Scaling & Root Planing
Deep Cleaning For Patients with Periodontal Disease
Scaling and root planing — often called a deep cleaning — is a non-surgical periodontal treatment designed to stop the progression of gum disease. Unlike a routine dental cleaning that focuses on the surfaces of the teeth above the gumline, scaling and root planing targets bacteria, plaque, and hardened calculus that accumulate deep beneath the gums. During this procedure, we carefully remove infection-causing buildup and smooth the root surfaces of the teeth to help the gums reattach and heal. By reducing inflammation and eliminating harmful bacteria at their source, scaling and root planing is one of the most effective ways to stabilize periodontal disease and protect the bone that supports your teeth.
Key Benefits of Scaling & Root Planing
Choosing the right treatment for gum disease can significantly impact your overall health and well-being. Here are the key benefits of Scaling & Root Planing:
- Prevents Gum Disease Progression: Scaling and root planing effectively removes bacteria and toxins that contribute to gum inflammation, stopping the advancement of periodontal disease and protecting your oral health.
- Improves Gum Attachment: By smoothing root surfaces, this procedure promotes the reattachment of healthy gums to teeth, reducing pocket depths and creating a healthier oral environment.
- Freshens Breath: Eliminating bacteria and infected tissue not only improves gum health but also addresses persistent bad breath, boosting your confidence in social situations.
- Protects Overall Health: Treating gum disease through scaling and root planing can positively impact your systemic health, potentially reducing risks associated with heart disease, diabetes, and other conditions linked to periodontal inflammation.
- Preserves Natural Teeth: By addressing gum disease early, scaling and root planing can help prevent tooth loss and the need for more invasive treatments in the future, saving you time, discomfort, and expenses.
The Evaluation Stage
What to Expect During Consultation
When you visit our office for a consultation, our skilled periodontist will conduct a comprehensive examination of your gums and teeth. We’ll assess the extent of any gum disease, measure pocket depths, and may take x-rays to evaluate bone levels. This thorough evaluation allows us to determine if scaling and root planing is the most appropriate treatment for your specific case.
During this appointment, we’ll discuss our findings with you in detail, explaining the condition of your gums and the benefits of scaling and root planing. We encourage you to ask questions and share any concerns you may have. Our team will work with you to develop a personalized treatment plan that addresses your needs and helps you achieve optimal oral health.
The Treatment Process
What to Expect During the Procedure
- Scaling:
When scaling is performed, calculus and plaque that attaches to the tooth surfaces is removed. The process especially targets the area below the gum line, along the root. Scaling is performed with a special dental tool called an ultrasonic scaling tool. The scaling tool usually includes an irrigation process that can be used to deliver an antimicrobial agent below the gums to help reduce oral bacteria. - Root Planing:
Root planing is performed in order to remove cementum and surface dentin that is embedded with unwanted microorganisms, toxins and tartar. The root of the tooth is literally smoothed, which promotes healing, and also helps prevent bacteria from easily colonizing in the future.
Antibiotics or irrigation with anti-microbials (chemical agents or mouth rinses) may be recommended to help control the growth of bacteria that create toxins and cause periodontitis. In some cases, we may place antibiotic fibers in the periodontal pockets after scaling and planing. This may be done to control infection and to encourage normal healing.
When deep pockets between teeth and gums are present, it is not possible to thoroughly remove plaque and tartar or infection. Patients can seldom, if ever, keep these pockets clean and free of plaque. Consequently, surgery may be needed to restore periodontal health.
In Depth Explanation of Scaling and Root Planing
The American Dental Association specialty organization, the AmericanAcademy of Periodontology (AAP) has treatment guidelines stating that periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment, including root planing and scaling (a careful cleaning of the root surfaces to remove plaque and calculus (tartar) from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins), with adjunctive therapy such as local delivery antimicrobials, systemic antibiotics as needed on a case by case basis, depending on the severity of the disease. A dental professional, like a Periodontist that regularly studies the extensive periodontal literature can help you separate fact from hype and has the skills and techniques to perform these tasks.
Scaling is the process by which dentists and hygienists remove bacterial plaque (Biofilms), calculus, stains, food debris and other accretions from the surfaces of the tooth. Root planing is a separate procedure that can be performed at the same time as scaling but is best performed at separate appointments from the initial scaling during multiple visits of periodontal therapy. Root planing is a definitive treatment procedure designed to remove cementum or surface dentin that is rough, impregnated with calculus, or contaminated with toxins or microorganisms. Root Planing is the process by which residual embedded calculus and disease root cementum are removed from the tooth surface to produce a smooth, hard and biologically clean surface which helps allow patient’s oral tissues namely, the periodontal (gum) tissues, and supporting bone to repair, regenerate on the tooth root surfaces of the dentition. Root planing requires refined sharp smooth dental instruments made specifically for the procedure to create as close as possible a root surface smoothness once again, similar to the white enamel of a tooth, or a kitchen glass or other smooth surface that will minimize bacterial growth and help prevent repopulations of microorganisms on the root. The root surfaces during and after root planing should be tested for smoothness with special instruments.
