**6. Treatment of PD**

Typically, treatment for periodontitis includes physical removal of the biofilm and calculus from under the gingiva by way of scaling and root planning (SRP) followed by comprehensive care (CC) (www.NHS.uk; www.ADA.org) (**Figure 8**). Whereas, in cases where more severe destruction has occurred, flap surgery is performed, which is often accompanied by expensive reconstructive treatments and/or procedures. In all cases of PD, patients are advised to adhere to lifelong CC to mitigate any further destruction [73–76].

Adjunct therapies are often combined to optimise results following SRP [76]. For example, one type of host modulation therapy (HMT) consisting of a sub-antimicrobial dose of doxycycline (SDD), is an internationally approved adjunct treatment for PD. SDD acts through the inhibition of the pathogenic collagenase activity in the host, thus decreasing inflammation and tissue destruction [77].

Interestingly, some naturally occurring phytonutrients also may work through the management of the host inflammatory response. For example, chemically modified curcumin has been shown to be safe and effective for the treatment of PD and other inflammation-mediated diseases in animal models [77–79]. Another bioactive phytonutrient of interest is trans-resveratrol, which in combination with curcumin, has been gaining attention as a supplement for the prevention and treatment of PD and other inflammation-mediated conditions [80].

#### **Figure 8.**

*Scaling and root planning with an open (left) and closed (right) curettage for the treatment of periodontitis.*
