Limitations of Scaling & Root Planing

When an individual fails to adhere to a daily toothbrushing and flossing routine, a sticky layer of bacteria called plaque builds up on the teeth. If these plaque deposits are permitted to linger, periodontal, or gum, disease results. Scaling and root planing are minimally invasive procedures and therefore usually the periodontist's first choice to stop gum disease. Often effective, these procedures carry certain limitations.

Scaling

• The first part of a deep cleaning procedure, scaling involves using special tools to remove plaque that has built up below the gum line. In periodontal disease, plaque hides in deep pockets beneath the gums' surface. To halt decay and damage to teeth and gums, these pockets must be scraped, or scaled clean of all buried plaque. Often, the plaque has turned into tartar, a hard substance that binds to teeth much like cement. Local anesthetics help eliminate the pain caused by inserting instruments beneath the gums.

Root Planing

• Root planing frequently follows the scaling procedure. Because both are time-consuming interventions, the periodontist frequently performs them over a series of appointments instead of all in one day. In root planing, the doctor inserts a small curette into the pocket surrounding the tooth. He then uses the blade of the curette to cut away and smooth out the root's surface. This enables healthy new gum growth to attach solidly to the tooth, eliminating the bacteria-harboring pockets that contribute to periodontal disease. Local anesthesia numbs the areas subjected to root planing. Orally applied or ingested antibiotic treatment frequently follows scaling and root planing in an attempt to control bacterial overgrowth during the time it takes for the gums and tooth roots to heal.

Limitations

• Though a fairly invasive procedure, scaling and root planing provides only a temporary solution to periodontal disease. If the patient fails to adopt consistent daily oral hygiene practices, plaque will build up again over time, causing further damage to teeth and gums. Patients who fail to control gum disease after scaling and root planing often find themselves candidates for more aggressive surgical treatment.

Advanced Treatments

• Gum and bone tissue should fit snugly against each other, without pockets to enable bacterial overgrowth. When scaling and root planing fails to eliminate these pockets, a periodontist will recommend one of several surgical solutions. Pocket reduction surgery, regenerative procedures using tissue-stimulating proteins or bone grafts or covering exposed roots with soft tissue grafts can all assist in preventing further decay.