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Scaling and Root Planing for Periodontal Disease

Dana Arenas
Kirkwood community College

Periodontal disease, or periodontitis, is the number one most prevalent disease in the
United States. Almost 50 percent of the US adult population age 30 years and older have mild,
moderate, or severe periodontal disease. Periodontal disease is a serious infection of the gingiva
causing the breakdown of bone and surrounding tissues that support the teeth. Periodontal
disease is typically the result of poor oral hygiene. Periodontitis is caused by the buildup of
bacterial plaque on the teeth and gum surfaces. Plaque forms when sugars left on the teeth and in
the oral cavity are consumed by bacteria present in the mouth and the multiplication of these
bacteria. If plaque formation is not removed daily by brushing and flossing the plaque will
harden into calculus and adhere to the tooth surfaces along the gum line. The plaque and calculus
formation will soon get below the gum tissues causing inflammation. Ongoing inflammation is
destructive to the gums and supporting tissues as well as the alveolar bone. The destruction of
these hard and soft tissues is the basis of periodontal disease. If periodontitis is not treated and
controlled the teeth will become loose and eventually fall out.
Although poor home care is the main reason for periodontal disease there are also many
predisposing factors for periodontitis. The biggest risk factors for periodontal disease are
diabetes and smoking which also increase the rate of onset and severity of the disease. Stress is
also a predisposing factor. Stress affects the body making it less capable of fighting off diseases
including periodontal disease. Local factors such as dental irregularities including; rough tooth
surfaces, plaque or food traps, crowded or overlapping teeth can all contribute to the onset of
periodontal disease because plaque can form more readily and is more difficult to remove. Diet
and eating habits as well as certain medications can also increase the risk of periodontal disease.
Osteoporosis may also be a contributing factor of periodontal disease. There are many
contributing factors that increase a persons risk for developing periodontal disease.

Specific bacteria are responsible for periodontal disease. Gram positive streptococci are
present during the first day of plaque buildup. Up to three weeks as bacterial multiply
Actinomyces and Veillonella strains of bacteria most predominant. Next, plaque continues to
grow and become anaerobic moving below the gum tissue. Gram negative rods and Spirochetes
increase in numbers. Bacteria in subgingival calculus, Porphyromonas gingivalis, Actinobacillus
actinomycetemcomitans, Tannerella forsythensis, and spirochetes are responsible for periodontal
disease (Stanfield-Hann, pp. 16).
There are few treatment options for periodontal disease. Non-surgical treatments can
include frequent dental visits for scaling and root planing. Local or systemic antibiotics can be
used to kill the bacteria associated with periodontal disease. Laser treatments and surgical
regenerative procedures are other treatment options used to help rebuild the bone supporting the
teeth. Scaling and root planing is the most common form of treatment for periodontitis and
typically the first treatment because it is nonsurgical.
AAP treatment guidelines stress that periodontal health should be achieved in the least
invasive and most cost-effective manner. This is often accomplished through non-surgical
periodontal treatment of scaling and root planing (Non-Surgical Periodontal Treatment | Scaling is done with special sharpened instruments to remove plaque, calculus and
staining around the crown and root portion of the teeth. Root planing is removal of calculus and
bacteria on the root surfaces of the teeth and in the periodontal pockets. Root planing also
smoothes out rough areas of cementum to make it more difficult for calculus to form. A patient
new to dental visits may take up 4 appointments or more to complete scaling and root planing of
the entire mouth. These appointments are called quad scaling because only a quadrant of the
mouth is completed at each visit. Patients with periodontal disease that have finished their initial

