Scaling and root planing

Not to be confused with Dental antibiotic prophylaxis.

Scaling and root planing
Intervention
Close-up image of a hand scaler.
ICD-9-CM	96.54
MeSH	D012534

The objective of scaling and root planing, otherwise known as conventional periodontal therapy, non-surgical periodontal therapy or deep cleaning, is to remove or eliminate the etiologic agents which cause inflammation: dental plaque, its products and calculus, thus helping to establish a periodontium that is free of disease.

Plaque

Main article: Dental plaque

Plaque is a soft, sticky mixture of bacteria, waste products from bacteria, and some food debris. It irritates the gums, or gingiva, and causes inflammation over time: gingivitis. The longer plaque is left on the teeth, the harder it gets. After 24 hours, some plaque hardens into calculus, otherwise known as tartar. Calculus is mineralized plaque and does not come off with the brush and floss anymore. The bacteria in plaque and calculus causes an ongoing state of inflammation called gingivitis. If left untreated, gingivitis can progress to a more serious disease called periodontitis. The most common treatment for periodontitis is Scaling and Root Planing.

Plaque build up and bone loss

Because the bone is alive, it has cells in it that build bone, and cells that break down bone. Usually these work at the same speed, and keep each other in balance: it is called bone remodeling. The chemical by-products of ongoing inflammation stimulate the cells that break down bone, which now start working faster 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.

Periodontal scaling

Periodontal scaling procedures "include the removal of plaque, calculus and stain from the crown and root surfaces of teeth. Root planing is a specialized skill involving scaling of the root of the tooth, made up of cementum. Because cementum is softer than enamel, it is affected more by ongoing build-up and inflammatory byproducts. A smooth cementum provides less opportunity for bacteria to hang out and form calculus, so root planing is an important part of stopping periodontal disease where it is at, and preventing periodontal disease from getting worse, specially once deeper pockets have formed in the gums, which is really in the bone. So, root planing is a specific treatment that removes the roughened cementum and surface dentin that is impregnated with calculus, microorganisms and their toxins."

Because in periodontal disease pockets form that are deeper than the usual gingival depth, such scaling and root planing are often referred to as deep cleaning, and may be performed using a number of dental tools, including ultrasonic instruments and hand instruments, such as periodontal scalers and curettes.

A dental hygienist demonstrates scaling.

Removal of adherent plaque and calculus with hand instruments can also be performed prophylactically on patients without periodontal disease. A prophylaxis, or prophy for short refers to scaling and polishing of the teeth in order to prevent oral diseases. Polishing does not remove calculus, only some plaque and stains, and should therefore only be done in conjunction with scaling.

Sometimes a device may be electric, known as an ultrasonic or sonic scaler. Ultrasonic scalers vibrate at a frequency that breaks down bacterial cell membranes and removes both plaque and calculus. Hand instruments are used to complete the fine hand scaling that removes anything the ultrasonic scaler left behind.

Two ultrasonic instruments.

Sonic and ultrasonic scalers are powered by a system that causes the tip to vibrate. Sonic scalers are typically powered by an air-driven turbine. Ultrasonic scalers typically use either magnetostrictive or piezoelectric systems to create vibration. Magnetostrictive scalers use a stack of metal plates bonded to the tool tip. The stack is induced to vibrate by an external coil connected to an AC source. Ultrasonic scalers also include a liquid output or lavage, which aids in cooling the tool during use, as well as rinsing all the unwanted materials from the teeth and gum line. The lavage can also be used to deliver antimicrobial agents.

There is some debate over whether there is an advantage to sonic or ultrasonic scaling over hand scaling and some issues arise from powered scalers.^{[citation needed]} Although the final result of ultrasonic scalers can be produced by using hand scalers, ultrasonic scalers are sometimes faster and less irritating to the client. Ultrasonic scalers do create aerosols, which can spread pathogens when a client carries an infectious disease. Relying solely on ultrasonic scalers for all scaling is inadequate; it is best to follow ultrasonic scaling with hand scaling.^{[citation needed]} Of particular importance to dentists themselves is that use of an ultrasonic scaler will greatly decrease their likelihood of getting Carpal Tunnel Syndrome (Or other similar forms of RSI).^{[citation needed]}

Effectiveness

Scaling and root planing is considered the basic treatment of periodontal diseases and may be the only treatment required to treat mild cases of periodontitis; however, it may also be the initial therapy prior to future surgical needs. For the procedure to be considered effective, the patient must be able to be maintained at a level of periodontal health that will prevent reinfection with periodontal pathogens. This requires optimal home care and ongoing periodontal maintenance therapy, usually every 3 to 4 months to sustain health.

It is effective only when certain conditions are fulfilled. A complete removal of calculus from the periodontal pockets using hand and ultrasonic instruments is not totally effective. The depth of the pocket, when identified by the probe, exceeds more than 3mm then calculus removal becomes more insufficient. The maximum access of a probing instrument is up to 6mm, any calculus beyond that can't be reached. If there is calculus exceeding more than 6mm, then scaling and root planing are ineffective and the best treatment option in such cases will be surgical access for complete pathogen and calculus free area.

The probing depth and methods affects the success of the procedure, and factors like root grooves, concavities, and furcation involvement may limit visibility of underlying deep calculus and debris. In severe periodontal disease where there is a systemic involvement, scaling and root planing are insufficient and surgery is required.^{[citation needed]} Scaling and root planing are ineffective in cases where tooth mobility is severe, such conditions require periodontal surgery and placement of bone grafts.^{[citation needed]}

See also

• Tooth polishing
• Debridement (dental)
• Periodontal disease

External links

• What is Deep Cleaning (Scaling and Root Planing)?
• Dickson, Murray (July 1996) [1983]. "Scaling Teeth" (pdf). Where There Is No Dentist (7th printing ed.). Palo Alto, CA: The Hesperian Foundation. pp. 121–128. ISBN 0-942364-05-8. http://www.healthwrights.org/books/WTINDent/WTINDchapt8.pdf. Retrieved March 2006. 
• Root Planing – Limitations and Goals by Dr Muna