Scaling and Root Planing

WHAT IS SCALING AND ROOT PLANING?

Scaling and root planing (sometimes called “deep cleaning”) is the most common procedure for treating periodontics, or gum disease. During the procedure, dentists use scalers to clean debris off the enamel surfaces of the teeth. Then, we use specially-curved instruments called “curettes” to remove calculus and other diseased tissue that accumulates on root surfaces in periodontal pockets beneath the gum line. That’s the root planing part. Removing calculus and debris from root surfaces that have periodontal pockets allows the gums to reattach to the root surfaces and helps stop the progression of gum disease and damage.

WHEN IS SCALING AND ROOT PLANING NEEDED?

Healthy gum tissue forms a tight seal around each tooth just below the visible gumline. There is a small space called a “sulcus” between the top of the gums and where they attach to the tooth, just below and on the inside of that gum crest. For reference, the sulcus is where popcorn husks usually get stuck. In healthy gums, the sulcus is only 1 to 3 millimeters deep. When gums become inflamed because of gingivitis, however, they swell and pull away from the teeth. This swelling enlarges the sulcus and creates a bigger space between the teeth and gums. Even more bacteria and plaque get into that space, which leads to the gums pulling away from the tooth root.

If left untreated, this process continues. Eventually, the bacteria and acids in plaque deepen the space between the gums and teeth into a deeper hole called a “periodontal pocket.” Toothbrushes and floss can’t reach deep enough to clean periodontal pockets, so the bacterial plaque inside them transforms into hardened calculus. Calculus accumulation in a periodontal pocket causes all kinds of problems, including periodontal bone loss and tooth loss.

The only way to reliably remove calculus from periodontal pockets is to have your dentist perform a scaling and root planing operation. Scaling and root planing completely removes built-up calculus, bacterial plaque, and other diseased tissue from the periodontal pockets. Root planing smooths out root surfaces and helps the gums re-attach to those root surfaces. If you have gum disease, scaling and root planing is probably the first procedure your dentist will recommend.

HOW DO I KNOW IF I NEED A SCALING AND ROOT PLANING?

Your dentist will recommend scaling and root planing if they diagnose that you have sulcus pockets deeper than 3mm. We measure these pockets with a probe during a regular dental exam. We can also locate calculus inside periodontal pockets using x-rays. If you have any of the following symptoms of gum disease, you should see your dentist right away:

  • Bleeding gums (a sign of an ongoing oral infection)

  • Swollen gums

  • Red, sensitive gums

  • Pain when brushing or flossing

  • Gum recession

  • Gum discoloration

  • Tooth pain

  • Constant bad breath, no matter how much you brush or use mouthwash

As always, the best way to figure out if you need scaling and root planing is to ask your dentist. They’ll be able to identify the cause of your symptoms and recommend the best solution. If you’re worried about gum disease, schedule an exam immediately.

HOW DOES SCALING AND ROOT PLANING WORK?

Depending on how many of your teeth require scaling and root planing, the procedure may take several appointments to complete. During each appointment, you dentist perform the following steps:

1. We start by using a local anesthetic to numb the area of the mouth we’re working on. If we’re treating more than one area, we’ll probably only numb one area at a time to make sure the anesthetic doesn’t wear off too soon.

2. After we confirm that the anesthetic is working, your hygienist or dentist begins scaling the teeth and planing the roots of all calculus and debris in the periodontal pockets. Your dentist accomplishes this using curved instruments called scalers and curettes. These tools fit into the space between the teeth and gums, allowing your dentist to reach the periodontal pockets. We may also use an electric ultrasonic scaler to remove calculus a bit more quickly and efficiently.

Root planing actually involves removing small amounts of the tooth’s cementum and dentin. In addition to removing debris, the curettes also smooth out uneven surfaces on a tooth’s root to prevent bacteria, biofilm, and calculus from re-accumulating in the future. Root planing is required for the gumline to effectively re-attach to your teeth.

3. We generally divide scaling and root planing into four sections, or quadrants, of the mouth: upper right, upper left, lower right, and lower left. Scaling and root planing an entire mouth usually requires multiple appointments. After completing one section of the mouth, we may move on to another or stop until the next appointment.

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