Scaling and Root Planing
During your comprehensive examination, your full mouth was periodontally charted. This means that measurements were taken of the “trough” around your teeth. A normal or healthy trough ranges from 1 to 3 mm. Measurements of 4 mm indicate the signs of gingivitis or periodontitis (also known as gum disease). The measurements can be higher because of swelling from inflammation or from loss of attachment to the bone structure or bone loss. Overtime, plaque that is left on the teeth can become fortified with minerals and become stuck to your roots like barnacles on a ship. The only way to clean this off is through routine professional cleanings (every 6 months). If the trough or “pocket” depth is greater than 3, then scaling and root planing may be indicated.
When it is determined that there is loss of attachment or tartar below the gumlines, then a standard cleaning or “prophy” will not clean the teeth as well as they need to be cleaned. Scaling and root planing is the removal of all accretions on the teeth and diseased root structure. In order to accomplish this anesthesia may be needed. After numb, the provider will focus on cleaning the areas of attachment loss that were found during the exam. At the end of the appointment, a normal polishing will be performed. Depending upon the extent of the disease, a second visit or more may be needed to fully debride the teeth, roots, and gums. In certain instances, a scaling may be done concurrently with a round of antibiotic(s). This is used in the most severe forms of the disease only.
Following scaling and root planing you will need to return in 4 to 6 weeks based upon the severity of the disease to re-evaluate the body’s response. A full mouth probing will be done and a decision will be made on the next step towards health. A few things can happen:
1. Relative gingival health – outstanding. After scaling and root planing and a diagnosis of gum disease, all cleanings following will be periodontal maintenance visits. Periodontal disease is a chronic progressive disease that can only be halted by thorough, routine debridement. A standard cleaning will never be able to maintain a person’s teeth after this diagnosis. Localized scaling will be performed as needed at each periodontal maintenance visit. The worst forms of disease may need maintenance every 3 months, the least every 6 months.
2. Areas of continued attachment loss – not good. In areas where 4 to 6 mm pockets remain, another scaling and root planing and placement of localized antibiotics into the pocket may help the body heal in those areas. This antibiotic is called Arestin. Arestin is minocycline, an antibiotic in the tetracycline family.
3. Generalized or severe loss of attachment – bad. If there are multiple sites around the mouth where pockets remain over 6 mm, then referral to a periodontist or periodontal surgery may be needed to return the foundation of the teeth to health. Laser periodontal therapy and traditional surgeries can be used to more fully debride the teeth and gums, decrease pocket depths, and replace lost bone and/or gum tissue.
Following scaling and root planing, there is typically a few days of soreness. Over the counter anti-inflammatories and acetaminophen (Tylenol) can help to dull the ache while the body is healing. Please let our staff know if you ever have pain following a procedure.