What is Periodontal Disease, Perioscaling and Root-planing?
Simply put, perioscaling and root-planing is treatment for periodontal (gum) disease. I know it sounds pretty scary (root-planing certainly doesn’t sound fun) but what exactly is it?
Perhaps the best place to start with an explanation of scaling treatment is to take a look at what it is used to treat then discuss how the treatment is performed. Periodontal disease is gum disease. Left untreated it can ultimately lead to loss of bone in your jaw which may result in the loss of your teeth. That is why it is important that once the disease is diagnosed by your dentist that treatment is done to keep the periodontal disease under control and get your oral health into a state where the disease is not actively destroying the bone that holds your teeth.
You may see the first indications that you may have periodontal disease if your gums bleed when you brush and/or you have persistent bad breath. If that is happening, schedule an appointment to see your dentist. You may have an active periodontal disease. Bleeding gums are a leading indicator but for the most part, periodontal disease is insidious. You typically can’t see it or feel it so you are probably unaware that you have it until your dentist makes the diagnosis.
According to Paul Eke, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, “chronic periodontitis affects 47.2% of adults over 30 in the United States.” The November 22, 2013 article titled Periodontitis Among Adults Aged ≥30 Years — United States, 2009–2010 also says that the prevalence of total and moderate periodontitis increased with increasing age among all adults.
How Dentists Diagnose Chronic Periodontal Disease
When making the diagnosis of gum disease the dentist will look at a few factors to make their diagnosis and establish perio scaling treatment:
- Do the gums bleed when clinical probing is done? Gums should not bleed when your hygienist checks pocket depth while probing.
- Are the gums swollen and puffy? Your gums should be pink and firm, not swollen and puffy.
- When measuring pockets between the teeth and gums are the pockets more than 4mm in depth? It is normal to have a little space between your gums and teeth. Generally speaking 3 mm or less is considered healthy.
- After taking dental x-rays is there any evidence of bone loss occurring? Dental x-rays can show bone loss as well as teeth. The way that bone loss is identified is by comparing current dental x-rays with previous dental x-rays. If the current x-rays show a lower bone level than the previous then you are in the process of losing bone!
Let’s assume that you have the four indicators listed above and your dentist is ruling out gingivitis or has given you the diagnosis that unfortunately, you have active periodontal disease.
What are my Perio Scaling Treatment Options?
Treatment options will be dictated by how severe your periodontal disease is. Periodontal disease is tooth specific. Meaning that you can have periodontal disease on just one tooth and the rest of the mouth is fine. Also the deeper the pockets are between your teeth and gums the harder the periodontal disease is to treat. The pockets are measured in millimeters. You may have heard your hygienist in the past take their little probe out and call out numbers as she went through your mouth measuring the depth of pockets around all your teeth.
If your heard numbers of 2, 3 or maybe even a few 4s you are generally speaking, ok.
If you are hearing numbers of 4, 5 and 6 with bleeding present and your dentist sees it affecting your bone, you are probably heading towards a periodontal disease diagnosis.
If the pocketing reaches 7, 8 or greater you will probably be referred for specialist care for your disease.
Scaling and Root Planing to Treat Gum Disease
Now let’s take a look at how treatment options may work for you.
In the case where your pockets may be measuring 3mm with some 4mm pockets scattered throughout your mouth, and some bleeding but there is not evidence of bone being affected your dentist may diagnose gingivitis and recommend a better home care regime for yourself concentrating on better brushing and flossing. You will be advised to return to the office after a period between 1 and 6 months to determine if your improved home care has been able to effectively combat the disease. The way your dentist and hygienist know if treatment has been successful is by re-measuring your pocket depths to see if the 4mm pocket has now become 3mm or less and looking for reduced bleeding.
If your pocket depths are 3mm or less and there is no bleeding when the pocket measurements are taken your dentist will probably say that the gingivitis is under control and that your gums are healthy, negating the need for any further treatment. This is an optimal outcome for the patient. The gingivitis was caught early before it could turn into full periodontal disease and you were able to successfully treat it with home care. Not only that but you were able to avoid the time and expense of needing professional care for your teeth and gums.
Scaling and root planing cleans the gums and teeth from infection and bleeding so you can heal.
When the pockets between your teeth and gums get to be in about the 4mm to 7mm range, and your dentist starts to see your bone being affected, now is the time when your dentist may diagnose periodontal disease and may recommend perioscaling and root-planing as a treatment option. Professional care is now needed because as the pockets between your teeth and gums get deeper, improved home care is no longer an effective treatment option. You simply cannot get the toothbrush or floss into a pocket that deep to be able to attack the disease.
What happens is normally your hygienist will probably provide you with a treatment recommendation that includes perioscaling and root-planing for the disease. The exact recommendation will be contingent on what quadrant (part) of the mouth the disease is present and how many teeth are involved needing care. There are four quadrants in your mouth: upper right, lower right, upper left and lower left. Treatment recommendations may include one quadrant or all four quadrants depending on where the disease has established itself. The treatment plan will also include how many visits are involved on this first phase of treatment. This can be one to four visits depending on your hygienist and extent of disease.
Now this is what you have been waiting for.
What Exactly is this Scaling Treatment for gum disease and Root-planing treatment?
Well, when pockets get measurements from 4mm to 7mm and periodontal disease is present we know that bacteria is present. Over time this bacteria forms attachment to your jaw bone. It is these attachments that begin to destroy the jaw bone and needs to be gotten rid of. The way to do this is with perioscaling and root-planing. Your hygienist will use instruments to get into the pocket that has formed below your gum line. This is called root-planing. The root-planing will break up the attachments that have formed and stop the process of bone loss. The root-planing process also cleans the roots of the tooth, allowing your gum tissue to re-attach to the tooth and reduce the depth of the pocket.
Scaling needs to be done to get rid of any calculus or tarter that has built up on your teeth. After the perioscaling and root-planing is completed your hygienist will have you return after a period of one to four months. The purpose will be to see how effective the treatment has been. Hopefully, the pockets have shrunk and bleeding has been reduced as a signal that there was effectiveness in the care. Also at this visit, the hygienist will once again use instruments to break up any new bacteria attachments that may have formed to your bone.
When periodontal disease is present it usually takes 3-4 months to re-attach to your bone. This is why your hygienist will recommend you return every 3-4 months, to keep breaking up the attachments and prevent more bone loss. These visits back every 3 – 4 months will happen until your pocket depth has been reduced to a healthy 3mm level. At which point you may be able to take care of the periodontal disease with home care and return to the dental office for routine 6-month visits. This helps to ensure that no further related dental problems ensue.
Hopefully your periodontal disease hasn’t gotten to the point of needing to see a specialist but if it has there will be different surgical procedures that the periodontist may recommend to treat your gum disease. As is usually the case early detection and treatment of a disease are best for your health. Generally speaking the longer you wait the more damage is done and the more costly care gets for treatment. So as far as periodontal disease is concerned seeing your dentist regularly is your best bet for early detection and treatment. Hopefully, you will never get to a point of actually needing perioscaling and root-planing but at least now you know what it is in the event the term is ever brought up as part of your comprehensive dental plan!
Check it out, we may already be answering most of your dental questions on our FAQ page. If you would like to discuss this further, call our Plymouth, MN dental office. (763) 537-1238
Brian Denn is the Clinic Manager at Smile Design Dentistry in Plymouth, Minnesota. Brian has over 25 years of dental practice management involving making practices run smoother and patient experiences better. He also leads a dental practice managers group staying abreast of the latest dental practice management trends.