Scaling and Root Planing

Scaling and Root Planing Allentown - Philadelphia

Among the most common and yet most confusing procedures in all of dentistry are scaling and root planing.  Root planing is indicated for patients who have experienced a breakdown in the periodontal attachment fibers which hold the gingiva in place against the tooth roots and the teeth in place in the jaw bones.  Root planing is active treatment for an existing disease process. Simply put, if there's been no attachment loss, there's no need for root planing.  Scaling, however, is used to remove calculus deposits wherever they accumulate on a tooth and is generally performed at all profylaxis appointments as a preventive measure against the onset of periodontal disease.  Early attachment loss is the source of most of the confusion about root planing.  A periodontal measuring probe is used to evaluate the gingival attachment at six different positions around every tooth.  These numbers are recorded and become part of the patient's permanent recored.  In health, the gingival pocket formed where the teeth emerged through the gums is 3 millimeters deep or less.  Daily brushing and flossing can generally keep the area clean.

If allowed to remain on the teeth for more than 24 hours, bacterial plaque begins to solidify into calculus which adheres strongly to the site of the teeth especially the cheek side of the upper molars and the tongue side of the lower front teeth because thats where the major saliva glands are located.  In response to the continuous presence of bacteria the gingiva begin to swell with fluid which can raise the gingival margin reversibly by about a millimeter.  A measuring probe will read as much as 4 mm in these locations.  However, if there's been no loss off attachment, there's still no need for root planing.  When attachment loss occurs, the probe will measure greater than 4 mm and the diagnosis of periodontitis is made.  Periodontitis can be localized to a single tooth, generalized to all the teeth, or lie anywhere in between.  If there is active inflammation the gums will bleed on light stimulation and can be tender to probe.  If calculus is detected on the root surfaces, it needs to be removed,  again this is done by scaling. 

Ultrasonic instruments may prove helpful at removing larger deposits.  Chlorhexadine irrigation or other disinfecting solution can help reduce the bacterial population.  Even after calculus removal, the root surfaces are not as smooth as the enamel of the crowns.  Irregular root cementum can harbor the bacteria that lead to further periodontal breakdown.  Therefore, when the calculus is removed the root surfaces must be made smoother by root planing.  In most patients, when scaling and root planing procedures are completed satisfactorily, and the patient maintains excellent oral hygiene, healing will occur.  The swollen gingiva will shrink and inflammation will subside.  Some new attachment and reattachment of the periodontal tissues may occur and no bleeding on probing will be noted.  However, periodontal pockets greater than 4 mm will likely persist.  Additional forms of treatment, including the use of subgingival antibiotics and debridement of the periodontal pockets with soft tissue lasers may be employed to help control the disease.  Antibiotics may require multiple applications at various points around affected teeth for best results. 

It's not uncommon for teeth to be sensitive particularly to sweets and cold temperatures following scaling and root planing procedures, this is because healthy porous dentin is uncovered during removal of calculus and bacterial plaque which act as unhealthy insulating layers on the roots.  Treatment with topical fluoride or other compounds may reduce or eliminate sensitivity.  There is currently no cure for periodontal disease and once diagnosed with the condition you will need to evaluated regularly for signs of progression.  It is absolutely essential that excellent oral hygiene be practiced and regular periodontic maintenance visits be kept, if periodontal disease is to remain in remission.  Contact Allentown periodontist Dr. Potter today.