8. Periodontal Procedures – Part 1

In topic #7, a vari­ety of den­tal pro­ce­dures used to remove the cause and local con­tribut­ing fac­tors of peri­odon­tal dis­ease and when pos­si­ble to regen­er­ate lost bone and / or gum tis­sue was briefly men­tioned. Each of these pro­ce­dures has its indi­ca­tions, antic­i­pated results, lim­i­ta­tions, suc­cess rates and poten­tial risks or com­pli­ca­tions. Now these pro­ce­dures will be dis­cussed in more detail.

First, pro­ce­dures by the den­tal team to remove the cause and local con­tribut­ing fac­tors of peri­odon­tal dis­ease will be dis­cussed. The goal of these pro­ce­dures is to remove plaque and cal­cu­lus above and below the gums (the cause ) and to cor­rect any other local exist­ing den­tal con­di­tions that can increase the risk of peri­odon­tal dis­ease ( con­tribut­ing fac­tors ) occur­ring in an area.

There are spaces between the gums and the teeth often referred to as peri­odon­tal pock­ets. Each space has a cer­tain depth. It is impor­tant that the depths of these spaces are mea­sured by the den­tist, hygien­ist or peri­odon­tist by a probe and recorded as cer­tain den­tal pro­ce­dures are designed for shal­low spaces, mod­er­ate depth spaces and deep spaces. It is through the record­ing of these pocket depths that the den­tist or hygien­ist will know before­hand which procedure(s) will have the best chance of suc­cess in remov­ing all the plaque and cal­cu­lus below that gums that is possible.

Scal­ing ( often referred to as clean­ing ) is designed to remove plaque and cal­cu­lus in shal­low spaces only. Its lim­i­ta­tion is that this pro­ce­dure will not remove all plaque and cal­cu­lus in mod­er­ate or deep spaces regard­less of the den­tist or hygien­ist doing the clean­ing procedure.

The risk of only doing scal­ing in mod­er­ate or deep spaces is that there will be some improve­ment in the super­fi­cial lay­ers of the gums with less bleed­ing, how­ever the con­tin­ued increased risk of future bone loss in the area where the plaque and cal­cu­lus remains deep under the gums is still present. This tem­po­rary improve­ment in the super­fi­cial lay­ers of the gums com­bined with the con­tin­ued bone loss occur­ring deep under the gums, often after a num­ber of years, leads to a sur­prise for the patient who has had reg­u­lar 6 month clean­ings and is won­der­ing why some of their teeth con­tinue to become loose and be lost due to peri­odon­tal disease.

In other words, scal­ing has good long term suc­cess rates for shal­low spaces ( pock­ets ) only and its results can not be antic­i­pated or expected to deal suc­cess­fully in the long terms for areas of the mouth with mod­er­ate or deep spaces. The rea­son for this lim­i­ta­tion of the scal­ing pro­ce­dure is that the den­tist or hygien­ist is work­ing only by feel to remove plaque and cal­cu­lus below the gums. Removal of plaque and cal­cu­lus above the gums is not a prob­lem because the plaque and cal­cu­lus above the gums can be seen. The full extent of plaque and cal­cu­lus below the gums can not be seen when only per­form­ing the scal­ing pro­ce­dure. It is for this rea­son plaque and cal­cu­lus will be left in mod­er­ate or deep spaces below the gums, regard­less of which den­tist or hygien­ist is per­form­ing the clean­ing procedure.

Scal­ing is mostly done with­out any form of local anes­the­sia and often per­formed for the whole mouth in one appoint­ment. How­ever the time to com­plete scal­ing varies for each per­son. The time needed mostly depends on the amount of plaque and cal­cu­lus present above and below the gums. Other fac­tors such as the num­ber of teeth and tol­er­ance of the per­son for the scal­ing pro­ce­dure also influ­ences the time needed for the scal­ing procedure.

It is the scal­ing pro­ce­dure, rec­om­mended to be per­formed at reg­u­lar inter­vals, that peo­ple are most famil­iar with. Depend­ing on the amount of plaque and cal­cu­lus to be removed, the patient’s oral hygiene or lack of it and the judg­ment of the den­tist, peri­odon­tist or hygien­ist, the reg­u­lar inter­vals most com­monly vary between 3 to 6 months.

In topic #9, den­tal pro­ce­dures to remove the plaque and cal­cu­lus in mod­er­ate to deep spaces below the gums will be discussed.