The goals of achieving and maintaining periodontal health lead to the endpoint of obtaining a healthy and functional dentition for life. We track progress towards that endpoint by assessing the health of the periodontal attachment apparatus structures. Therapeutic options are evaluated by the degree to which those outcomes are met, as well as with the relative costs (measured in dollars, time, morbidity, comfort, esthetics, etc.) required to achieve them. All therapies which assist in limiting the deleterious effects of the host response to periodontal pathogens can be considered bone-preserving, as well as tooth-preserving therapeutic options. The most effective therapies may be those most under-rated in the minds of some dental professionals. Adequate plaque control by the patient and routine scaling and root planing and adjunctive therapies in the general practice and periodontal practice are essential to attain and maintain periodontal health for most patients. Surgical therapies complement non-surgical therapies to provide a range of valuable options.
Gordon Douglass, installed as president of the AAP September 25, 2002, addresses treatment goals and strategies in his January 24, 2003 letter to the Medical/Health Editor of the New York Times, AAP treatment guidelines have always stressed that periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment, including scaling and root planing (a careful cleaning of the root surfaces to remove plaque and tartar from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins), followed by adjunctive therapy such as systemic and local delivery antimicrobials and host modulation, as needed and on a case-by-case basis. Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment, including surgical therapy. Most periodontists also agree that determining surgical needs before assessing a patient's response to non-surgical therapies is putting the cart before the horse. In fact, surgery is reserved for those situations when non-surgical therapies have failed to achieve the desirable clinical outcome of periodontal health, and to repair damage to gum tissue and bone as a result of periodontal disease."