One of the goals of periodontal disease treatment is to
arrest and control the progression of the bacteria that cause gingivitis and periodontal
disease. As the bacteria infect the gum tissues, they release toxic substances
that trigger the breakdown of gum and bone. The gum then separates from the
teeth, forming a gap that is called a periodontal pocket. These spaces are
inaccessible to daily oral hygiene techniques. Bacteria settle in these pockets
and continue to accumulate and reproduce, creating further gum and bone
destruction.
Periodontal disease treatment such as scaling and root planing involve the removal of the irritants and bacterial
deposits (plaque and tartar) that have accumulated above and below the gum line
in the periodontal pockets. The root surfaces of the teeth are planed (smoothed)
to promote healing and to help prevent future bacterial reattachment. At the
same time, gingival (gum) curettage can be done to remove the infected soft
tissues that line the periodontal pockets.
Most of the time, scaling and root planing is done in two to four visits. For
patient comfort, the gums can be numbed by the periodontist using a local anesthetic. One-quarter of
the mouth is usually treated at the time and treatment of each quarter can take
45 minutes to an hour (three to four hours for the entire mouth). Most patients
report minimal discomfort during these periodontics treatments.
During scaling and root planing appointments, the dental care provider will
review oral hygiene techniques that are aimed at improving the person's
ability to control plaque and to help avoid bacteria from reinfecting the
pockets. Patients also will receive advice on the modification of certain risk
factors associated with periodontal disease.
In some circumstances, the dental care provider may recommend the use of
adjunctive products for
periodontal treatment. To be effective, antimicrobial products such as Chlorhexedine, PerioChip, and Atridox should be used in combination with scaling
and root planing. Periostat is also a product that can be used as an adjunct to
scaling and root planing in order to impede further tissue breakdown and promote
healing.
Several weeks after completion of scaling and root planing, a periodontal
re-evaluation should be completed. The purpose of this exam is to assess the
response to treatment and determine if there is a need for further treatment.
The best way to stop the progression of periodontal disease is to
mechanically remove the bacterial plaque and tartar that have accumulated in the
periodontal pocket. Daily oral hygiene and supportive
periodontal treatment
(see article "Supportive Periodontal Treatment")
is key to the success of
scaling and root planing. Without treatment, the tartar and plaque buildup
underneath the gums will continue to cause periodontal tissue breakdown,
progression of periodontal disease, and eventually tooth loss and/or systemic
(general) complications.