visits are scheduled for scaling and root planing maintenance appointments every 3-4 months.
These treatments are performed by dental hygienists at non specialized dental clinics or at
specialty periodontal clinics by dental professionals specializing in periodontal disease. It is also
common for patients to alternate scaling and root planing appointments between their regular
dental practice and the periodontal clinic. Ideal candidates for scaling and root planing treatment
of periodontal disease are patients with slight to moderate periodontitis, can continue good oral
home care, will be compliant with maintenance appointments, and show improvement in
periodontal health with this treatment. The cost of scaling and root planing treatment can be quite
high. Even with dental insurance scaling and root planing may not be covered. Scaling and root
planing treatments are often preformed one quadrant of the mouth at a time, meaning initial
treatment would take 4 appointments. Cost for a single quadrant scaling and root planing can
range from $100-$450. Scaling and root planing is most common and often treatment of choice
but can be very expensive for some patients.
There are several benefits for scaling and root planing for treatment of periodontal
disease over other treatment options. Scaling and root planing is a nonsurgical outpatient
procedure. Patients can come for treatment and leave without a chaperone. Patients can opt for
local anesthesia so there is no pain during the procedure. It is beneficial that patients periodontal
charting is updated at scaling and root planing visits for frequent evaluation of the disease.
Scaling and root planing treatments can be used for the life of the patient. There are no limits to
the number of treatments the patient can receive. There is no risk of antibiotic resistance as there
is with systemically treated periodontal disease (Stanfield-Hann). Most periodontists would
agree that after scaling and root planing, many patients do not require any further active
treatment (Non-Surgical Periodontal Treatment |

One drawback of scaling and root planing in treating periodontitis is that some patients
may not show sufficient improvement in periodontal pockets or maintenance of perio status with
scaling and root planing alone. In these cases the patient will be sent to a periodontist and some
of the other methods for treating periodontitis may be used in conjunction with scaling and root
planing. In any treatment of periodontal disease homecare is equally important in the success of
the treatment option. Patients must have good homecare to keep the teeth clean and free of
plaque to keep the bacterial levels low or the disease can easily relapse. For many patients with
periodontal disease regular scaling and root planing treatments can be costly. Many dental
insurance plans will not cover these deep cleanings. If the patient does respond well to scaling
and root planing treatment, lifelong maintenance appointments are especially costly. Another
drawback of scaling and root planing is the requirement for patient compliance. While most
patients do respond well to conventional mechanical therapy (scaling and root planing) others do
not or experience a relapse of disease. Specific forms of periodontitis that do not respond well to
traditional therapy include refractory forms of periodontitis, recurrent periodontitis, aggressive
periodontitis, and periodontitis associated with diabetes or other immunosuppressive diseases
(Stanfield-Hann, pp. 16). It is unfortunate that for some patients additional and or alternate
therapies will be required to treat their periodontal disease. Cost of treatment, patient
compliance, and the patient population that does not respond well to this treatment are the main
drawbacks of scaling and root planing.
An important part in the success of scaling and root planing treatment are the
responsibilities of the dental hygienist and the patient. The dental hygienist must perform quality
scaling and root planing being careful to remove as much calculus around the tooth and root
surface as possible. The hygienist is responsible for making sure the patient understands the

disease process, treatment, and understands what is required for home care. It is imperative that
the patient understand and comply with home care between scaling and root planing
appointments. Patients must continue with maintenance appointments to keep up with their
current periodontal status. Patients must also come to maintenance appointments so the dental
hygienist can reevaluate their periodontal status and determine if there has been any
improvement with gingival attachment or progression of periodontal disease. During
maintenance dental hygiene appointments local anesthesia may be needed for patient comfort to
reach the bottom of the periodontal pockets and for the removal of root surface calculus. There
may also be alterations to the patients homecare. Depending on the dentition of the patient there
may need to be more than brushing and flossing for homecare. For example, if the patient has
missing teeth or spacing between teeth, end tuft brushes, proximal brushes, soft picks, or super
floss may need to be used to remove plaque between teeth. There are also other auxiliary aids
that the patient may use to help with homecare in cleaning below the gingival such as oral
irrigation and floss picks. Again, patient compliance with good oral hygiene homecare is most
important with maintaining periodontal status between scaling and root planing appointments. If
the patient is not compliant with good homecare and in keeping maintenance appointments the
disease will progress and the treatment will be unsuccessful.

Clark, S (2015) Periodontology, Kirkwood Community College.
How Much Does Teeth Cleaning Cost? - (n.d.). Retrieved October 8, 2015.
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Mo.: Elsevier/Saunders.
Stanfield-Hann, A. (2015). Treating periodontitis systemically. Dimensions, 13(5), 16-22
Wilkins, E. M. (2013). Clinical practice of the dental hygienist. (11th ed.). Philadelphia, PA:
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