The bases of any periodontal treatment are scaling and “root planing” procedures. They do, to an extent, go hand-in-hand, but we will focus on the latter in this article.
The primary objective of both these procedures is to restore one’s gum health by removing the causative factors – i.e. plaque (soft deposits), calculus (hard deposits) and the microbial organisms which cause the disease in the first place.
Scaling is the process by which soft and hard deposits are removed from both above and below the gum tooth surfaces. No deliberate attempt is made to remove tooth substance along with the deposits. This is usually done with ultra-sonic instruments. Read more on this here.
Root planing also frees these surfaces of any calculus, but also aims to remove any unhealthy/infected tooth structure from the root surface (“cementum”). The aim being to produce a smooth and clean surface. The procedure involves the use of small, sharp instruments and is performed under local infiltration anesthesia, so as to make the patient most comfortable.
So why is it necessary?
In simple terms, the smoother the root surface is, the:
- Less easy it is for plaque, and therefore tartar, to build up on the tooth,
- Easier it is to keep clean, in terms of at-home oral hygiene and future dental cleanings,
- Better the outlook for the periodontal disease treatment.
So, root planing is done to help with the prognosis of periodontally diseased teeth, meaning they are more likely to stay around!
Does root planing hurt?
The simplest answer to this is no, so long as adequate local anesthesia is applied, this treatment should not hurt. There may be a degree of tenderness and sensitivity afterward, which to a large extent depends on how severe the periodontal disease was in the first place.
Also, due to greater amount of instrumentation and being technique sensitive, deep cleaning costs more than the regular non-anesthesia cleaning.
Scaling and root planing are usually the initial (and primary) steps in a sequenced treatment plan. After careful analysis, the dentist (or specialist periodontist – more on them here) will estimate the number of appointments required to complete this phase of treatment. The number (and frequency) of follow-up maintenance visits depends to a large extent on how well you comply with the oral hygiene instructions given.
Patients with small amounts of calculus and relatively healthy gums can be treated in one appointment. But the majority require several treatment sessions. Sometimes root planing every surface is not possible, due to inaccessibility of certain areas and one shall then need supportive periodontal treatment…
Supportive Periodontal Treatment
Alongside root planing and scaling as the main periodontal treatment, the local application of antibiotics such as minocycline (commonly called Arestin) and chlorhexidine may be used as an adjunctive therapy. These agents are only effective when applied after thorough deep cleaning, ie they don’t work alone.
Along with root planing, tissue curettage (which involves removing the affected gum tissue) facilitates faster healing. Gingivectomy is another procedure in which the gums are cut and reshaped to regain a natural contour, mostly in cases of deep pockets and severe gingivitis (inflammation of gums). Gingivectomies are usually also supplemented by thorough root planing and curettage.
Periodontal surgery provides the best access to most difficult-to-reach root surfaces and is thus sometimes required. Here, the gum is incised and held back. The dental surgeon will have visual access to the roots, making for easier and more thorough cleaning via scaling, root planing and tissue curettage. The gum is then sutured back into place.
After thorough cleaning (‘debridement’), a dramatic change in the oral micro-ecosystem should occur. This will be accompanied by a marked reduction in inflammation. But to keep things healthy, this needs to be maintained regularly by periodic scaling and root planing procedures, along with meticulous tooth-brushing, flossing and regular use of mouthwash during the (indefinite) maintenance phase.
To sum it up, root planing is a method of cleaning the tooth surfaces and leaving them smooth. This not only makes for healthier gums in the immediate term but also helps by making these areas easier to keep clean. The aim is obtaining a smooth glass-like surface, which is free of calculus and is less prone to future deposits as well.