Procedures

Scaling & root planing

The process

Before SRP is undertaken, it is necessary to establish a diagnosis of "periodontal disease".
Learn more: Diagnoses › Periodontitis

On the date of SRP, your health history will be reviewed. You may require pre-medication with systemic antibiotics if you have prosthetic joints, prosthetic heart valves, or certain types of heart murmurs. Your physician may also recommend pre-medication if you have certain other medical conditions (e.g. transplants).

If you take blood thinning medication, your dentist may recommend suspension of the medication prior to SRP. This should be coordinated with your physician, of course.

Due to the potential for discomfort in instrumenting tooth root surfaces, local anesthetic is typically given. Generally, the fee for local anesthetic is included in the cost of the procedure. But be sure you understand the billing practices of your dentist before undergoing treatment.
Learn more: Procedures › Local anesthetic

Frequently, swishing or irrigation with 0.12% chlorhexidine rinse (or Listerine®) is performed prior to the procedure, to minimize the number of live bacteria in the mouth. This can help prevent development of chapping and cold sores post-operatively, and transmission of contagious bacteria or viruses to the dental professional. It can also prevent soft tissue infections from developing post-operatively.

A specialized probe called an "explorer" is used to identify deposits of calculus and roughened cementum on the roots. The deposits are then removed, and the root surfaces are planed smooth.

Large deposits of calculus can be removed from the teeth using an ultrasonic or piezoelectric scaling device. Use of these devices can greatly increase the efficiency of the procedure, and can significantly reduce the time necessary to perform SRP.

Scaling involves an upward (i.e. directed toward the crown of the tooth) pulling application of the curette to the deposits of calculus in order to break and cut them free of the tooth (Figures 1a and 1b under "Overview").

Root planing is more of a rubbing motion designed to smooth the roughened root surfaces and make them less plaque-retentive. In addition to calculus removal, the goals of scaling & root planing include a reduction in the number of bacterial colonies and their food supply; and improved access for the patient, so that they can keep the affected teeth as clean as possible after treatment. If the bacteria and their food supply (plaque and calculus) are removed and kept from returning (through effective oral hygiene), the body's immune response (bleeding and enlargement of the gums) will no longer be needed to deliver immune-competent (i.e. disease-fighting) cells and compounds to the area to fight bacteria.

Ironically, the body's immune system is partly responsible for the breakdown in connective tissue that characterizes periodontal disease. Removing the problematic calculus and bacteria reduces the need for an immune response from the body, and allows healing to occur.

There is controversy about whether or not use of a laser to clean the gum pockets produces better results. While early healing may be improved, it is not clear whether there is any long-term advantage.

Following SRP, your dental professional will often give specific instructions on how best to manage your unique dental situation. For example, if you have lost bone around multi-root teeth that allows food debris and bacterial plaques to build up between the roots, use of a toothpick, "interdental brush", or "perio aid" may be recommended. When your dental professional is certain you understand how to maintain your dentition, a "periodontal re-evaluation" appointment should be scheduled.

The periodontal re-evaluation appointment is generally set four to six weeks after the completion of SRP. At that appointment, areas which have accumulated new calculus will be identified. Areas where bleeding continues and the tissue remains enlarged are identified as sites of continued inflammation. This implies bacteria (and probably deposits of calculus) remain. Some localized refinement of the SRP may be necessary. It may also be helpful to place subgingival antibiotics in the gum pockets around certain teeth.

When plaque removal is deemed to be effective, and no inflammation remains, probing pocket depths will be measured, and an appropriate interval for periodontal maintenance visits will be established.