Phase One Perio involves a lot of scraping, digging and smoothing of the diseased root surface. Called scaling and root planing, it's a non-surgical treatment that involves removing the offending substance above and below the gum.
Scaling removes the deposits of tartar above and below the gum. A scaler looks like a pen with a curved end, making it easier for the hygienist to get into the hard-to-reach spots, such as the pockets. Scaling also removes any diseased bacteria (called bacterial endotoxins) that may have gotten under the gum and stuck to the root surfaces. After scaling, most hygienists go over the area again with an ultrasonic vibrating tool, which acts like a mini sand blaster that literally blasts the more accessible hardened deposits off the teeth.
Root planing goes after the bacterial endotoxins under the gum and removes any diseased cementum (that cell layer covering the outside of the root that keeps the tooth attached) that might be there as well. Root planing smoothes the area the same way a carpenter buffs away roughness in a piece of wood.
If the gum tissue is also inflamed, the hygienist or dentist will do something called curettage. Curettage removes the inner lining of the inflamed tissue, which then allows the new tissue to heal against the newly cleaned, "buffed" root surface.
Once cleaned out, the gum tissue should shrink and tighten around the newly cleaned root surface, eliminating much of the pocket. Once the tissue is healed, the pocket then has to be monitored to see if phase one was successful.
Before she sends you home to care for your tender healing gums, your hygienist may also insert a chemotherapeutic agent into the area, either in a chip that she'll stick under your gum flap or a gel, called Arestin, which she'll insert with a syringe. They usually contain an antibiotic, such as doxycycline or minocycline, which kills any remaining bacteria, speeds healing time and helps the pocket shrink faster. They're time-released and continue to work for about ten days. Many hygienists also like to give patients an anti-bacterial rinse, called Peridex (lab name: chlorhexidine gluconate). Peridex stains teeth, so you need to over compensate with an at-home stain removing, whitening product during the entire time that you use it.