Scaling and Root Planing (AKA Deep Cleaning) is the standard and highly effective treatment for controlling and managing periodontal disease (periodontitis).
At Asiri Dental Center, we provide excellent scaling and root planing services in Quito. We want you to understand all the details of this treatment, so you can feel confident when you visit your periodontist to control the progression of this silent and damaging disease.
This guide will cover everything from the basics, such as when the treatment is necessary and its benefits, to important recommendations for before and after the procedure.
Table of Content
What is Scaling and Root Planing (SRP)
SRP is a treatment for chronic periodontitis that combines two mechanical techniques to resolve inflammation. Its goal is to completely eliminate the local factors on the tooth surface that cause inflammation, such as plaque, calculus (tartar), and altered cementum.
The immediate objective of this technique is to create a smooth, clean dental surface free of harmful agents.
Once this smooth texture is restored and pathogens are removed, the periodontal tissues can begin to recover from inflammation.
Difference between Scaling and Root Planing
- Scaling: This is a deep cleaning that removes calculus, plaque, stains, and any unwanted organic material from the outer surface of the tooth. Tooth enamel is naturally smooth, so simple scaling is often enough to achieve a smooth surface. However, the root surfaces are not always smooth, and damaging agents can hide in these irregularities, which is why root planing is also necessary. When scaling is performed below the gumline, it is called subgingival scaling; when it is above the gumline, it is called supragingival scaling.
- Root Planing: Due to the irregular characteristics of the root surfaces (the root cementum), achieving a smooth and clean surface requires an additional step. Root planing involves eliminating these irregularities along with the plaque and calculus deposits found within them. Scaling without root planing is not sufficient to remove the factors that cause inflammation. For this reason, both procedures should not be considered or performed independently.
Objectives of Scaling and Root Planing
As we have seen, the immediate objective of SRP is to create a smooth, clean dental surface free of harmful agents.
However, its true goal goes a little further: to eliminate or control the disease and maintain periodontal health by promoting the recovery of the tissues surrounding the tooth.
Benefits of Scaling and Root Planing
Scaling and Root Planing can improve your quality of life by:
- Prolonging the life of your teeth.
- Improving the health of your gums.
- Reducing or eliminating periodontal pockets, which are typical of periodontal disease. The treatment re-establishes a biologically acceptable dental surface where separated tissues can reattach.
- Allowing tissues to partially or totally recover their healthy, natural color, contour, and consistency.
- Reducing gum bleeding.
- Making brushing and flossing easier.
- Controlling bad breath (halitosis).
Scaling and root planing are effective in fighting periodontitis, and when combined with good oral hygiene and regular maintenance, these positive effects can last for several years.
Who Performs the Scaling and Root Planing
The SRP can be performed by the General Dentist, however, in more complex cases, it is highly recommended that it be performed by a specialist in Periodontics or as it is known, a Periodontist.
In any case, you need a prior evaluation to determine the level of periodontal disease and with this level already defined, an appropriate treatment plan is made for each person.
When is Scaling and Root Planing Necessary
This treatment is the primary method used to combat periodontal disease. Generally, it is indicated in the following cases:
- Individuals with periodontal disease.
- As a preventive measure for people who are prone to generating large amounts of plaque or calculus.
- As a maintenance treatment for people with periodontitis.
- When there are periodontal pockets larger than 3 millimeters.
When Scaling and Root Planing is NOT Necessary
When periodontal pockets are less than 3 millimeters, scaling and root planing is not necessary. In these cases, regular dental cleanings and appropriate dental hygiene techniques should be sufficient.
Contraindications of Scaling and Root Planing
According to Matos Cruz R. y Bascones-Martínez A. the following cases are identified as cases in which carrying out a SRP is counterproductive
- People with poor plaque control and who are uncooperative.
- Patients suffering from acute leukemia, agranulocytosis, and lymphogranulomatosis.
- Recent myocardial infarction.
In any case, a prior evaluation is required to determine the suitability of the treatment, as well as joint work with the attending physician.
Treatment Plan
This point can only be defined by your periodontist. However, I will give you some parameters that can serve as a reference. Depending on the complexity of the case, your periodontist will outline the phases in which the SRP should be performed. The key steps are:
- Dental Hygiene Education: The success of any treatment for periodontitis must be supported by excellent dental hygiene education and practice. Without excellent dental hygiene, it is very difficult to control periodontal disease.
- Defining Treatment Sectors: This is where the quadrants or sextants of the mouth to be treated are defined. A quadrant is the result of dividing the mouth into four parts, while a sextant divides it into six parts. The method to be used in each sector is also defined: open-field or closed-field scaling and root planing.
- Method to Use: Depending on the complexity of each case, which is mainly determined by the size of the existing periodontal pockets, SRP can be performed in different ways:
- Open Flap Debridement: This method is used in the most complex cases and involves a surgical procedure. The gum is displaced to better see and reach the root surfaces. Once the roots are exposed, it is much easier and more effective to perform the SRP because the periodontist has better visibility and access for the instruments.
- Closed-Field: This method does not require displacing the gum. Access to the roots is achieved by inserting special instruments between the gum and the tooth.
Discomfort After a Scaling and Root Planing
If you are wondering if a scaling and root planing procedure is painful, the answer is no. It is performed under local anesthesia, so you will not feel pain during the procedure. After the anesthesia wears off, you may experience some normal discomfort for this type of treatment. Below is a list that can help you get an idea:
- Pain or discomfort in the gums: This usually occurs more in highly complex cases.
- Sensitivity in the teeth: Sensitivity to cold, heat, or sweets may be experienced.
- Changes in appearance: There may be some root exposure or the appearance of spaces between the teeth.
- Bleeding: Some bleeding may occur. It can be reduced by applying pressure with gauze and drinking cold beverages.
Possible Complications after Scaling and Root Planing
Your periodontist will always strive to work in the best possible way. However, as in all medical and dental procedures, unwanted situations can occasionally arise. In a general and informative way, here is a list of some complications that can be generated during a SRP. If any of these happen to you, you should notify your doctor immediately:
- Epithelial adhesion damage.
- Bacteremia.
- Periodontal abscess (localized).
- Uncontrolled bleeding.
Periodontal Maintenance
After a SRP has been performed, you must attend a periodontal check-up at an average frequency of every three months. This check-up is called periodontal maintenance, and its objective is to supervise your periodontal health and take any necessary corrective measures. According to your periodontist’s assessments, it is possible that some treatments or diagnostic studies will be carried out during these appointments to evaluate your progress in oral health. Examples of things that could be done at a maintenance appointment include:
- Measurement of pockets or periodontal sacs.
- Taking X-rays.
- Evaluation of the quality of your oral hygiene practices.
- Prophylaxis, cleanings, or supragingival scalings.
- More complete scalings in case of periodontal pockets greater than 3 millimeters.
Conclusions
Scaling and root planing is an excellent treatment, but its success depends on your collaboration. It is very important that you:
- Attend periodontal maintenance appointments.
- Maintain excellent oral hygiene habits.
- Avoid eating foods high in sugar.
- If applicable, give up smoking. Smoking is a proven factor in the development of periodontal disease.
By following these tips and your periodontist’s instructions, you will have won a large part of the battle.
Author:
Our Foundress and guardian of our Values
Dr. Krisna makes sure that the treatment you receive is successful by contrasting opinions between all the doctors that are necessary and ensuring a neat execution of all the processes.
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