Periodontitis is a beast of a disease, sometimes we think we have it figured out and then we get a case where there is no calculus, low plaque scores, continued pocketing and attachment loss... what do we do? Katrina Sanders, RDH has the answers in this episode! In this episode we discuss: Definition of refractory periodontitis Subgingival microflora with high incidence of resistance Historical use of antibiotics and new resistance to them Use of topical oxidizing agents used subgingivally   Resources: More Fast Facts: https://www.ataleoftwohygienists.com/fast-facts/ Katrina Sanders Website: https://www.katrinasanders.com  Katrina Sanders Instagram:   https://www.instagram.com/thedentalwinegenist/  www.perioprotect.com/RDH www.perioprotect.com/claims - READ THE RESEARCH HERE! Magnusson I, Walker CB. Refractory periodontitis or recurrence of disease. J Clin Periodontol. 1996 Mar;23 (3 Pt 2):289-92. doi: 10.1111/j.1600-051x.1996.tb02091.x. PMID:8707992. Cochrane, R. B., & Sindelar, B. (2015).  Case series report of 66 refractory maintenance patients evaluating the effectiveness of topical oxidizing agents. J Clin Dent,26(4), 109-114.