Scaling and Root Planing

What is Scaling and Root Planing?

This is a therapeutic procedure that is used for the treatment of periodontal disease. It is also called a deep cleaning or non-surgical periodontal therapy. Scaling and root planing is done because you have an infection. The infection will not be resolved by a regular dental prophylaxis. A good comparison would be going to your regular doctor for you yearly physical. At this appointment they gather information. If you are healthy it may be all you need (like in the dental prophylaxis) but if you find out there is a more serious issue you will need treatment for the disease, the physical will not resolve any infection or disease. If you are told you need scaling and root planing you need this treatment to resolve your infection or it will not go away and will most likely progress.

Risks of uncontrolled Periodontal Disease include:

  • Continued infection
  • Loose Teeth
  • Tooth Loss
  • Bad Breath
  • Bone Loss
  • There is also an association between periodontal disease and diabetes, stroke, cardiovascular disease, Alzheimer’s disease and preterm low birth weight babies born to mothers with periodontal disease

If you are interested in taking a risk assessment test from the American Academy of Periodontology you can follow this link. It is quick and short but it can give you an idea of your personal risk.

When you get to the office for your scaling and root planing appointment you will be seated with the hygienist and be asked to sign a consent form. This form will be different depending on the office you go to but what you can expect is a general description of the procedure and a list of risks associated with treatment. For someone who is anxious this form can be intimidating. Think of it like the papers you get from the pharmacy when you pick up a new medication. Usually there are tons of risks listed but most are very rare. You are being told about any possibility so that you are completely informed before agreeing to anything. The most common things that patients experience after a scaling and root planing are:

  • A dull ache the day the scaling is performed. Generally taking an over the counter medication such as acetaminophen or ibuprofen is enough for this discomfort.
  • Bleeding, which will get better over the next day or so.
  • Sensitivity to hot or cold, areas that may have been covered with buildup are now exposed so sensitivity can occur.

A local anesthetic may be given. I let my patients choose if they want to be numbed or not. Not every patient will need anesthesia. If an anesthetic is given it is generally an injection like you would get for a filling. Most people call this Novocaine, but Novocaine has not been used in years. The most common anesthetic given today is lidocaine. A topical gel is placed on the gums before the injection is given to pre-numb the area to make the injection more comfortable. The topical gels or the non injectable option Oraquix numb only the soft tissues (the gums) but not the tooth itself. You may be more comfortable with one of these gel options if only the gums are tender, but if you experience a lot of sensitivity an injection may be necessary as this is the only way to numb the actual tooth. My general guideline for patients for numbing options is to let me know how you feel as we go. Don’t try to be brave, but I don’t think everybody needs to be numb. Numbing options are there if you need it but I’m not going to force it on you.

The next step is a complete periodontal charting. This involves measuring the space between the tooth and the gum with an instrument called a probe. If you are told “I am going to probe you now” this is the procedure. It sounds scary but it a very simple information gathering technique. The probe is like a little ruler. It is gently placed into the space between the tooth and the gum and a millimeter measurement is taken on six places on each tooth. Another measurement taken during this process is the amount of root showing above the gum line. These two measurements together are used to calculate the amount of bone loss. Any bleeding during this process is an indicator of disease.

After periodontal charting is completed removal of calculus (also known as tartar, the hardened stuff) and biofilm (plaque or the soft stuff) is completed. The hygienist may use hand instruments or ultrasonic/sonic instruments to do this. I always start with ultrasonics. They use sound waves to break up the hardened buildup. They spray a mist of water which is used to keep the instrument cool. Most of my patients like this instrument as it uses less pressure on the tooth and tends to be more comfortable. Some patients with a lot of sensitivity have discomfort from this instrument. In these cases I usually recommend the patient be numbed. Sonic instruments do the same thing, just with a using different sound waves. Very few places use the sonic instruments, ultrasonics are much more common. Since these instruments use water the suction will be used during this part of the appointment. I like to let my patients hold the suction. I find they tend to be more comfortable when they are in charge of something during the appointment. Some hygienists will bend the suction and hang it on the side of the mouth. Both ways work fine, it is really a matter of preference. If you want to hold the suction just ask, I’m sure it won’t be a problem. After the majority of the build up has been removed using the ultrasonic the hand instruments are used to remove any bits left behind and assure that the root surfaces are smooth.

Fast Tube by Casper

Scaling and root planing is usually scheduled by quadrant. This means that you may be scheduled for one or two quarters of the mouth in one appointment. This depends on the amount of build up and depth of pockets in the areas being worked on. Heavier buildup and deeper pockets will take longer to thoroughly remove all build up.

Additional treatments during the scaling and root planing appointment

The scaling and root planing explained above is often accompanied by more procedures to help promote healing and aid in bacterial removal. Compare this procedure to a kid who falls skateboarding. There will be a wound with bits of sand, gravel and other gunk stuck in it. The first step is to remove all this junk from the wound so healing can occur. You could stop here but better results will come from placing medication. Common medication procedures used with scaling and root planing include irritating the gums with Chlorhexidine Gluconate and placing antibiotic medications directly into deep periodontal pockets. Common types include Arestin and Atridox. I highly recommend these treatments as resulting healing is better. The antibiotic I have the most experience with is Arestin. I have seen excellent results using this. Placing Arestin is very simple. It comes in premeasured doses that are placed in a syringe and “injected” into the periodontal pocket. It is not an injection into the tissue, it is place into the space between the tooth and gum where the probe was used to take measurements. What is injected is a yellow powder that will time release for up to a month. You don’t need to have it removed, your body will absorb it over time. It doesn’t really taste like anything and the placement is pretty quick.

I also usually have patients take home a prescription rinse, either chlorhexidine gluconate or a stannous fluoride rinse. These rinses are strong antimicrobial rinses. They are not used long term, often for 2 weeks to a month. Prescription 1.1% neutral fluoride gel is another medication I often send patients home with. This is more of a long term treatment to help patients maintain the health achieved with the scaling and root planing and medications used.

The most important thing for patients undergoing nonsurgical periodontal therapy (scaling and root planing and medications) is that this is not a cure. It is not the end of treatment. Periodontal treatment is an ongoing commitment between the patient and hygienist. We must work together to maintain the bone that is left and prevent further loss. Home care is extremely important. Using an electric toothbrush, continuing to use your 1.1% neutral fluoride, flossing or other recommended treatments need to be done at home. You should see your hygienist about every 3-4 months for periodontal maintenance procedures to maintain and prevent disease. I say every 3-4 months but 3 months is the time frame needed by most patients. Your hygienist will be able to tell you what is best for you. Some patients try to push for the extra month between appointments and come back with bleeding and build up indicating disease has come back. Don’t let that happen. When the disease is active treatments need to be more aggressive, including going through the scaling and root planing procedure and medications again. This is far more costly than coming in 4 times a year. Maintenance is key.

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