the roots and bone to repair damage caused by periodontal disease.  Because of his years of additional training in the diagnosis and management of periodontal disease, Dr. Ramirez has specialized capabilities to perform an accurate risk assessment and develop an appropriate plan for management of your periodontal condition. The doctor follows the American Academy of Periodontology treatment guidelines, which stress that periodontal health should be achieved in the least invasive and most cost effective manner.

The primary cause of periodontal diseases is the body's inflammatory response to bacterial plaque.  The purpose of nonsurgical periodontal therapy is to remove or eliminate the etiologic agents which cause inflammation: dental plaque, its toxins, and hardened dental plaque referred to as calculus or tartar.

Oral Hygiene Training

Proper oral hygiene is the first step towards periodontal health.  If you've been diagnosed with periodontal disease, you may be more susceptible to future breakdown. For this reason, you may need to keep your teeth cleaner than most people. We take our role as coaches very seriously, so that you can improve your daily oral hygiene efforts.

There are so many products on the market that it can become confusing when choosing which products and tools to employ in your home oral hygiene regimen. Dr. Ramirez is a strong believer in the value of oral hygiene aides such as electric toothbrushes, interproximal brushes for between your teeth, and dental floss. We see excellent results with electric toothbrushes like the Oral B Braun or Sonicare brushes. 

If used in conjunction with brushing and flossing, fluoride toothpaste and mouth rinses can reduce tooth decay as much as 40%. Sensitive teeth toothpaste can assist with controlling the sensitivity brought on by exposure of the roots due to periodontal diseases.  Anti-plaque rinses contain agents that may help control gum disease in the early stages and should be used in conjunction with brushing and flossing.

Your periodontal hygienist is the best person to select the products that will work best for you. Dr. Ramirez encourages their patients to bring their oral hygiene aides with them to their prophylaxis, scaling and root planing, and maintenance visits, so that continuous oral hygiene training can take place.


A prophylaxis is a routine dental cleaning performed on patients with normal, healthy mouths to maintain health and prevent the initiation of dental diseases. Traditionally, it has also been utilized for the management of mild gingivitis patients who do not have significant calculus (tartar) built up below the gum line.

Scaling and Root Planing (Deep Cleaning) 99999

Scaling and root planning, also referred to as a deep cleaning, is a careful cleaning of the root surfaces to remove plaque and calculus (tartar) from deep periodontal pockets. This procedure smooths the tooth roots to remove bacterial toxins and make it more difficult for plaque to accumulate along the root surfaces. When performed properly, scaling and root planing can reduce gingival inflammation and probing depths and can shift the bacterial composition from one associated with disease towards one associated with health. It is considered an active treatment for periodontitis, and the results of the therapy should be assessed after adequate time for healing has been allowed. For those patients who achieve periodontal health following scaling and root planing, ongoing maintenance therapy is necessary to sustain health.

After scaling and root planning has been completed, many patients do not require any further treatment. However, nonsurgical therapy does have its limitations, and areas that have not responded favorably may require further treatment. Because of the complex anatomy of the root surfaces below the gum line, scaling and root planing is a much more demanding procedure than a prophylaxis. It is often necessary to perform the scaling and root planing treatment over the course of more than one appointment. Local anesthesia is used so that a thorough job can be performed in a comfortable manner for the patient.

Locally Delivered Antimicrobials

Locally delivered antimicrobials are antibiotic medications that are delivered directly into periodontal pockets to suppress or eradicate periodontal bacteria. They are utilized in conjunction with thorough scaling and root planing of the pocket. Dr. Ramirez and Dr. Gonzalez recommend the use of locally delivered antimicrobial medications in those patients who have a few sites that have not responded favorably to scaling and root planing or surgical therapy.


A reevaluation should be performed, following active periodontal therapy, to determine if the treatment goals have been achieved. For areas that continue to exhibit signs of periodontal disease, further active therapy may be indicated. Depending on the specific needs of the patient, the treatment options include continued non-surgical therapy, laser periodontal therapy, periodontal surgical therapy, dental implant therapy, or a combination of each. Dr. Ramirez and Dr. Gonzalez are able to asses your condition and effectively anticipate your response to various treatments available for management of your periodontal condition. 

Periodontal Maintenance

Periodontal maintenance is a specialized program developed for each patient once the periodontal condition has been improved.  These appointments tend to be more thorough than traditional six-month cleanings. They are designed to prevent periodontal disease from reoccurring in patients who have undergone treatment for periodontitis or dental implant therapy. This ongoing phase of treatment will allow the doctors and hygienists to assess your periodontal health and make sure that infection stays under control. Periodontal diseases are chronic diseases, just like diabetes. Without careful, ongoing treatment, periodontal diseases can and often do recur.



View More