Once your dentist has diagnosed you with periodontal disease, they will present different treatment options to you depending on stage of disease you fall under.

 

For early, mild and some moderate:

The most common and usually first-line of treatment is called scaling and root planing. Instead of receiving a prophylactic cleaning like those who have healthy gums, your dental hygienist will initiate active periodontal treatment to help manage or reverse your periodontal status.

 

Unlike a traditional cleaning, which is performed to clean plaque or calculus from above and slightly (1-3mm) below the gum line, scaling and root planing involves cleaning all plaque and calculus from both above the gum line and below the gum line to the bottom of the pocket. Due to depths of pockets involved in periodontal disease, much more effort and time is required to complete a thorough cleaning.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WHAT TO EXPECT DURING SCALING AND ROOT PLANING

 

• Scaling and root planing can cause discomfort for some patients, while the level of discomfort varies by individual. To ensure your comfort during the procedure, most offices will offer anesthetic either by injection or topical application.

 

• Depending on the severity of disease and how many teeth are involved, scaling and root planing can take anywhere from 1-4 appointments to complete, and some patients may even require more than 4 appointments. This may seem like a lot of time, however, adequate time is required to completely remove all irritants from the periodontal pockets.

 

• During the scaling and root planing procedure a variety of tools and instruments are used to clean the teeth. Generally, an ultrasonic scaler is used first to remove any large deposits of calculus and rinse away plaque. After this is done, hand instruments are used to further remove remaining deposits and smooth out the root surface.

 

• In some instances, radiographs may be taken after the scaling and root planing is complete to ensure all heavy calculus deposits are fully removed.

 

• Adjunctive procedures may be used at this time to further eliminate bacteria and improve the health of your gums. These can include laser therapy, oral irrigation or placement of subgingival antibiotics. Oral irrigation involves rinsing below the gumline with a syringe and irrigation liquid. The most common liquid used for this is chlorhexidine. Placement of subgingival antibiotics occurs directly into the pockets that are infected. These medications remain under the gums and slowly release medication to the gums for several days after placement. Another common addition to scaling and root planing procedures is the application of fluoride varnish to the teeth. Scaling and root planing can result in some sensitivity in the teeth; fluoride varnish will help to prevent any sensitivity symptoms from arising.

 

• Extensive home care instructions will be provided. Tailored to your mouth and your needs, these home care instructions may include recommendations for habit changes, product recommendations and general oral hygiene education.

 

 

 

WHAT TO EXPECT AFTER SCALING AND ROOT PLANING

 

• A feeling of soreness in your mouth may become evident after the anesthetic wears off. This soreness will lessen with time and shouldn’t last more than a few days. Over the counter pain relievers such as Tylenol or Advil can be taken to help reduce any pain.

 

• Swelling or inflammation in the gum tissue may also be noted. Rinsing daily with a warm salt water rinse (1 tsp. salt to 8 oz. of warm water) can help reduce swelling and aid in healing.

 

• Smoking can delay the healing of your gum tissue after scaling and root planing. It is advised to avoid smoking or using tobacco products after scaling and root planing.

 

• You may eat as tolerated after scaling and root planing, however, it is recommended to stick to a soft food diet for the first few days and avoid anything small and crunchy that can get caught under your gums and cause irritation (nuts, seeds, popcorn, etc).

 

• Increased sensitivity to cold or hot can also occur due to the removal of plaque and calculus that was protecting the tooth from feeling these sensations. Using a sensitivity relief toothpaste or other over the counter sensitivity product can help to minimize sensitivities. READ MORE ABOUT AVAILABLE SENSITIVITY PRODUCTS HERE.

 

• In the week following your scaling and root planing, you will notice a change in the color and shape of your gums. Any of these changes are considered normal unless gums become increasingly red or swollen.

 

• If a subgingival antibiotic was placed, follow the instructions provided by your dentist or dental hygienist. It is important to comply with any post treatment recommendations to allow medication to remain under your gums and working for as long as possible.

 

• Proper home care including brushing and flossing or interproximal cleaning is essential in healing your gums and allowing for reduction of periodontal pockets. In order to maintain your periodontal disease and prevent the need for further, more extensive and invasive treatment, it is critical for patients to exhibit the best home care possible after scaling and root planing.

 

• After the initial scaling and root planing treatment, you will be placed on a periodontal maintenance recall. This will require more frequent visits to the dental hygienist for cleaning and monitoring of periodontal condition. Usually, these periodontal maintenance appointments are performed every 3 to 4 months. Many insurance companies may only pay for two of these appointments each year, none the less, it is important to follow the recommendation of the dentist and dental hygienist as to frequency of visits to prevent the advancement of your periodontal disease.

 

 

 

 

WHEN SCALING AND ROOT PLANING IS NOT ENOUGH

 

For moderate periodontal disease:

After scaling and root planing is completed, your dentist or hygienist will monitor your periodontal pockets at each subsequent dental visit. If no reduction of pockets or reduction in inflammation, bleeding, or hygiene is seen then your dentist may refer you to a gum specialist. Periodontist are dentists who have received expanded education focusing on gums. For periodontal disease unresolved by scaling and root planing, surgical interventions by the periodontist may be required.

 

For severe periodontal disease:

Referral to a periodontist will be immediate. At this stage in the disease, a great amount of supporting bone has been lost and surgical intervention is the treatment of choice. Some teeth may even require extraction if too much bone has been lost.