Scaling and Root Planing (“Deep Cleaning”)

Article Updated February 24th, 2017.

So it’s been a couple of years since your last dental cleaning and you go into the dental office. They take a bunch of x-rays and stick a sharp little probe all around your gums all the while calling out random numbers. Then they sit you up and explain to you that you have “periodontal disease” or “gum disease”. They’re going to need to do scaling and root planing! Is this for real?

What is going on?

Let’s break it down. First the x-rays. Here is a patient of mine who hadn’t been to the dentist in quite a few years. This is actually one of the worst cases of build-up that I’ve ever seen but it gives you a good picture of what can happen. See those white projections on the side of the teeth? That is called tartar or calculus (not the math kind either!). Dental plaque that sits on the tooth too long calcifies and becomes hard. When it gets to this point it is almost impossible for you to remove yourself, especially when it is under the gum-line. These areas attract more bacteria and plaque which just continues to build up. Your body attacks the area and you start losing bone around the teeth! Eventually this can lead to the teeth getting so loose that they fall out! I’ve literally had patient’s come in with their teeth in their hand.

Pockets and Probings

Now next let’s talk about all those numbers. When they going around each tooth and calling out numbers they are actually measuring how deep the “pockets around the teeth are. Bone loss and inflammation will generally cause higher numbers. Normal is 1-3 mm, 4 is borderline, and anything over 5 mm indicates periodontal disease. When you get to numbers like 7-10 you’re looking at severe bone destruction and the need for more intensive treatment. The really terrible part is that generally bone around your teeth can’t be regrown except in very limited circumstances.

The following pictures are from my favorite tooth model of periodontal disease. One side of the mouth shows normal bone around the teeth while the other side shows build-up around the teeth as well as bone loss which is especially severe around the back molar teeth. When we go in to do scaling and root planing on patients, this is exactly the kind of thing we see! Please get treatment done and don’t let it progress until you lose your teeth or affect your overall health!

Gum Disease… A Silent Tooth Killer

Periodontal disease is much like heart disease or diabetes in that it silently causes damage and you generally don’t know there is a problem until it is too late. Usually the only signs early signs are bleeding and puffy gums. If any other part of your body easily bled, you would likely be worried and would see a physician. It should be the same with bleeding gums. Bleeding with brushing is not normal and should be addressed!

It seems to me that gum disease is one of the least understood problems from a patient’s point of view. I think it is hard because it isn’t something you can usually see until it is far too late. Major bone loss has to occur before you notice gums receding and loose teeth. Like we talked about before, it is a lot like heart disease in that respect. A lot of people don’t ever realize they have heart disease until they have a heart attack. Would you ever tell your physician that you don’t think they should treat your heart disease because it isn’t hurting right now? Of course not. You don’t want to wait until it causes a problem. You want to treat it aggressively so that it doesn’t become a problem. It is exactly the same for gum disease. Sure, gum disease won’t directly kill you (but it can contribute to some other diseases that can) but losing your teeth early can cause a huge drop in overall quality of life.

There are also a lot of myths out there surrounding gum disease. We hear a lot of them from our patients including “It doesn’t hurt so I don’t need treatment”, “My gums aren’t bleeding so I can’t have gum disease”, “My whole family lost their teeth so I will too”, or “I brush my teeth all the time so there isn’t any way I have gum disease”. Dr. Nemeth, a world renowned Periodontist (gum disease specialist), has a nice article on his website answering some of these gum disease myths… Common Myths About Gum Disease.

Taking care of periodontal disease is also important to overall health. Periodontal disease is linked to heart disease, diabetes, and preterm births. See our section on the Mouth-Body connection for information on this link.

OK, so what do we do about this? How do we stop it? Prevent it?

The first line of treatment is generally known as scaling and root planing, which many people call a deep cleaning. What your dentist or hygienist will do is numb the entire area and then go under the gum-line and clean out all that build-up and smooth the surfaces. They will use a combination of hand instruments and ultrasonic instruments that break up the tartar and disrupt the bacteria. For most people this will allow the area to heal and get back on track.

For people with mild to moderate gum disease, scaling and root planing along with a change in oral hygiene habits will be enough to get their mouth healthy again. For people with more severe disease or other factors that complicate the situation, they may need additional treatment at a periodontist. This can include surgery, laser treatments, and/or antibiotics.

Now, it’s really important to realize that this isn’t the entire fix. You’ve got to change your habits and how you clean your teeth to maintain this condition. If you go back to minimal brushing and no flossing, you’ll be back in this same situation in a couple of years. Brushing for two minutes, twice a day, and flossing daily is the single most important thing you can do to keep periodontal disease away and maintain your teeth for a lifetime.

If you’re a smoker, I highly recommend working on cutting back or quitting. Smoking is one of the biggest risk factors for gum disease.