Scaling & Root Planing

 The initial stage of treatment for periodontal disease is usually a thorough cleaning that may include scaling or root planing. The objective of these non-surgical procedures is to remove etiologic agents such as dental plaque and tartar, or calculus, which cause gingival inflammation and disease. Scaling and root planing can be used as a stand-alone treatment, or a preventative measure. They are commonly performed on cases of gingivitis and moderate-to-severe periodontal disease.

What does scaling and root planing entail?

Drs. Kiarash or Behmanesh will only perform scaling and root planing after a thorough examination of the mouth, which may include taking x-rays and visually examining the mouth. Depending on the condition of the gums, the amount of tartar present, the depth of the pockets, and the progression of periodontitis, Drs. Kiarash or Behmanesh may recommend scaling and root planing. In some cases, a local anesthesia may be used 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, Drs. Kiarash or Behmanesh 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 difficult for Drs. Kiarash or Behmanesh to thoroughly remove plaque and tartar. Patients can seldom, if ever, keep these pockets clean and free of plaque. Consequently, surgery may be needed to restore periodontal health.

Benefits of Scaling & Root Planing Treatment

If treatment is successful, scaling and planing may have many periodontal benefits. One is that it can help prevent disease. Research has proven that bacteria from periodontal infections can travel through the blood stream and affect other areas of the body, sometimes causing heart and respiratory diseases. Scaling and root planing remove bacteria that cause these conditions.

Another benefit of treatment is protecting teeth against tooth loss. When gum pockets exceed 3mm in depth, the risk for periodontal disease increases. As pockets deepen, more bacteria are able to colonize, eventually causing a chronic inflammatory response by the body to destroy gingival and bone tissue. This leads to tooth loss.

Finally, scaling and root planing may make the mouth more aesthetically pleasing, and should reduce bad breath caused from food particles and bacteria in the oral cavity. Superficial stains on the teeth will be removed during scaling and planing, adding an extra bonus to the procedures.

​TYPICALLY ONE OF 3 OUTCOMES WILL OCCUR FOLLOWING THIS THERAPY

  1. In cases of “mild periodontitis”, this procedure will attempt to stop progression of disease, in which case the treatment objective will have been obtained and the patient is then placed into maintenance therapy to help reduce the chances of the disease from coming back. 
  2. In cases of “moderate periodontitis”, this procedure alone will not be able to stop the progression of disease by itself. The objective in these cases is to help reduce the spread of the disease as much as possible so that surgical therapy will then only be targeted to the more advanced areas that are affected by more destruction and are more resistant.
  3. In cases of “advanced periodontitis”, surgical therapy is the only predictable means of treating the patient’s condition. However typically in these cases the level of disease is so advanced that surgery cannot be performed immediately until the patient’s condition is improved to a level to which their body can then undergo surgical therapy. In these more advanced cases the initial therapy will be “Root Planing” to help reduce the bacterial load in the gums and in order to help the gums and bones be able to undergo the surgical treatment.

​In all 3 of the above scenarios, typically 4-8 weeks afforded to the gums before a re-evaluation examination is performed to evaluate the bodies ability to heal and improve and ultimately determine the next step of therapy, if needed. 

​Typically all patients who have previously suffered from periodontitis “gum disease” are at a higher risk of having the disease come back in the future, and thus are recommended in monitoring their periodontal condition more closely by their periodontist and family dentist hygienist.

​Your periodontist will typically suggest the best interval for you individually based on the severity of your initial condition as well as other contributing risk factors.