Deep scaling and Root Planing

If, during a thorough Periodontal evaluation, we find that you have a lot of periodontal pockets, (see Periodontal exams for an explanation of what this is) bleeding, inflammation, infection and possibly bone loss, we will most likely recommend a more intense and effective deep scaling and root planing. This differs from a ‘regular cleaning’ in that we will need to go deeper to get to the base of the pockets to remove all plaque and calculus (tartar) which is keeping your gum tissue from being healthy.

First, let’s understand the difference between plaque and calculus. Plaque is the soft, sticky film which is always forming on your teeth and you cannot prevent this from happening. This soft plaque can be removed completely from your teeth with frequent brushing and flossing using correct techniques. When not removed and allowed to stay on your teeth, the minerals in your saliva will make it calcify. Your teeth are basically porous, so when your plaque calcifies, it bonds to your teeth by attaching itself into these pores called dentinal tubules. Once this happens, you can brush and floss all you want and will be unable to remove this calcified plaque which is called calculus or tartar. This calculus makes your tooth surface rough which allows more plaque to attach itself and calcify and the process accelerates. This can happen both above the gums and down under the gums in the periodontal pocket area. When the calculus continues building up under the gums, the ligaments holding the gums to the bone release and the pockets get deeper and deeper. Along with this, the gums get more and more inflamed, sore and they typically will bleed when stimulated with your brush, floss or the dental tools.  Many people state that they don’t notice bleeding when they brush or floss. We often find that they aren’t doing it correctly and help to teach you how to effectively remove the soft plaque from your teeth every time you brush and floss so that we can get the results after your deep cleaning. It definitely takes teamwork for total healing to happen after the deep cleaning.

Deep Cleaning requires anesthesia of some type. Depending on the depth of your pockets and your own response to probing, we will decide together whether you will need full anesthesia requiring injections or if we think that maybe gels and rinses might suffice. You will always be a part of that decision.

After appropriate numbing, we will begin by using an ultrasonic scaler to remove the majority of the calculus and flushing out the pockets with water. After this, we will use hand instruments to fine scale the tooth and root surfaces until they are smooth like glass so that it will be harder for plaque to adhere.

Upon completion of the deep scaling, we will often irrigate with an antimicrobial solution for residual bacterial reduction and will likely recommend that you use an antimicrobial rinse as part of your daily routine.

We want to be clear that having deep scaling and root planing done is just half the battle. We can be sure to get your teeth completely clean, but the plaque and calculus will begin to build up again in the next 24 hours and it is imperative that you be ready to make necessary changes to your daily oral hygiene habits to keep your teeth clean and gums healthy.

We most often recommend that you come back for your next Dental cleaning after 3-4 months so that we can be proactive not to allow too much calculus to accumulate. There are people who work very hard at home to prevent calculus buildup but just cannot keep up with it.  This usually has to do with the mineral content of their saliva. These people are often on a 3 month cleaning cycle for life to remain healthy. We recommend doing whatever it takes to help you find the right balance to stay healthy.