SCALING & ROOT PLANING
WHAT IS SCALING AND ROOT PLANING?
Scaling and Root Planing, also known as a Deep Cleaning, is a procedure used to help remove any plaque and tartar accumulation that has developed below the gum line. The procedure is identical to a regular cleaning, for the exception that the instrumentation is performed below the gums. Due to the discomfort, anesthesia is typically provided. The procedure is per quadrant or quarter of the mouth and is typically performed on half the mouth at a time.
WHY DO I NEED IT?
Every time we eat, plaque, a combination of food particles and bacteria, accumulates on our teeth. This can develop both above and below the gum line. With proper brushing and flossing habits, accumulated plaque can be easily removed without any negative consequences.
If, on the other hand, the plaque remains on the teeth two things can happen. Firstly, inflammation will develop in the area causing gingivitis, or inflammation of the gum tissue. This presents as red, swollen gums that bleed easily. Often times people will notice that they have severe bleeding when brushing and flossing at night. At this stage, improved brushing and flossing habits may still be sufficient to treat the problem and reverse all signs and symptoms. Secondly, the calcium normally present in our saliva will begin to calcify and harden; the plaque accumulation turning it into the harder substance calculus, a.k.a. tartar. Again, early on this will only cause gingivitis. However, once tartar is accumulated a dental cleaning is required, as tooth brushing and flossing cannot remove such hard substances.
Bone, including that in your jaw supporting your teeth, is not a static being. In fact, throughout the course of someone's life bone is absorbed and deposited. The accumulation of plaque and tartar, as stated previously, create an inflammatory response by your body. This inflammatory response has the side effect of preferentially activating the cells that absorb or eat away at the bone. This results in bone loss around the teeth, allowing more and more accumulation of plaque and tartar significantly further below the gum line. It is at this time that a simple dental cleaning is no longer sufficient; instead scaling and root planning is required.
MEDICAL CONDITIONS AND OTHER EXTERNAL FACTORS AFFECTING YOUR GUMS
As anyone who has suffered from diabetes knows, infections can spread very rapidly in diabetics, particularly in cases where the diabetes is poorly controlled. This is also true for infections in the mouth. Diabetics are significantly more susceptible to the effects of accumulated plaque and calculus. Not only are they more likely to develop gingivitis and periodontitis, but they are also more likely to have a slower response to treatment.
Among the many symptoms of pregnancy are bleeding gums and gingivitis. For some people this can be very severe and is secondary to the effects of high hormone levels. Though the likelihood of periodontitis is not affected, poor oral hygiene will worsen the degree of gingivitis and bleeding. Often times, with good oral hygiene practices, this will self-resolve without any treatment following labor and nursing.
Smoking reduces oxygen flow to your mouth and oral tissues. Without sufficient oxygen, tissue is unable to heal as quickly and completely as it otherwise would, worsening inflammation. As a result the likelihood and severity of gingivitis and periodontitis is worsened. In fact, nearly all smokers suffer from at least mild cases of gingivitis that could easily be resolved if the smoking habit ceased. Yet another reason to stop smoking!
Braces and orthodontic movement in itself can cause significant inflammation in the supporting structures of the teeth due to the severe forces being applied to these areas to allow tooth movement.
As in all these cases, any plaque and calculus accumulation which could cause inflammation in its own right, will serve to significantly worsen the inflammation in these patients' mouths; again, resulting in more severe and more difficult cases to treat. With ideal oral hygiene, on the other hand, these cases of gingivitis typically resolve on their own after completion of orthodontic treatment.
HOW ARE GINGIVITIS AND PERIODONTITIS DIAGNOSED?
Gingivitis is diagnosed by a clinical examination. In these patients redness and swelling is typically visible in the gum tissue. The gums are prone to bleeding, quite heavily at times. This is often reported by patients as a something they see when brushing. Your dentist and hygienist will also note it during cleanings and restorative procedures.
Periodontitis, on the other hand, causes physical changes in the bone and can be found both by clinical and radiographic examination. During your biyearly exam, measurements are taken of your gum tissue. These measurements record the "pocket" that is present between your tooth and your gum tissue, as your gums don't adhere to your tooth at their height in your mouth, but instead further down. In a normal, healthy mouth this pocket is typically about 3mm in depth - a depth that your toothbrush bristles can reach to remove all plaque and debris accumulated below the gum line. When inflammation causes the bone loss consistent with periodontitis, the pocket depth is found to be deeper, sometimes reaching more than 10mm. Yearly x-rays confirm these findings by showing a reduction in the height of the bone supporting the teeth from its ideal location. In addition, often times you can even see the accumulated tartar attached to the teeth below the gum line.
WHAT IS THE COURSE OF TREATMENT?
If the diagnosis of periodontitis is made on your initial visit, depending on the severity of calculus accumulation you may be advised to have a cleaning or "full mouth debridement" intially. The full mouth debridement is typically reserved for cases where there is such a large amount of accumulated debris proper, complete examination of the tooth structures and periodontal tissue is impossible. These intial treatments will then be followed by Scaling and Root Planing in the regions where it is indicated. In other cases, it may be possible to go directly to the deep cleaning without any other intial work.
For more long term patients, typically the progression to periodontitis, assuming no drastic lifestyle or medical changes, is something that has been presented to you over previous visits. Often times, the doctor and hygienist will have been monitoring pocket depths of 4mm from prior visits. In these cases, you will typically experience your 6 month cleaning and then be advised to return for Scaling and Root Planing.
Patients usually experience some soreness in the gum tissue following treatment. It is typically mild, usually lasting less than one week, and easily managed with over-the-counter Ibuprofen. It is important that ideal brushing and flossing habits are maintained during this time, despite potential soreness, to ensure there are no new causes of inflammation allowing the tissue to heal fully. Patients will be sent home with a prescription for an antibiotic mouthwash, specifically targeted at the bacteria that causes gingivitis and periodontitis to aid in healing.
Patients are advised to return to the office in 6 weeks for a re-evaluation of the gum tissue to see the degree of healing and bone regeneration. Depending on the findings, further treatment may be indicated and will be discussed at that time. If, as is common, ideal improvement is found, you will be advised to return for cleanings or "periodontal maintenance"
procedures every 3 months. Again, depending on the degree of bone loss and healing, after a period of time certain patients may graduate to cleanings every 4 months or even return to twice a year.
WHAT TO EXPECT?
As with every aspect of your health, every person, mouth and situation is different. Each patient will be evaluated and treated as the individual they are.
WHAT IF I DON'T GET TREATMENT?
Unfortunately, once the pocket progresses beyond 3mm in depth, your toothbrush bristles cannot reach the depth needed to remove the plaque accumulation. Nor can your toothbrush remove calculus accumulation within the 3mm depth. As such, the perpetual inflammation will result in further and further bone loss around your teeth. Eventually, this will cause your teeth to become loose. Some patients experience severe pain from the moving and shifting of teeth they feel when eating. Others can develop an abscess from the infection, which can present as a severe throbbing ache or swelling adjacent to the involved teeth. Luckier patients do not have pain but can experience movement of teeth affecting their esthetics. Finally, and what will eventually happen in all mouths after a long enough time, teeth will become so loose they fall out on their own.