Scaling is the removal of calculus, plaque, tooth deposits and some stains. It can be done either above the gum (supra-gingival) or below the gum (sub-gingival).
Root planing is a more radical treatment. It involves the removal of dead (necrotic) substance from the surface of the tooth under the gum. Otherwise it is similar to scaling.
Initially, the patient will have to be examined by a dentist. The treatment given will vary depending on the severity of the periodontal disease. In its least severe form, the patient may only need some oral hygiene instruction. If plaque and calculus is found above the gum scaling may be necessary. In more severe forms where plaque and calculus is found under the gum, scaling below the gum margin and root planing may be required.
Either a dentist or a hygienist can carry out the scaling and root planing. But. the more complex cases will be carried out by the dentist.
Scaling and root planing are done using special scaling instruments or ultrasonic devices. Hand instruments are made in various designs appropriate for reaching and removing plaque and calculus from all areas of teeth. The use of hand instrument can be tedious and time consuming.
Ultrasonic devices fracture deposits off the tooth surface. They also use water to help clear blood, debris, necrotic tissue and calculus. They are quicker to use and less tiring for the operator. However, some patients find them uncomfortable.
Depending on the amount of pre-existing plaque and calculus, scaling above the gum can take 15 to 30 minutes. Longer visits are necessary if it is a first visit and the patient has a lot of plaque and calculus. However, once the initial therapy has been done and good oral hygiene practices are carried out at home, subsequent maintenance visits can be as little as 15 minutes.
Sub-gingival scaling and root planing visits usually last an hour. The procedure is normally requires a local anaesthetic.
Above the gum scaling is usually pain-free. However, if the gums are very inflamed they can be very sensitive. If so, a topical anaesthetic cream or some local anaesthetic will be used to alleviate the pain. Below the gum scaling and root planing are usually done under local anaesthetic and so, discomfort is infrequent.
The teeth and gums can sometimes be tender a few days after scaling and root planing. Post-operative pain and sensitivity of the teeth can be treated with desensitising agents available from your dentist. Also, mouthwashes and desensitising toothpastes are helpful.
In the treatment of periodontal disease, the advantages of scaling and root planing outweigh the disadvantages. This is because if periodontal disease is left untreated, it will lead to tooth loss.
However, there are a few disadvantages of scaling and root planing:
- Post-operative pain
- Gum recession, which is usually only marked in advanced cases of periodontal disease
- Fillings can occasionally be dislodged during the procedure.