Periodontal Therapy

Periodontal scaling procedures include the removal of plaque, calculus and stain from the crown and root surfaces of teeth. Root planing is a specialized skill involving scaling of the root of the tooth, made up of cementum. Because cementum is softer than enamel, it is affected more by ongoing build-up and inflammatory byproducts. A smooth cementum provides less opportunity for bacteria to hang out and form calculus, so root planing is an important part of stopping periodontal disease where it is at, and preventing periodontal disease from getting worse, specially once deeper pockets have formed in the gums, which is really in the bone. So, root planing is a specific treatment that removes the roughened cementum and surface dentin that is impregnated with calculus, microorganisms and their toxins.

Because in periodontal disease pockets form that are deeper than the usual gingival depth, such scaling and root planing are often referred to as deep cleaning, and may be performed using a number of dental tools, including ultrasonic instruments and hand instruments, such as periodontal scalers and curettes.

Removal of adherent plaque and calculus with hand instruments can also be performed on patients without periodontal disease.  This treatment would then be referred to simply as scaling.  A prophylaxis (a cleaning, although literally it means “prevention”) or a prophy for short refers to the polishing that is sometimes done after the scaling and root planing are complete.  Polishing does not remove calculus, only plaque, and should therefore only be done after all calculus has been removed, or else the calculus will get burnished onto the tooth.

Sometimes a device may be electric, known as an ultrasonic or sonic scaler.  Ultrasonic scalers vibrate at a frequency that breaks down bacterial cell membranes and as such, because the bacteria are what make the plaque and the calculus stick, the ultrasonic scaler removes a lot of both plaque and calculus.  Hand instruments are used to complete the fine hand scaling that removes anything the ultrasonic scaler left behind.

Gingival fluids may also be tested to identify microbial pathogens which can be targeted with effective localized and systemic medications to help restore periodontal health.

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