Unbiased oral health information

Procedures

Scaling & root planing

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Only a dentist can diagnose or recommend treatment for your specific needs. Web-based research by a patient is no substitute for the extensive training and clinical experience of a dentist—but it can empower you to ask intelligent questions that can result in the best treatment for your unique needs. This page lists some things to keep in mind and offers some suggested questions you can ask your dentist about this topic.

What is the likelihood of having sensitivity after the procedure? Ask whether desensitizing varnishes or gels may be used to minimize sensitivity. Creating a smooth tooth root surface that is less conducive to bacterial colony formation frequently results in some degree of sensitivity. If a patient knows to expect it, there is less likelihood of disappointment.

What is the likelihood that the gums will recede so much that the tooth roots will be visible? If it is likely, it is best to know ahead of time. Keep in mind that the main goal of SRP is to re-establish healthy tissue around the teeth that can be maintained by the patient.

Who will perform the procedure, and what are their credentials? There have been reports of dental assistants performing the procedure, which is beyond their level of training and a violation of the Dental Practice Act in all fifty states. Under the law, a dentist (including general dentists and specialists) or registered dental hygienist must perform scaling & root planing.

Sharp curettes are essential to effective removal of calculus. It is common to see patients who have undergone scaling & root planing procedures with dull instruments that simply polish the surface of the calculus. The deposits must be removed, or the bacteria they contain will remain and continue to cause inflammation.

After SRP is completed, if there are sites which remain inflamed, you should discuss whether there are "local factors" present which are negatively impacting the health of the site. These may include over-sized or irregular tooth restorations (like fillings with overhangs), crowns with open margins (gaps between the edge of the crown and tooth), etc. (Figure 3). If so, you should consider having them recontoured or replaced. The dental professional may be able to show you effective ways to clean them. If you are aware of these types of "local factors", and do your best to keep the area free of plaque, you may not have to have the restoration replaced.
Learn more: Diagnoses › Poorly contoured dental restorations

Dental x-ray shows overcontoured silver filling in tooth causing periodontal pocket

Figure 3: A large overhang (1) on this silver filling has led to a localized area of chronic periodontal inflammation and bone loss (2), despite otherwise good periodontal health. Problems like these can also lead to decay on the adjacent tooth, or under the restoration itself. If you have restorations like this that have caused a similar problem due to inability to keep the area clean, you may need to have the restoration re-contoured or replaced.

Some patients may have particularly aggressive species of bacteria present. The dentist can sample the bacteria and send them to a laboratory to determine exactly which ones they are. For some of those, treatment with subgingival antibiotics can be a useful adjunctive treatment. By reducing bacterial infection and the immune response that follows, it can help to reduce the pocket depths measurably.

Most cases of periodontal disease can be controlled by motivation and active involvement of a patient who understands the condition, and wants to avoid its negative consequences.