Dental Scaling and root planing.

 Dental 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. It is a part of non-surgical periodontal therapy. This helps to establish a periodontium that is in remission of periodontal disease. Periodontal scalers and periodontal curettes are some of the tools involved.

The processes of calculus formation from dental plaque are not well understood. Supragingival calculus formation is most abundant on the buccal (cheek) surfaces of the maxillary (upper jaw) molars and on the lingual (tongue) surfaces of the mandibular (lower jaw) incisors. These areas experience high salivary flow because of their proximity to the parotid and sublingual salivary glands. Subgingival calculus forms below the gumline and is typically darkened in color by the presence of black-pigmented bacteria, whose cells are coated in a layer of iron obtained from heme during gingival bleeding. Dental calculus typically forms in incremental layers that are easily visible using both electron microscopy and light microscopy. These layers form during periodic calcification events of the dental plaque, but the timing and triggers of these events are poorly understood. The formation of calculus varies widely among individuals and at different locations within the mouth. Many variables have been identified that influence the formation of dental calculus, including age, gender, ethnic background, diet, location in the oral cavity, oral hygiene, bacterial plaque composition, host genetics, access to professional dental care, physical disabilities, systemic diseases, tobacco use, and drugs and medications.

The first evidence of periodontal disease damage becomes apparent in radiographs as the crestal bone of the jaw begins to become blunted, slanted, or scooped out in appearance. This destruction occurs as a result of the effect of bacterial endotoxins on bone tissue. Because the bone is alive, it contains cells in it that build bone, known as osteoblasts, and cells that break down bone, called osteoclasts. Usually these work at the same speed and keep each other in balance. In periodontitis, however, the chemical mediators, or by-products, of chronic inflammation stimulate the osteoclasts, causing them to work more rapidly than the cells that build bone. The net result is that bone is lost, and the loss of bone and attachment tissues is called periodontal disease.

These processes will persist, causing greater damage, until the infectious bacterial agents (plaque) and local irritating factors (calculus) are removed. In order to effectively remove these at this stage in the disease process, brushing and flossing are no longer sufficient. This is due to several factors, the most important to note being the depth of the periodontal pocket. Brushing and flossing are effective only at removing the soft materia alba and biofilm in supragingival areas, and in pockets up to 3 mm deep. Even the best brushing and flossing is ineffective at cleaning pockets of greater depths, and are never effective in removing calculus. Therefore, in order to remove the causative factors that lead to periodontal disease, pocket depth scaling and root planing procedures are often recommended.

Once the bacteria and calculus are removed from the periodontal pocket, the tissue can begin to heal. The inflammation dissipates as the infection declines, allowing the swelling to decrease which results in the gums once again forming an effective seal between the root of the tooth and the outside environment. However, the damage caused by periodontal disease never heals completely. Bone loss due to the disease process is irreversible. The gingival tissue of the gums also tends to suffer permanent effects once the disease reaches a certain point. Because gum tissue requires bone to support it, if bone loss has been extensive, a patient will have permanent recession of the gums, and therefore exposure of the roots of the teeth in involved areas. If the bone loss is extensive enough, the teeth may begin to become mobile, or loose, and without intervention to arrest the disease process, will be lost.

Contrary to old beliefs, it is not a normal part of aging to lose one's teeth. Rather, it is periodontal disease that is the main cause of tooth loss in the adult population.
Dental scaling is routinely performed to help patients with gum disease and excessive plaque buildup. While a standard cleaning will address the surface of the tooth, scaling goes much deeper.

This is a type of dental cleaning that reaches below the gumline to remove plaque buildup. The process of scaling and root planing the teeth is often referred to as a deep cleaning. This treatment goes beyond the general cleaning that you receive with your regular checkup and annual visit.

Everyone experiences some form of plaque buildup. The saliva, bacteria, and proteins in your mouth form a thin layer that covers your teeth at almost all times. When you eat, tiny particles, acids, and sugars from the food stick to this film, creating a buildup on the teeth known as plaque. The bacteria that lives in this plaque can cause gum disease and tooth decay. Brushing, flossing, and regular dental cleanings will help remove the plaque and prevent more serious problems.
If you have healthy gums, the tissue will fit tightly around the tooth and keep plaque out. However, if gum disease begins to form, this tissue will loosen. Healthy gums attach to the tooth just 1 to 3 millimeters below the gumline. With gum disease, you’ll begin to develop deeper pockets. These can fill with plaque, worsening your problems and causing symptoms like bad breath.
If you have pockets of 4 millimeters or more, your dentist will probably recommend dental scaling to remove the plaque beneath the gumline and help treat the gum disease.

Dental scaling can be uncomfortable, particularly if you have sensitive gums. Your dentist may offer a local anesthetic to numb your gum tissue and make the procedure more comfortable. Speak with your dental care provider about your options for desensitizing the area if you’re concerned about pain or discomfort during the process.
Dental scaling can take several visits, each one addressing a different portion of the mouth. Some dentists divide the mouth into four quadrants, while others will perform dental scaling in two halves. If you’re nervous about the process, ask your dentist if you can schedule your scaling for a single visit. Though this isn’t an option for all cases, it may be available if you have only moderate gum disease and are willing to sit for a lengthy procedure.

Treatment of periodontitis may include several steps, generally, the first step is the removal of dental plaque, the microbial biofilm, from the tooth, a procedure called scaling. Root planing involves smoothing the tooth's root. These procedures may be referred to as scaling and root planing, periodontal cleaning, or deep cleaning. These names all refer to the same procedure. The term "deep cleaning" originates from the fact that pockets in patients with periodontal disease are literally deeper than those found in individuals with healthy periodontia. Such scaling and root planing may be performed using a number of dental tools, including ultrasonic instruments and hand instruments, such as periodontal scalers and curettes.

The objective for periodontal scaling and root planing is to remove dental plaque and calculus (tartar), which house bacteria that release toxins which cause inflammation to the gum tissue and surrounding bone. Planing often removes some of the cementum or dentine from the tooth.
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.