The rationale for the treatment and management of periodontal disease has varied over the last three to four decades and as such the clinician should be aware of these changes to manage the condition effectively. For the example, the recognition that the modification and/or removal of the dental biofilm on the tooth surface is key to reducing the impact of the oral microflora on both the hard and soft tissues of the mouth rather than concentrate on the concept of the removal of ‘calculus removal and diseased cementum of the root to achieve success. The understanding of the role of the oral flora has also changed particularly with the emergence of the key pathogen hypothesis and this concept may have an impact on how the condition is managed. The improvement in instrumentation and surgical techniques together with the adjunctive use of antimicrobials in both non-surgical and surgical procedures has also impacted on our treatment philosophy. The aim of this paper, therefore, is to provide an overview on the dynamic changes in philosophy in the treatment and management of periodontal disease.