Scaling & Root Planing / Deep Cleaning

Scaling & Root Planing Therapy

The first phase of periodontal therapy is the initial preparation.  This is when the patient learns how to properly brush their teeth and use dental floss.  They are taught and encouraged to remove the bacterial film - called plaque - that sticks to their teeth and dental restorations.   During these visits, the periodontist or hygienists performs a thorough and meticulous cleaning that includes scaling to remove plaque and tartar deposits beneath the gum line.  Because this procedure goes deeper than a regular cleaning, you will be given an anesthetic to minimize any discomfort.  The cleaning will usually take two visits to complete, depending on the extent of the disease.

Subgingival Scaling (Deep Cleaning)

Root planing is a procedure that removes the irritants, much like removing a splinter from an infected finger.  Patients generally experience little discomfort afterwards and the gums actually feel better.  This procedure allows us to remove: contamination, toxins, micro-organisms, plaque “biofilm”, and tartar “calculus” that have permeated around and below the gum. The root surfaces of your teeth are smoothed so the gum tissues can more firmly reattach.

Root Planing

This is the most basic procedure performed to treat periodontal disease.  Often, changes can be seen immediately following a series of scaling and root planing sessions.  After the procedure, previously red, swollen and bleeding gums become more pink and firm.  Bleeding is reduced or eliminated, and the pockets get smaller. When this happens it is easier to practice plaque control measures, and it helps slow down the disease process.

In most cases the occlusion (bite) may require adjustment.  When bacteria cause inflammation of the gums, teeth are not tightly anchored to the bone and they tend to “float” in the pocket space making them loose and mobile.  Once the scaling and root planing (deep cleaning) is completed, the teeth will settle into a new position, requiring a bite adjustment to further aid in the proper alignment and uniform fit of the chewing surfaces.  If the bite adjustment is not completed, certain teeth in the new position will bear the entire biting force, causing further loosening of the teeth and improper healing of the gums.

Periodontists may incorporate other treatment methods at the same time to increase the effectiveness of treatment.  Systemic antibiotics may be prescribed to help boost your immune system to combat the bacterial infection in your gum tissue.  Periodontists may introduce local chemotherapeutic agents directly into pockets where bacteria are harbored, or they may irrigate pockets with antimicrobials. 

In some cases, periodontists may recommend the use of a laser in conjunction with scaling and root planing to remove diseased tissue in the gum pocket, eliminate bacteria and stimulate healing cells.  This helps to remove diseased gum tissue and more effectively remove the bacterial biofilm on the root surfaces that cause tissue breakdown. 

In many cases, patients respond quite well to this "deep cleaning" and bite adjustment and may not require more aggressive treatment.  Even in cases where there is severe disease, non-surgical periodontal therapy is used to stabilize the disease and to increase the health of gums prior to surgical intervention.  This has been shown to improve tissue health and potentially decrease the amount of surgery needed, as well as improve your tissue's response to surgery. 

After the initial treatment of scaling and root planing, the periodontist will re-evaluate the level of improvement that has been made and your body’s response to therapy.  In addition, your oral hygiene regimen will be reviewed and oral hygiene techniques will be further modified.  At this visit the frequency of maintenance cleanings will be prescribed to further maintain your periodontal health.  This is usually done by alternating visits every two to four months between your general dentist and our office. 

At times, another session of scaling and root planing using local anesthetics, or surgical treatment may be prescribed.  This is necessary in order to create a more permanent, healthier environment around the teeth.  During periodontal surgery, the periodontist has an opportunity to not only see and remove remnants of calculus on the roots, but also reshape irregular bone patterns in order to achieve an optimal healing result that leaves the patient with shallower pockets.  Shallower pockets are easier to maintain both for the patient and the dental professionals who clean their teeth and treat their gums at periodic intervals.