February 7, 2012

Scaling and Root Planning

In Cape Coral, Florida we have over 400 miles of waterfront property and everyone here has a dock or lives across the street from one.  So when I tell my patients that scaling and root planing their teeth is like, “Scraping the barnacles off of their pilings below the water line”, they usually understand what I mean.

Humans have lived with bacteria in their mouths for a very long time.  Some of these bacteria are beneficial and some are not.  The beneficial bacteria usually help occupy niches in the mouth so that the bad bacteria cannot populate them in sufficient numbers to cause an unwanted infection.  Unfortunately, the good bacteria cannot always protect us from the bad bacteria and this is when we can develop gingivitis, and periodontal disease.  Brushing and flossing helps keep our mouths disease free, if done properly, but few people have the dental IQ or manual dexterity to actually pull this off.  This is why the World Health Organization estimates that 85% of adults have some form of periodontal disease and 5-20% have severe periodontal disease (loss of tooth/teeth).

When bacteria are left unchecked too long around the necks of your teeth, they can use the calcium from your saliva and build solid “homes” that are very hard to remove with regular home care.  These homes are called calculus or tartar and are hard to remove. Professional cleaning can get rid of them.  When calculus is found above the gum-line it is called supragingival calculus and is scaled off.  If it is found below the gum-line it is called subgingival calculus and it is root planed off. The process of removing both supra and subgingival calculus is called scaling & root planing.

In Florida, a simple cleaning can be done by an expanded duties dental assistant, but scaling and root planing can only be preformed by the doctor or a state licensed dental hygienist.

Everyday in our practice we hear from new patients that they never have had such a good cleaning.  The secret?  Taking the time to do it the right way.  Each of our 3 Registered Dental Hygienists only take 8 patient per day.  This insures that they have enough time to do a completely thorough and comfortable job.  Not some hurry up, turn and burn, buff and shine “cleaning” that you get from most chain dental clinics who are just looking at the numbers and not patient care.

Health History:

New patients can expect a complete dental exam which includes a complete health history review.  This is a very important part of the dental visit.  With our population living longer, we often run into poly-pharmacy issues, artificial joints and heart valves, blood thinners, diabetes, and psychiatric problems just to name a few.  Each of these conditions need to be considered when customizing any treatment plan.

Hard and Soft Tissue Charting:

Hard tissue charting is where we write down into your chart the different fillings, crowns, bridges, implants, root canals, dentures, missing and impacted teeth in your mouth at that moment in time you started at our office.  Soft tissue charting involves the gums.  Gum problems like muco-ginvival defects, bleeding, purulence, and periodontal disease pocket probing depths help in the decision making process and treatment planning for your mouth.

Periodontal disease:

During the complete exam process it may be found that you have periodontal disease.  This is where bacterial have set up colonies around the necks of your teeth.  Calculus or tartar can build-up and invade down the side of your teeth causing pocketing.  If these pockets get deeper that you can clean on your own (>4mm) then they will have to be cleaned out professionally.  In our office a registered dental hygienist would be prescribed the task of scaling and root planing your teeth.

Scaling and Root Planing:

Scaling the calculus above the gum line in usually not a difficult task for most hygienists.  It involves using a ultrasonic scaler such as a Cavitron or Pro-Select to vibrate off the deposits off the teeth.  Root planing, on the other hand, can be quite involved and difficult to do a good job.  It involves using instruments specially designed to be inserted deep below the gum line and “plane” the calculus and necrotic dentin off of the root surfaces.  Pockets any deeper that 6mm are usually not well cleaned by ordinary root planing.  At this point the patient is usually referred for periodontal surgery.

Compromised Maintenance:

Scaling and root planing is also used in compromised maintenance.  This is where a patient knows they have periodontal disease but has chosen to not have periodontal surgery.  It is called compromised because root planing is not enough treatment to completely stop the progression of the disease, but it is usually enough to slow it down to a crawl.  Eventually, the teeth will succumb to the disease process if the disease process is present long enough.


1. Adv Dent Res. 2011 May;23(2):221-6. Global oral health inequalities: task group–periodontal disease. Jin LJArmitage GCKlinge BLang NPTonetti MWilliams RC. Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.

2. http://www.nlm.nih.gov/medlineplus/news/fullstory_118663.html