Perio Scaling and Root Planning
Periodontal (gum disease) is an acute or chronic infectious process affecting the tissues surrounding the teeth. This includes the gums and the fibrous attachments which buttress the teeth and supporting bone. Gone unchecked, periodontal disease can result in bone loss and eventual loose teeth and tooth loss. It is often associated with systemic conditions such as diabetes and heart disease.
Periodontal disease is usually a slow, painless and progressive process. Most adults with periodontal disease are unaware they have it. If diagnosed and treated early, however, the teeth can be saved.
The primary cause of periodontal disease is the accumulation of bacterial plaque at and under the gum line. Plaque is an often colorless mass of bacteria and food debris that sticks to teeth, dental crowns, dental bridges and other tissues in the oral cavity. Plaque is constantly forming on the teeth and must be removed regularly to maintain dental and periodontal health. Inadequate oral hygiene results in irritation of the gums, causing them to become red, tender, and swollen.
Over time, plaque combines with natural minerals in the mouth forming calculus (tartar). These hard concretions adhere to the teeth and form a rough surface on the teeth and roots, allowing for even more plaque accumulation. Calculus of itself does not cause the deterioration of the periodontal attachment. Rather, it serves as a substrate for the further colonization of bacterial plaque on the irregular root surfaces. The bacteria initiate and perpetuate the inflammatory process that causes periodontal disease.
After X-rays, a clinical dental exam, including a periodontal charting, patient education, scaling and root planing is the first treatment for periodontal disease. The procedure serves to remove the calcified irritants under the gums to reduce inflammation and infection.
One-fourth or half of the mouth is anesthetized so that the hygienist can comfortably scrape below the gums. This is called scaling and it's similar to removing the scales from a fish. The procedure may be performed by a dentist, dental hygienist or periodontist (gum specialist), using hand instruments or ultrasonic vibrating instruments to blast deposits off the teeth.
Scaling alone may leave a rough surface, so it is usually combined with root planing. Just as a carpenter planes a door to make it smooth, the hygienist carefully planes the root surfaces to avoid future buildup of calculus. Smooth root surfaces allow the gums to regenerate without irritation. The gum tissue shrinks and tightens around the teeth because the irritant has been reduced or eliminated.
Consequently, after several days or weeks, depending on the severity of the condition, there is a dramatic reduction in gum bleeding. After scaling and root planing is completed and the soft tissues have healed, the status of the periodontal structures is determined by another charting of pocket depth. The ultimate goal is a shallow valley around the teeth with a depth of 1 to 3 mm. This may be cleansed with good hygiene techniques.
One common side effect of periodontal scaling is sensitivity to hot and cold, due to exposed roots after the gum shrinks. Conscientious oral hygiene, use of a desensitizing toothpaste, and "tincture of time" usually minimizes the sensitivity.
For many patients, scaling and root planing is the only treatment needed. It can often eliminate the inflammation and infection that promotes the tissue destruction around teeth from periodontal disease. Most effective in treating early periodontal disease, this non-surgical approach is well-received among dental patients. Unfortunately, scaling alone is not a cure for periodontal disease. It must be followed by an ongoing process of good dental hygiene and regular professional dental care.
In more advanced cases, pocket depths of greater than 5 or 6 mm, all the subgingival (beneath the gum) calculus may not be eliminated. Depending on the re-evaluation of the periodontal tissues after scaling, further treatment -- often surgical re-contouring of the gums -- may be required to establish an environment which can be maintained with brushing teeth, floss and other cleansing aids.
The ultimate success of any periodontal treatment is a cooperative partnership between the patient and the dental staff. Alone, neither can accomplish this goal.