Scaling and Root planing:

Scaling and root planing procedures involve careful smoothing of the root surfaces and removal of the bacterial toxins, plaque, and calculus (tartar) that over time have been built up on the teeth and below the gum. This cleaning is done by use of delicate instruments specifically designed for this purpose. In cases with deep pockets, in order to perform thorough scaling and root planing around teeth, multiple appointments under local anesthesia may be required.

Scaling most often is the initial phase in treatment of gum disease. In some cases, host modulation, systemic or locally delivered antimicrobials may also be used as adjunctive therapy at this phase. After this initial step, periodontal re-assessment is done by your periodontist. During re-assessment, if your periodontist notices that non-surgical treatment has not adequately treated the disease, surgical therapy may be considered. On the other hand, in many patients no additional treatment other than regular maintenance will be required.  The length and frequency of maintenance hygiene appointments are determined and are individually tailored by the periodontist based on the patient’s periodontal risk assessment. Regular maintenance is an essential pre-requisite for establishment of a periodontally healthy mouth.

 

Host Modulation Therapy (Periostat®)

Periodontal disease occurs in part due to an over active host response to pathological bacterial.  The host’s immune system sets off a cascade response which results in the supporting structures of the tooth (bone, ligament and gums) to be destroyed.  Occasionally some people, despite meticulously clean mouths, still have substantial destruction of their supporting structures.  When indicated, host modulation therapy with a prescription drug called Periostat® can arrest the disease process.

Locally Delivered Antibiotics

When treating periodontal disease, not all deep pockets are indicated for surgery.  There may be times when a moderately deep pocket can be treated with a combination of deep scaling and root planing coupled with a locally delivered antibiotic that is released slowly over a period of time.  This treatment is not painful and reseach has shownimprovements in pocket depths when used in indicated sites.