What is Scaling and Root Planing?
Scaling and root planing, also known as conventional periodontal therapy, non-surgical periodontal therapy, or deep cleaning, is a procedure involving removal of dental plaque and calculus (scaling or debridement) and then smoothing, or planing, of the (exposed) surfaces of the roots, removing cementum or dentine that is impregnated with calculus, toxins, or microorganisms, the etiologic agents that cause inflammation. This helps to establish a periodontium that is in remission of periodontal disease. Periodontal scalers and periodontal curettes are some of the tools involved.
After Scaling and Root planing
Following scaling, additional steps may be taken to disinfect the periodontal tissues. Oral irrigation of the periodontal tissues may be done using chlorhexidine gluconate solution, which has high substantivity in the oral tissues. This means that unlike other mouthwashes, whose benefits end upon expectorating, the active antibacterial ingredients in chlorhexidine gluconate infiltrate the tissue and remain active for a period of time. However effective, chlorhexidine gluconate is not meant for long-term use. A recent European study suggests a link between the long-term use of the mouthrinse and high blood pressure, which may lead to a higher incidence of cardiovascular events. In the United States, it is available only through a doctor's prescription, and in small, infrequent doses it has been shown to aid in tissue healing after surgery.
Site specific antibiotics may also be placed in the periodontal pocket following scaling and root planing in order to provide additional healing of infected tissues. Unlike antibiotics which are taken orally to achieve a systemic effect, site specific antibiotics are placed specifically in the area of infection. These antibiotics are placed directly into the periodontal pockets and release slowly over a period of time. This allows the medication to seep into the tissues and destroy bacteria that may be living within the gingiva, providing even further disinfection and facilitation of healing. Certain site specific antibiotics provide not only this benefit, but also boast an added benefit of reduction in pocket depth. Arestin, a popular site specific brand of the antibiotic minocycline, is claimed to enable regaining of at least 1 mm of gingival reattachment height.
In cases of severe periodontitis, scaling and root planing may be considered the initial therapy prior to future surgical needs. Additional procedures such as bone grafting, tissue grafting, and/or gingival flap surgery done by a periodontist (a dentist who specializes in periodontal treatment) may be necessary for severe cases or for patients with refractory (recurrent) periodontitis.
Patients who present with severe or necrotizing periodontal disease may have further steps involved in their treatment. These patients often have genetic or systemic factors that contribute to the development and severity of their periodontitis. Common examples include diabetes type I and type II, a family history of periodontal disease, and immunocompromised individuals. For such patients, the practitioner may take a sample from the pockets to allow for culture and more specific identification and treatment of the causative organism. Intervention may also include discontinuation of medication that contributes to the patient's vulnerability or referral to a physician to address an existing but previously untreated condition if it plays a role in the periodontal disease process.