Award Winner: Dr. Jim McCreight and Jamie Rotunno, RDH. The backbone of comprehensive periodontal therapy is scaling, the removal of bacterial communities, sometimes calcified, that are causing the infections in the gum tissue and the inflammatory response. When patients refuse scaling, there are not many alternatives. More brushing and flossing will not help singificantly. You can dismiss the patient, wait until the disease progresses and requires surgery or extractions or,