Scaling & Root Planing
Treating Periodontal(Gum) Disease
Scaling and root planing is one of the most effective ways to treat gum disease before it becomes severe. Scaling & root planing removes bacterial plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins), followed by therapy such as localized antibiotics, as needed on a case-by-case basis. The goal of this therapy is regain attachment of the gum tissue to the tooth by removing the constant irritation and infection by the bacterial calculus deposits. The new attachment of the gum tissue reduces the depth of the gum pockets, enabling you to clean the region with normal home care instruments, (toothbrush and floss). After healing has occurred the patient enters maintenance therapy, an ongoing program designed to prevent recurrence of disease process in the gum tissues and bone supporting your teeth.
Scaling Vs. Root Planing
Periodontal scaling procedures include the removal of plaque, calculus and stain from the crown and root surfaces of teeth, whereas root planing is a specific treatment that removes the roughened cementum and surface dentin of the tooth that is impregnated with calculus, microorganisms and their toxins leaving a smooth root surface. Why is this necessary? It's easier for gums to reattach themselves to a smooth root. The smooth surface also helps keep dental plaque from attacking the tooth's root, making it easier to maintain the gums following treatment.
Your Office Visit
Usually, this procedure is performed by our highly trained hygienists. Depending on the severity of disease process the procedure is divided into quadrants of teeth.Typically with deeper pockets and extensive rough root surfaces, the deep scaling and root planing procedure might be broken down into quadrants of work per appointment. For example, the upper right side of the mouth might be worked on one day, and the three other parts worked on at separate appointments. We tend to focus on one quadrant at a time to ensure the quality of our performance, especially in advanced cases.
The Procedure
Does it hurt? Dr. Denny or the hygienist may need to use a local anesthetic to numb the area, so that the process is comfortable for you. Don't hesitate to discuss with your hygienist how to best manage any discomfort. On occasion an ultrasonic scaling tool maybe implemented, which use ultrasound vibrations to break up dental calculus. Although helpful, every patient does not require this type of tool. During the treatment the region may be irrigated with an antimicrobial agent chlorhexidine. Flushing the region with chlorhexidine removes bacteria, its toxins, and kills bacteria within the pocket. Dr. Denny or the Hygienist may place an antibiotic, into the pockets between your teeth and gums. The antibiotic will help speed healing and help prevent infection. This antibiotic will dissolve slowly over the course of about 1 week after the procedure.
What can I expect after?
- Discomfort can vary after root planing, but one can expect it to be more sore since it's usually in a deeper region under the gums.
- The teeth themselves can become a bit more sensitive to temperature, and bleeding might occur for a little while.
- Sensitivity toothpaste can be used to alleviate post op sensitivity.
- Over-the-counter painkillers such as ibuprofen work very well to alleviate discomfort, but stronger painkillers can be given should you need them.
- Brushing and flossing can be delayed or done more gently to avoid aggravating any bruised or tender gum areas.When you must brush, place the brush under some warm or even hot water to soften the bristles.
- You should be able to floss as usual, but be gentle under the gums.
- To promote healing, stop all use of tobacco. Smoking or using spit tobacco reduces your ability to fight infection of your gums and delays healing. For more information, see the topic Quitting Smoking.
- Your dentist or hygienist may recommend salt water (2tsp salt to 6oz warm water) or chlorhexidine rinses.
Periodontal Maintenance Therapy?
Maintenance therapy is an ongoing program designed to prevent recurrence of disease process in the gum tissues and bone supporting your teeth. The building blocks of this program are simple: conscientious care of your mouth at home and regular maintenance visits with your dentist.
Why is Maintenance Therapy Important?
The main cause of gum disease is bacterial plaque, a sticky, colorless film that constantly forms on your teeth. Toxins (or poisons) produced by the bacteria in plaque constantly attack your gums and teeth. If the plaque is not removed, it hardens into a rough porous deposit called calculus, or tartar. Daily oral hygiene including brushing and flossing will keep the formation of calculus to a minimum, but it won't completely prevent it. No matter how careful you are in cleaning your teeth and gums, bacterial plaque can cause a recurrence of gum disease from two to four months after your last professional cleaning. To keep your teeth and gums healthy, a dental professional must check for potential hidden problems and remove the hardened plaque at a time interval appropriate for you.
Periodontal(Gum) Surgery
If the pocket that has formed is inaccessible to the hygienist or does not heal during regular treatment, it may be necessary to gain access to the area to have it cleaned properly. Sometimes this is done by periodontal surgery, under local anesthetic, when the gum is lifted back so the dentist can clean the area and then lay the gum back in place. It is usually secured in place by a couple of sutures, and will then heal normally. In more severe cases the bone may need re-contouring or grafting of new bone to fill large defects in the ridge.
Deep cleaning and other periodontal treatments can largely be avoided if you are careful with your cleaning. One of the ideas of having regular check-ups and routine prophylactic cleanings, is to avoid such problems developing.
Periodontal (GUM) Disease; Gingivitis; Oral Hygiene; Bone Grafting