For most patients of advanced periodontal disease, those having periodontal disease pocket depths of 5mm to 10mm or more, the favorable reduction in disease parameters will occur when root planing and scaling is performed repeatedly for each tooth for each of the 4-6 visits over 3-5 months. Research indicates significant periodontal health improvements with recordings of bacterial scores, bleeding on pocket probing, probing pocket depths and probing attachment levels following 3-5 months after start of therapy. Many patients have little to no discomfort when they have root planing and scaling done by experienced periodontal clinicians and require no anesthetics for pain or discomfort. As a contracted dental insurance company provider, the fees for covered periodontal services including these comprehensive services of root planing and scaling at my office, are established and they are usual and customary. Research indicates, however, that when pocket depths at some teeth persist despite this above approach to restore health, then periodontal surgery is indicated to visibly ensure that root planing is thoroughly performed to allow for pocket probing depths to return to the 1-3mm normal range and complete this root planing treatment task properly.
Will Surgery be Necessary After Scaling and Root Planing?
After assessing the results from root planing and scaling, it may be necessary to recommend additional treatment to help reduce deep, lasting pockets to the more normal range of 1-3mm. In order to create a more permanent, healthier environment around the teeth, periodontal surgery may be recommended in areas of the mouth that do not respond to non-surgical treatment (root planning and scaling).
Soft tissue plastic surgery may be needed to improve cosmetics, or regenerative surgery may be necessary to rebuild and replace the lost bone support around the teeth. During periodontal surgery, the doctor has an opportunity to visibly ensure that all calculus (tartar) on the root surfaces has been thoroughly removed and more importantly that the proper root planing is accomplished to provide the tooth root surface with a biologically clean surface. In addition, where possible, your gums and underlying bone supporting surfaces may be enhanced with tissue Growth factors such as found in medicine, to achieve optimal healing results, leaving the patient with shallower pockets and less gum recession.
Your gums will typically heal within 1-2 weeks. While the use of bone graft Growth-factors promotes more rapid healing than other therapies, it may take several months for bone to mature into its final dense structure. They will improve the health of the jaw bone and surrounding tissues that have been damaged as a result of periodontal disease. By using these, your surgeon is providing you with state-ofthe- art treatment which will enhance your potential to heal, beyond what other therapies have been shown to do.
The components used are safe and effective and have a history of safe use in other medical applications. In addition, they have been evaluated in one of the largest, most rigorous clinical trials ever conducted in the United States for a regenerative product in dentistry.
Most commonly available treatments provide a platform supporting the in-growth of tissues necessary to regenerate the diseased site. Treatment with Growth-factor Enhanced Matrix provides both a platform for regeneration to occur and an active growth factor which stimulates regeneration of bone and tissue. The active growth factor has been shown to attract cells necessary for healing and cause them to multiply. The growth factor is called platelet-derived growth factor (PDGF). PDGF is a wound healing agent found normally in the body. As the name implies, PDGF is a naturally present in your blood platelets. Platelets are cells normally involved in tissue repair. PDGF is released from platelets at a site of injury and stimulates the initiation of healing. This Growth factor Enhanced Matrix captures the power of this well known wound healing agent, by delivering PDGF in a highly concentrated, purified form, directly to the treatment site.
We advise our surgery patients, pre-operatively and postoperatively that they should experience no pain, no swelling, no bleeding after any type of surgery, just soreness at the surgical sites.
Shallower pockets are easier to maintain both for the patients and for the dental professionals who regularly and periodically clean their teeth and treat their gums.
Recovery and Aftercare
After scaling and root planing, it’s normal to experience some sensitivity and minor discomfort for a few days. Your gums may feel tender, and your teeth might be sensitive to temperature changes. We’ll provide you with detailed aftercare instructions to manage these symptoms and promote healing. Over-the-counter pain relievers can help alleviate any discomfort, and rinsing with warm salt water can soothe your gums.
You may notice some bleeding when brushing or flossing in the days following the procedure. This is normal and should subside as your gums heal. It’s crucial to maintain good oral hygiene during this time, gently brushing and flossing as instructed to support the healing process. We recommend using a soft-bristled toothbrush and avoiding hard or crunchy foods for the first few days after treatment.
Most patients can return to their normal activities immediately after the procedure. However, we advise avoiding strenuous exercise for the first 24 hours to minimize bleeding and promote healing. You’ll likely notice improvements in gum health within a few weeks, with reduced inflammation and firmer, pinker gums. We’ll schedule a follow-up appointment to assess your healing progress and determine if any additional treatments are necessary to maintain your gum health.
At our periodontal practice, we’re committed to providing exceptional care and support throughout your treatment process. By choosing scaling and root planing with our experienced team, you’re taking a crucial step toward improved gum health and a brighter, more confident smile.