The periodentium is the investing and supporting tissue of the tooth and consists of the periodental ligament, the gingiva, cementum and alveolar bone.

• Dental plaque
• Stains
• Calculus

Trauma from occlusion plays important role in contributing destruction of periodentium.

Dental plaque : It is a soft, amorphous granular deposit which accumulates on the surfaces of teeth, dental restoration and calculus. It cannot be removed by air or water spray. It cannot be seen clinically. Removal requires mechanical brushing.

Plaque is a monolayer of bacteria. Plaque grows by the addition of new bacteria, multiplication of bacteria and the accumulation of bacterial products. Heavy deposits of plaque show nodular globular appearance. It is not a food residue. Plaque formation is more during sleep. After removal, plaque gets formed within 4 hours and maximum plaque gets formed within 30 days.

Calculus : Calculus is dental plaque which has undergone mineralization. Saliva is mineral source for supragingival calculus and gingival fluid most likely furnishes the minerals for subgingival calculus. Microbial colonies undergo central calcification which enlarge and coalesce to form a calcified mass spread.

Initial deposits of plaque results in gingivitis. When deposits gets calcified, supra and subgingival calculus gets formed. It results in detachment of gingival resulting formation of periodontal pocket (Periodentitis). Pyorrhea is chronic generalized suppurative periodentitis.

Treatment :

• Removal of soft and hard deposits by scaling.
• Removal of unhealthy granulation tissue from inner walls of the pocket by curettage.
• Removal of unhealthy gingiva - gingivectomy.
• Removal of hyperplastic gingiva - gingivoplasty.
• Pocket eradication by Flap operation - Mucoperiosteal flap is reflected. Inner side of the flap is cleaned, all unhealthy granulation tissue removed, cementum filed and flap sutured back for good reattachment.