Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form bacteria-harboring “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.
The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.
When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth.”) In periodontitis, gums pull away from the teeth and form “pockets” that are infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s enzymes fighting the infection actually start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and connective tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.
How is Periodontal Disease Treated?
The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. Additionally, modifying certain behaviors, such as quitting tobacco use, might also be suggested as a way to improve treatment outcome.
Deep Cleaning (Scaling and Root Planing)
The dentist, periodontist or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease.
Medications
Medications may be used with treatment that includes scaling and root planing, but they cannot always take the place of surgery. Depending on the severity of gum disease, the dentist or periodontist may still suggest surgical treatment. Long-term studies will be needed to determine whether using medications reduces the need for surgery and whether they are effective over a long period of time. Here are some medications that are currently used:
Scaling and Root Planning-Periodontal Maintenance
The Need for Deep Cleaning
When going to the dentist, the dental hygienist will use an instrument called a probe to measure the area around your teeth to see if you have any pocketing (area between the tooth and gum where bacteria will form). The depth of the gum tissue between the teeth and gums are called pockets when it is five millimeters or more. The American Academy of Periodontology recommends that every adult receive a periodontal evaluation each year to determine whether additional treatment is needed. Measuring pocket depth is just one part of a comprehensive dental evaluation.
Ideally, normal healthy pockets will be no more than 3 millimeters deep, according to the National Institute of Dental and Craniofacial Research (NIDCR). If the pockets are greater than 5 millimeters, your dentist might prescribe a deep scaling and root planing appointment with the dental hygienist.
Deep Cleaning Process
Deep cleaning is also known in the dental world as scaling and root planing. Scaling involves removing plaque and tartar from the surface of the teeth and from the pocket area between the teeth and gums, according to the NIDCR. The dental hygienist can perform scaling and root planing using either electriceor ultrasonic instruments or manual scaling tools.
The other part of deep cleaning is root planing. The dental hygienist will use a scaling instrument to remove plaque and tartar from the surface of the roots of your teeth. A scaling and root planing procedure will require a minimum of two visits as an appointment. A follow-up visit may be necessary to confirm that your gums and teeth are getting healthier and there is no pocket depth.
Care after Scaling and Root Planing Appointments
Ideally, after this deep cleaning appointment, the bacteria in the pockets of the teeth will be removed and in the next few weeks the gums should become healthier if the person is doing oral hygiene everyday. The optimal cleaning toothpaste your dental professional will recommend is Colgate Total toothpaste. If an additional mouthrinse is required, your dentist might prescribe an antibacterial mouthwash, such as Colgate® PerioGard®, to reduce bacteria in your mouth.
If you have been told you have periodontal (gum) disease, you’re not alone. An estimated 80 percent of American adults currently have some form of the disease.
Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost.
Gum disease is a threat to your oral health. Research is also pointing to possible health effects of periodontal diseases that go well beyond your mouth (more about this later). Whether it is stopped, slowed or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.
How do I Know if I Have Periodontal Disease?
Symptoms are often not noticeable until the disease is advanced. They include:
- Bad breath that won’t go away
- Red or swollen gums
- Tender or bleeding gums
- Painful chewing
- Loose teeth
- Sensitive teeth
Any of these symptoms may signal a serious problem, which should be checked by a dentist. At your dental visit:
- The dentist will ask about your medical history to identify underlying conditions or risk factors (such as smoking) that may contribute to periodontal disease
- The dentist or hygienist will examine your gums and note any signs of inflammation
- The dentist or hygienist will use a tiny ruler called a ‘probe’ to check for periodontal pockets and to measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters
- The dentist or hygienist may take an X-ray to see whether there is any bone loss
The dentist may refer you to a periodontist, a specialist who treats gum diseases
| What is it? | Why is it used? | How is it used? | |
| Prescription antimicrobial mouthrinse | A prescription mouthrinse containing an antimicrobial called chlorhexidine | To control bacteria when treating gingivitis and after gum surgery | It’s used like a regular mouthwash |
| Antibiotic micro-spheres | Tiny, round particles that contain the antibiotic minocycline | To control bacteria and reduce the size of periodontal pockets | The periodontist puts the micro-spheres into the pockets after scaling and root planing. The particles release minocycline slowly over time. |
Post Op Instructions
- Following scaling and root planing, you can expect to notice less redness, less bleeding, and less swelling of your gum tissues. Your teeth may feel smoother, and your mouth will taste and feel better. Your gum health must be maintained with proper home care, as instructed, and regular professional care.
- When anesthesia has been used, your lips, teeth, and tongue may be numb for several hours after the appointment. Avoid any chewing until the numbness has completely worn off. It is easy to bite or burn your tongue or lip while numb. It is recommended that you take some ibuprofen (Motrin or Advil, 1-2 tablets every 4-6 hours as needed) before the anesthetic completely wears off. This will help with any swelling or pain at the injection sites where the anesthetic was administered.
- It is not unusual for the teeth to be more sensitive to hot or cold temperatures, and/or sweets. This occurs as the gum tissue heals and shrinks in size. Brushing two to three times daily with sensitivity toothpaste or using fluoride rinses may help alleviate this over time.
- For a few days, a soft diet is recommended, chewing on the opposite side.
- Consistent and thorough daily oral hygiene is essential to the proper healing of your gum tissues. Brushing, flossing and rinsing with recommended products are critical. Use Listerine, or if prescribed, Peridex (Chlorhexidine).
- If a localized antibiotic (Arestin) was placed, please follow all additional instructions given to you at your appointment.
In most cases, only one half of the mouth is treated at a visit. Please remember to keep all appointments to complete the treatment on the opposite side, and all follow-up appointments thereafter.