Teeth Scaling and Root Planing


The most common and conventional treatment for gum disease (i.e., gingivitis) and periodontal disease (i.e., loss of oral bone supporting the teeth) are teeth scaling and root planning. Scaling consists of removing plaque and calculus (commonly called tartar) that have attached to the surfaces of the teeth. Scaling and root planning particularly target the tooth areas below the gum, along the tooth root. Plaque usually adheres to the rough tooth surfaces, so during root planing there is an attempt to remove any and all plaque and calculus, and to also smooth out any rough and irregular tooth root surfaces. Dental plaque forms from bacteria and other substances in the mouth, and tends to be very sticky, thus adhering to the tooth. In most case, overtime, plaque will harden to form calculus.

Why is this procedure used?

Periodontal disease is caused by certain bacteria, and unsmooth tooth surfaces make it easier for the bacteria and plaque to adhere to the tooth surfaces and roots. Periodontal scaling and root planing are performed to remove these bacteria, plaque and the resulting calculus, and to smooth the root surfaces, making it harden for plaque to congregate in these areas, thus trying to prevent periodontal problems from recurring. However, immediately after the scaling and root planning, the periodontal tissues will heal, and there will be dramatic improvement to you gums and the teeth�s supporting structures. Scaling and root planning have been shown to be extremely efficient in resolving gingivitis. However, when more advanced periodontitis exists, scaling and root planning are usually the first step, and this may in turn be following by surgical procedures to resolve the problem. Even when a surgery is required, scaling and root planning are used during the surgery.

Patient Concerns to be Addressed:

Scaling and root planning may cause aches and pain for certain patients. Prior to the procedures, some local anaesthetic(s) can be used to numb the area of the mouth being treated.

How is this procedure performed?

Scaling and root planing are performed by using hand-held dental scaling instruments shaped to reach certain areas of the mouth and teeth; these instruments are not powered. These are usually used in combination with ultra-sonic electric or air-powered scalers with copious amounts of water to make sure that the teeth are not damaged by heat, and to help wash out the loose calculus and other debris. The ultra-sonic scalers that are attached into the hand piece are usually dull tips made of metal that pulsate at extremely high frequencies and knock the plaque and calculus from the teeth being working on. These are typically used first to remove heavy plaque and calculus deposits from the exposed tooth crowns and root surfaces. This is followed by the hand-held scalers and curettes in order to ensure that the teeth are clean and smooth. Hand-held instruments produce a much finer tactile sense for the operator(s), and allow them to remove non-visible plaque and calculus using their touch, and to also feel if the tooth�s root is smooth. In some cases with gingivitis only, one visit is required for this procedure to be completed. However, for individuals with periodontitis, several visits are required. A periodontist usually performs the scaling and root planning on one quarter of the mouth (i.e., a quadrant) each dental visit.

Post-Operative Concerns:

For a few days after the scaling and root planning is performed, you could experience soreness, and sensitivity to heat and cold. You can use a non-prescription pain reliever to remedy this situation. Your dentist or periodontist may also ask that you use an antibacterial mouth rinse after the scaling and root planing. This will be helpful for sore gums and also as an efficient oral hygiene measure. But, make sure that you continuing to brush and floss. You may also experience small amounts of bleeding for several days following the procedure, but this usually subsides rather quickly.

Perils of Periodontitis:

Periodontitis therapy reduces gingivitis and removes periodontal pockets that may entrap plaque. Thus, with successful treatment, your gum tissue can recede and shrink, leaving some of the root surfaces exposed. The more severe the initial periodontitis, the higher probability that your gums will shrink and expose the tooth�s root surface. The exposed tooth can cause tooth sensitivity to brushing, heat and cold temperatures. It can also make your teeth look longer. The root surfaces are also not at hard as the tooth enamel found on the crowns of the teeth; you may be more susceptible to root surface caries. Your dentist in all likelihood will give you a prescription for a gel that contains higher amounts of fluoride than regular toothpaste, to prevent this from happening. Remember, it is more important now that you brush and floss efficiently. Also, if you need to be pre-medicated with antibiotics prior to a dental procedure, make sure that you let your dentist and hygienist know ahead of time.