Scaling and Root Planing

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. The process especially targets the area below the gum line, along the root.

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

Plaque is more likely to stick to rough surfaces. For this reason, the root surface is made smooth in a process called root planing. Root planing removes any remaining calculus and smooths irregular areas of the root surface.
                                       

What It's Used For

Bacteria cause periodontal disease. Plaque and calculus provide an irregular surface that allows these bacteria to attach easily. Scaling and root planing are done to remove the plaque and calculus. For early stages of the disease, this treatment may be all that is needed to get the condition under control. This is especially effective with gingivitis. With more advanced gum disease, scaling and root planing may be the first step before surgery.

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. They have two components:

1. A relatively dull metal tip that vibrates at a very high frequency and "knocks" plaque and calculus off the tooth.
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 that your dentist or hygienist uses to chip away plaque and calculus.
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 are then 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. He or she will rely on the sense of touch to feel for roughness on the root surface.
Sometimes, scaling and root planing can be completed in one visit. This usually is possible if you have gingivitis, the earliest stage of gum disease. However, if you have periodontitis, multiple visits are usually needed. The periodontist typically will do one-quarter of your mouth (a quadrant) at each visit.

Follow-Up

For two to three days after the treatment, you may have some soreness and be sensitive to hot and cold temperatures. Over-the-counter pain relievers can help.

You may be asked to use an antiseptic mouth rinse after scaling and root planing. This is especially likely if your gums are very sore. However, you should continue brushing and flossing as usual. You can expect some minor bleeding in the first days after scaling and root planing. This usually stops within a week.

Risks

Treating periodontitis decreases gum inflammation. It also eliminates periodontal pockets, which can trap plaque. Therefore, if treatment is successful, the swelling will be gone and 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 more your gums will recede after successful therapy. As a result, some part of the root is exposed. This makes the tooth look longer. It also will be more sensitive to heat and cold. To prevent root cavities, your dentist may prescribe a fluoride-containing gel. It's also important to control plaque.

Pulp Polyp

The pulp polyp, also known as chronic hyperplastic pulpitis or proliferative pulpitis, is an uncommon and specific type of inflammatory hyperplasia that is associated with a nonvital tooth.

Pulpal diseases are broadly divided into reversible and irreversible pulpitis and are based on the ability of the inflamed dental pulp to return to a healthy state once the noxious stimulus has been removed. In the case of the pulp polyp, the disease process is irreversible. In contrast to most cases of irreversible pulpitis, the pulp polyp is usually an incidental finding that occasionally mimics reactive and neoplastic diseases of the gingiva and adjacent periodontium.

Medical Care

• Treatment of a pulp polyp in a permanent tooth includes either root canal therapy or extraction of the tooth.
• The more conservative pulpotomy treatment has been successful in selected cases when only the coronal pulp is affected.
• In immature teeth with incomplete root development, placement of an apical barrier and strengthening of the thin root with composite resin may be indicated prior to root canal treatment.
• Pulp revascularization of an immature permanent tooth is another new treatment approach that results in the formation of vital pulpal tissue.
• The tooth requires a full-coverage crown following endodontic therapy.
• Prior to extensive restorative treatment, the risks and benefits of this treatment, including the long-term prognosis of the affected tooth in a young child, needs to be thoroughly explained.

Surgical Care

• The affected tooth is extracted when primary teeth are involved or when minimal tooth structure in permanent teeth is available for restoration or the alveolar bone support is unfavorable.
• A surgical crown lengthening procedure may be needed to prepare a tooth for a full-coverage crown.
• Healing is uneventful in most cases.

Medication Summary

Systemic medications are not recommended for the management of this lesion. Antibiotics are not prescribed for the treatment of the pulp polyp, despite a bacterial component. However, an antibiotic paste mixture is used within the canals of the infected tooth when the revascularization process is performed for the treatment of the nonvital tooth.

Further Outpatient Care

• Periodic dental examinations are recommended to monitor the success of the root canal therapy or to intercept problems associated with the premature loss of a tooth.
• Orthodontic treatment may be needed to restore the occlusion.
• If a tooth is extracted, either a dental implant or fixed dental prosthesis (bridge) is a treatment option to restore function and aesthetics.

Complications

• Space discrepancy from crown destruction or premature loss of a tooth may result in a crowded malocclusion, supereruption of an opposing tooth, or the impaction of a succedaneous tooth.
• Without definitive treatment, some of these long-standing, nonvital teeth may progress to symptomatic disease, including periapical inflammatory disease and (rarely) cellulitis and osteomyelitis of the jaws.

Prognosis

• The prognosis is excellent. No risk for recurrence exists once definitive treatment has been rendered.

Patient Education

• Reinforce the importance of routine oral health care to prevent the development of deep carious lesions that may cause inflammatory pulpal disease and more serious sequelae.