Malhotra Dental Care Centre

Cleaning and Polishing of Teeth

What Is It?
Scaling and root planing is the most common and conservative form of treatment for periodontal (gum) disease. Scaling is the removal of calculus (commonly called tartar) and plaque that attach to the tooth surfaces, especially below the gum line along the root surface. Because plaque is more likely to stick to rough surfaces, the root surface is smoothed down in a process called root planing. Root planing removes any remaining calculus and smoothes root-surface irregularities.

Plaque is a sticky substance, full of bacteria, that usually forms on your teeth. When plaque hardens over time, it is called calculus.

What It’s Used For
Scaling and root planing are done to remove the irritants (plaque and calculus) that can cause periodontal disease. For early stages of the disease, especially gingivitis, this treatment may be all that is needed to get the condition under control. With more advanced gum disease, this may be the first step before moving on to surgical treatment.

Preparation
For some patients, scaling and root planing can cause discomfort. A local anesthetic may be used to numb the portion of your mouth that is being worked on.

How It’s Done
Scaling and root planing are done with a combination of ultrasonic scalers and hand instruments. Ultrasonic instruments are electric or air-powered devices that have two components: 1) a relatively dull metal tip that vibrates at a very high frequency and “knocks” plaque and calculus off the tooth, and 2) a water irrigation system that cools the tip and helps to flush out debris from around the teeth. Hand instruments are not powered. They have cutting edges and are pressed against your teeth by your dentist or hygienist. These instruments come in various shapes and sizes. Different instruments are used for different teeth, and even for different surfaces of the same tooth.

Typically, ultrasonic instruments are used first to remove large deposits of plaque and calculus from the crowns and roots of the teeth. Hand instruments called scalers and curettes then are used to remove any remaining material and make sure that the tooth surface is clean and smooth. When working under the gum line, your dentist or hygienist cannot see the plaque or calculus, so he or she will rely on the sense of touch to feel for roughness on the root surface.

If you have gingivitis (the earliest stage of gum disease) or localized periodontitis (more advanced gum disease located in only one part of your mouth), scaling and root planing usually can be completed in one visit. However, if you have periodontitis throughout your mouth, your periodontist typically will do a quarter of your mouth (a quadrant) at a time. This means that four visits will be necessary to complete the scaling and root planing.

Follow-Up
For two to three days after the treatment, you may have some soreness and sensitivity to hot and cold temperatures. Over-the-counter pain relievers can relieve this discomfort.

You may be asked to use an antispectic mouthrinse after scaling and root planing, especially when soreness of the gums prevents effective oral hygiene measures. However, brushing and flossing should be continued as usual. Some minor bleeding can be expected the first days after scaling and root planing, but this usually stops within a week.

Risks
Treating periodontitis decreases gum inflammation and also eliminates periodontal pockets, which can trap plaque. Therefore, if treatment is successful, your gums will shrink or recede. The extent of shrinkage depends on the initial depth of the pocket and the severity of periodontitis. The more severe the disease, the larger the recession of the gums after successful therapy. As a result, some part of the root is exposed, making the tooth look longer and making it more sensitive to hot and cold temperatures. To prevent root cavities, your dentist may prescribe a fluoride-containing gel, and will emphasize the importance of good plaque control.

If your medical doctor has told you that you need to take antibiotics before certain dental procedures, you should inform your dentist or hygienist about this before you undergo scaling and root planing

Curettage–a scraping away of the diseased gum tissue in the infected pocket, which permits the infected area to heal.

• Flap surgery–involves lifting back the gums and removing the tartar. The gums are then sewn back in place so that the tissue fits snugly around the tooth. This method also reduces the pocket and areas where bacteria grow.
• Bone Grafts –used to replace bone destroyed by periodontitis. Tiny fragments of your own bone, synthetic bone, or donated bone are placed where bone was lost. These grafts serve as a platform for the regrowth of bone, which restores stability to teeth.
• Soft tissue grafts –reinforce thin gums or fill in places where gums have receded. Grafted tissue, most often taken from the roof of the mouth, is stitched in place over the affected area.
• Guided tissue regeneration –stimulates bone and gum tissue growth. Done in combination with flap surgery, a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow to better support the teeth.
• Bone (osseous) surgery –smoothes shallow craters in the bone due to moderate and advanced bone loss. Following flap surgery, the bone around the tooth is reshaped to decrease the craters. This makes it harder for bacteria to collect and grow.
• Medications –in pill form are used to help kill the germs that cause periodontitis or suppress the destruction of the tooth’s attachment to the bone. There are also antibiotic gels, fibers or chips applied directly to the infected pocket. In some cases, a dentist will prescribe a special anti-germ mouth rinse containing a chemical called chlorhexidine to help control plaque and gingivitis. These are the only mouth rinses approved for treating periodontal disease.