Risk factors for periodontal disease include cigarette smoking, diabetes, stress, poor oral hygiene, the presence of periodontal pockets, and heredity. Because the signs and symptoms of periodontal disease are not equal to the risk factors for periodontal disease, the method to determine a diagnosis of periodontal disease differs from the method to determine the risk for periodontal disease. Consequently, a comprehensive evaluation of periodontal status necessitates separate determinations for diagnosis and risk, which together comprise a broader description of a patient's periodontal status than diagnosis alone. Where subjective methods are used for determining risk there is a natural inclination to associate the level of risk with the severity of disease. While it is definitely true that high severity must equal high risk, it is just as true that low severity provides little or no information on risk level, because health must always go before severe disease (Martin, Page & Loeb, 2006.). Steps to Treating Periodontal Disease

The first step of treatment is to get rid of all of the known causes of the periodontal disease. Mouth bacteria found in saliva forms colonies on the teeth and tissues, which is called plaque. This clear film of bacteria is the main cause of periodontal inflammation and breakdown. Calculus, also known as tartar, is formed when salts from the saliva precipitate into the plaque. This forms a hard substance, which holds fast tightly to the tooth. Both the calculus and the plaque must be removed to attain a successful result. The patient is taught to get rid of the plaque, while the dental professional must get rid of the calculus. Initial preparation also includes creating an environment that makes plaque removal by the patient as easy as possible. Following Initial Preparation, the tissues are looked at again after they have had a chance to heal to see if more periodontal therapy is needed. If the disease has been arrested, the optimal periodontal maintenance schedule is determined for the patient. If the disease persists, further non-surgical treatment may be performed. If surgery is needed to get rid of pockets that persist, a surgical treatment plan is formulated (Diagnosis and Treatment of Periodontal Disease, n.d).

Initial Preparation usually creates shrinkage of the inflamed gum, and therefore a reduction of the pocket depth. Frequently, if the patient has excellent oral hygiene habits and keeps regular maintenance appointments, this is enough to stabilize a case. On the other hand, with pockets that continue to bleed when probed, or with pockets deeper than 5mm, there is a high likelihood the disease process will continue. In those cases removal of the remaining pockets is the best treatment. If it is apparent during the examination that surgery is needed to obtain the best result, parts of the Initial Preparation may be shortened or circumvented completely. Scaling and root planing may be done during surgery, when access is the most ideal. This approach avoids repeating steps of Initial Preparation that would be performed during surgery, saving time and reducing expenses (Diagnosis and Treatment...

It has been shown that without routine maintenance there is twenty times more of a chance of recurrent disease. Most patients who are vulnerable to periodontal disease must be seen for periodontal maintenance appointments every three months, rather than the characteristic twice yearly cleanings. Frequently, maintenance appointments are alternated between the general dentist and the periodontist. There is nothing a patient can do that is more important to maintaining a healthy mouth than flossing daily and brushing along with constant periodontal maintenance (Diagnosis and Treatment of Periodontal Disease, n.d).
Conclusion

Periodontal diseases are serious bacterial infections that destroy attachment fibers and supporting bone that hold teeth in place in the mouth. There are many risks that contribute to a person getting this disease. Some of these risks are modifiable while others are non-modifiable. Before any periodontal treatment is undertaken, a diagnosis must be made. In order to reach a diagnosis, the patient's dental and medical histories must be taken, a clinical examination must be carried out, and dental x-rays must be looked at. The first step of treatment is to get rid of all of the known causes of the periodontal disease. If these causes are modifiable then the patient needs to change their behavior if they are non-modifiable then steps need to be taken to mitigate these risks as much as possible. The key is to get an early diagnosis and then follow this up with the appropriate treatment.

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