Periodontal treatment depends on the type of the disease and how severe it is. If the disease is caught early (when it is gingivitis), and no damage has been done to the supporting structures of the teeth (bone and periodontal ligament), you may simply need a professional dental cleaning along with proper daily brushing and flossing. However, if periodontal disease advances, the first step in treating it usually involves a special deep cleaning called scaling and root planing.
Scaling and root planing is a non-surgical procedure used to treat gum disease.
During the scaling process, specialized dental instruments are used to remove dental plaque and calculus from beneath the gums. Planing is the procedure used to smooth the tooth’s root after the scaling process. Root planing helps the gums heal and reattach themselves to a cleaner and smoother root surface.
How is periodontal disease diagnosed?
If you schedule regular dental exams, your dentist and hygienist can catch periodontal disease before the gums and bone supporting your teeth are severely damaged. During a periodontal evaluation the dentist or hygienist does the following:
- Uses a periodontal probe to gently measure the spaces between the teeth and gums. In a healthy mouth, this space (pocket) is usually less than 3 millimeters deep. Very deep pockets (greater than 6 millimeters) are a sign of advanced periodontal disease.
- Dental x-rays usually are taken to show the extent of bone loss. Low bone levels can be a sign of damage from periodontal disease.
If periodontal disease is diagnosed, your dentist and hygienist may provide treatment (scaling and root planing) or may refer you to a periodontist (a dentist who specializes in the diagnosis, prevention, and treatment of periodontal disease). A periodontist may need to offer periodontal surgery in advanced cases.
What does scaling and root planing involve?
Scaling and root planing treatment is usually performed by a Registered Dental Hygienist in two separate one-hour appointments (each treating one half of the mouth). It is only performed after a thorough examination with x-rays and a periodontal diagnosis has been made. Depending on the current condition of the gums, the amount of calculus present, the depth of the pockets, and the progression of the disease, local anesthetic may be used. It is generally performed in the following steps:
- Scaling – This procedure is usually performed with special dental instruments and often includes the use of an ultrasonic scaling tool. The scaling tool removes calculus and plaque from the surface of the crown (supragingival) and root surfaces (subgingival). In many cases, the scaling tool includes an irrigation process that can also be used to deliver an antimicrobial agent below the gums that can help reduce bacteria.
- Root Planing – This procedure is used to remove cementum and surface dentin that is embedded with unwanted bacteria, their toxins, and calculus. The root of the tooth is literally smoothed in order to promote good healing of the adjacent gum tissue. Having clean, smooth root surfaces helps prevent bacteria from easily colonizing in the future.
- Subgingival Antibiotics – Following the deep cleaning procedures, in some cases, the gum pockets may be treated with antibiotics. This will soothe irritation and help the gum tissues to heal quickly.
- Follow-up Appointment – During a follow-up appointment, the dentist or hygienist will thoroughly examine the gums again to see how well the pockets have healed. If the gum pockets still measure more than 3 millimeters in depth, additional and more intensive treatments may be recommended or a referral to a periodontist may be necessary.
What care is needed after periodontal treatment?
Once your periodontal treatment is completed, your dentist may recommend more frequent checkups and deep cleanings (periodontal maintenance) to keep the disease under control. In some cases, your appointments may alternate between your regular dentist and periodontist.
Good oral hygiene at home also is very important to keep periodontal disease from becoming more serious or coming back. Brushing twice a day with fluoride toothpaste and flossing once a day helps keep plaque under control and reduces calculus buildup.
You don’t have to lose your teeth to periodontal disease. Brush, floss, eat a healthy diet, and visit us regularly for a lifetime of healthy smiles.