From the Guidelines
Scaling and root planing is a deep cleaning dental procedure used to treat gum disease by removing plaque and tartar from below the gumline. This non-surgical treatment involves two main steps:
- scaling, which removes plaque and tartar from tooth surfaces and beneath the gums using special instruments,
- and root planing, which smooths the tooth root surfaces to help gums reattach to the teeth and prevent future bacterial buildup. The procedure is typically performed under local anesthesia to minimize discomfort and may be completed in one or multiple visits depending on the extent of the disease. After treatment, patients might experience sensitivity, minor bleeding, or gum tenderness for a few days, which can be managed with over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours as needed) and warm salt water rinses (1/2 teaspoon salt in 8 ounces of warm water). Scaling and root planing is effective because it removes the bacterial colonies causing inflammation and creates a clean environment for gum healing, significantly reducing pocket depths and helping to prevent the progression of periodontal disease that could otherwise lead to tooth loss 1. Some studies have investigated the use of antibiotics as an adjunct to scaling and root planing, with results showing significant reductions in probing depth and clinical attachment level gain 1. However, the use of antibiotics should be considered on a case-by-case basis, taking into account the individual patient's needs and medical history. Additionally, the use of probiotics as an adjunct to non-surgical periodontal treatment has shown promise in reducing pocket depths and improving clinical attachment levels, but further research is needed to confirm these findings 1. Overall, scaling and root planing is a effective treatment for gum disease, and its effectiveness can be enhanced with the use of antibiotics or probiotics in certain cases.
From the Research
Definition of Scaling and Root Planing
- Scaling and root planing (SRP) is a non-surgical treatment for periodontitis, which involves the removal of subgingival calculus and biofilm deposits to create a biologically compatible root surface and reduce the inflammatory burden 2.
- The primary goal of SRP is to remove subgingival calculus and biofilm, which are covered with a biofilm of metabolically active bacteria, and are related to periodontal inflammation 2.
Importance of Scaling and Root Planing
- SRP is still critical to the treatment of periodontitis, and its execution is a critical part of therapy 2.
- The treatment has been shown to reduce pocket depth, attachment level, and bleeding on probing, and to improve clinical outcomes in patients with chronic periodontitis 3, 4.
- SRP can be used alone or in combination with other treatments, such as systemic metronidazole and professional plaque removal, to achieve better clinical outcomes 3.
Effects of Scaling and Root Planing
- SRP has been shown to reduce the number of sites with bleeding on probing, suppuration, and visible plaque, and to improve pocket depth and attachment level 3.
- The treatment can also alter the composition of the dental plaque microbiota, and increase the number of antibiotic-resistant genes (ARGs) and metal-resistant genes (MRGs) in dental plaque 5.
- However, the treatment may not completely eliminate the risk of pocket reinfection, and repeated professional supragingival plaque removal may be necessary to maintain clinical outcomes 4.
Combination Therapy
- The combination of SRP with other treatments, such as systemic metronidazole and professional plaque removal, can achieve better clinical outcomes than SRP alone 3, 6.
- The use of local adjunctive therapeutic agents, such as tetracycline, minocycline, and chlorhexidine, can also improve clinical outcomes, although the magnitude of the improvement may be modest 6.