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The Dissolution of Necrotic Periodontal Tissue

Dr. James McCreight and Donna Medina, RDH.

Their patient visited McCreight Progressive Dentistry in Steamboat Springs, CO in early September 2021 with the chief complaint of debris on back of his lower teeth, suppuration (pus) and a fetid odor.

Upon examination, Dr. McCreight found areas of Acute Necrotizing Ulcerative Gingivitis (ANUG)- like lesions combined with significant lower anterior bone loss, generalized subgingival calculus and severe inflammation. Diagnosed as Stage 2, Grade B periodontal disease, they began treatment based on the guidelines for wound therapy developed by the US Department of Health and Human Services for Local Wound Care and the Association for the Advancement of Wound Care (

Dr. McCreight’s main goal was to address and treat the cause of the opportunistic bacterial infection by cleansing the affected tissue and having the patient apply topical antimicrobial agents with the additional benefits of oxygen with Perio Tray™ delivery of Perio Gel™ with 1.7% hydrogen peroxide. He prescribed Perio Protect to reduce the anaerobic microorganisms and improve periodontal health with oxygen therapy.

The patient’s treatment began with two debridement appointments in September 2021 followed by Perio Tray™ therapy on October 21, 2021. The patient returned for recare on December 17,2021 when photos and periodontal charting were completed and when scaling was scheduled to start in February 2022.

At the December 2021 appointment, photos and perio charting demonstrate localized clinical attachment gain in the lower anterior region with a significant decrease in infection and inflammation. Bleeding on probing (BOP) decreased by 62%: 85% of sites before debridement and Perio Tray™ therapy dropped to 33% of sites with BOP at this December visit. The patient also noticed a lightening of tooth shade.

The patient continued to use Perio Tray™ therapy until he returned for laser assisted therapy with scaling and root planing in February 2022.

When he returned in April 2022 at his post SRP evaluation appointment, photos and perio charting illustrate additional reductions in inflammation, bleeding, and pocket depths. BOP dropped to 9% of sites.

Pocket depths continued to improve over time. By February 8, 2023, pockets over 4mm dropped from 83% of the pretreatment sites to 10% of all sites.

The best part is that this patient is happy and states his mouth has never felt healthier. Improving patient health and working with a great team is the ultimate win for hygienist Donna Medina. She first became interested in “teeth” in middle school, when she had extensive orthodontic treatment. The work culture at her orthodontist inspired her to work in a place like that office. She found it at McCreight Progressive Dentistry where she credits Dr. Jim McCreight and Dr. Wendy McCreight for opportunities to develop as a hygienist. “I was given the opportunity to treat patients from a systemic approach,” Medina explains, “and to practice as an oral health provider. MPD has continued to provide many hours of continuing education, hands-on learning, and full latitude of bringing new ideas to the team. The hygiene program at McCreight’s (MPDWay) is the most progressed it has ever been, and I am proud to be a part of that growth.”

Perio Protect is also proud to be a part of that growth. For additional information on McCreight Progressive Dentistry in Steamboat Springs, CO, visit

Details on prescription Perio Tray™ Therapy is available at Research results are posted on


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