Scaling and Root Planing: Periodontal Disease Treatment

What is Scaling and Root Planing?

Scaling and root planing (deep cleaning) is a restorative dental procedure involving the removal of plaque and calculus (tartar) stuck above and below the gumline.

The procedure is necessary after a patient’s gums, bones, and surrounding tissues become damaged due to periodontal disease (periodontitis).

Overview: What is Periodontitis?

Periodontitis is a severe inflammatory disease that affects the gums, bones, and surrounding tissues in the oral cavity.

Periodontal disease is initiated by the long-term buildup of dental plaque and calculus.

When teeth aren’t cleaned properly at home twice a day, and professionally at least twice a year by a dental professional, plaque is not removed completely.

Over time, the plaque hardens into tartar and bacteria spread to the gums. This process leads to gingivitis (early gum disease) and eventually periodontitis.

When the gums become irritated, they separate from the teeth and deep spaces form. These spaces are called “periodontal pockets.” The tartar is typically located beneath the gums (subgingival), on the base of teeth, between the gums, and on the roots of teeth.

Risk Factors & Symptoms of Periodontal Disease

The most common risk factors associated with periodontitis include:

  • Poor brushing and flossing habits, which leads to plaque and tartar buildup
  • Smoking or chewing tobacco long-term
  • Poor nutrition, such as sugary foods and drinks
  • Some blood pressure, heart disease, cardiovascular, bacterial pneumonia, seizure, or immunosuppressant medications
  • Crooked teeth, which makes the plaque and calculus more difficult to remove
  • Family history of periodontitis
  • Long-term stress, which causes inflammation

Symptoms of periodontitis range from mild to extreme and can include:

  • Red and swollen gums
  • Inflammation below or around the gums
  • Gums that bleed on probing (such as flossing)
  • Loose teeth or gums that pull away from the teeth
  • Bad breath, even after brushing
  • Pus between the teeth and gums
  • Sudden teeth misalignment or an incorrect bite

Scaling and Root Planing Procedure: Step-By-Step

Scaling and root planing involves the removal of plaque, hardened tartar (calculus), and stains from a patient’s teeth and tooth roots. The cost of scaling and root planing (deep cleanings) depends on the dentist’s location and whether or not the patient has insurance.

Your dentist typically separates the procedure into two appointments. During the first appointment, they clean the upper and lower quadrants of one side of your mouth. Then the other two quadrants are cleaned in the second appointment.

The cost of the procedure averages between $140 and $300 (per quadrant).

Scaling and root planing procedure steps typically include:

1. Local Anesthesia Administration

Scaling and root planing requires the administration of local anesthesia, also referred to as a membrane-stabilizing drug, to help control pain and hemorrhage. Local anesthesia is the most common type of anesthesia used during minorly invasive dental procedures.

Firstly, your dentist injects the drug into your mouth and numbs the treated area. Then, after about five minutes, a temporary loss of sensation occurs. You'll remain awake and conscious during the entire procedure but will not feel any pain. You might feel tenderness at the injection site during and after treatment.

2. Scaling

The second step in the procedure is performing subgingival scaling, which is when a general dentist, periodontist, or dental hygienist removes plaque and calculus beneath the gums, between the gums, and on the base of teeth crowns.

Scaling is either done manually or with an ultrasonic instrument, such as a Calvitron. Both techniques loosen plaque and remove hardened tartar.

To remove plaque and bacteria, the scaler is placed in the pocket with the bevel at an angle between 45 and 90 degrees to the tooth. The teeth and root surfaces are then scraped and cleaned in a vertical, circular, or horizontal motion.

3. Root Planing

Dentin, cementum, enamel, and dental pulp are the four main components of teeth. As periodontitis persists, the disease typically damages the cementum, dentin, or both. Root planing is an attempt to smooth rough surfaces and remove any subgingival bacteria.

During the procedure, a dentist cleans deep below the gums to remove plaque and tartar buildup on the roots of teeth where the bones are affected by the infection. Planing involves the complete removal of cementum, which is the calcified film that covers a tooth’s root.

The procedure may also involve the removal of a small superficial layer of dentin, which is the second layer of teeth that develops below the enamel.

4. Post Surgery

After the procedure is complete, your dentist flushes the area to remove any remaining bacteria. Then they apply pressure to ensure proper gum tissue growth.

Patients typically experience minor pain after the procedure. Properly healed gums appear as well-adapted, firm, and normally shaped tissue.

Common symptoms after treatment typically resolve within a few days and may include:

  • Bleeding gums
  • Irritated gums
  • Tooth discomfort, such as sensitivity to hot, cold, and sugar substances
  • Swelling and inflammation around the treated area
  • Allergies to some of the materials used during the procedure

Aftercare

Practicing good oral hygiene is necessary to prevent the development of chronic periodontitis. Periodontitis is the most serious form of gum disease that results in permanent bone loss that cannot grow back. Severe periodontal disease also typically requires invasive surgery.

To prevent the need for surgery, it is crucial to practice good oral care at home. These habits include cleaning your teeth with a toothbrush twice a day, using fluoride, flossing, and rinsing with mouthwash.

Follow-up appointments are also necessary a few weeks after treatment. This is when dentists examine the healing gums and ensure the periodontal pockets have decreased in size. If the pockets are deeper than 3mm, another procedure may be needed.


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Resources

Cohen, Edward S. Atlas of Cosmetic and Reconstructive Periodontal Surgery. Peoples Medical Publishing House, 2009.

Hollins, Carole. Basic Guide to Dental Procedures. John Wiley & Sons, Inc., 2015.

“Periodontitis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 6 Mar. 2018, www.mayoclinic.org/diseases-conditions/periodontitis/symptoms-causes/syc-20354473.

Syrbu, John DDS. The Complete Pre-Dental Guide to Modern Dentistry. 2013.

Updated on: June 29, 2020
Author
Alyssa Hill
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Medically Reviewed: September 18, 2019
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Lara Coseo
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