Deep Scaling and Root Planing
If plaque (biofilm which is a film of bacteria) and tartar (calculus) is left on the teeth, it provides the right conditions for bacteria to thrive. The bacteria will irritate the gums, which means that the gums will bleed more easily. You may notice this if you are brushing your teeth, or eating, and sometimes your gums may bleed a bit or when you are flossing you notice blood on your floss. This is the early stage of gum disease called gingivitis. If you have gingivitis, your dentist or hygienist will clean your teeth by deriding the bacteria/calculus from them. There may be a recommendation to use an antibacterial mouthwash and in our office we recommend the use of an essentials oil mouth rinse and show you how to brush and floss your teeth effectively. Most adults have some degree of gum disease.
If gingivitis (gum disease) is not treated and nothing is done about it, the inflammation will work its way down towards the foundations of the tooth causing a “periodontal pocket”. Again, within the confines of the pocket, the conditions are such that the bacteria can have a right old party, and cause more damage.
Gum disease breaks down the support (bone) structures of the teeth, so that eventually, they will become loose. The problem is that until it gets quite severe, the person often has no symptoms. Sadly, the damage to the support structures of the teeth is irreversible. The good news is that if gum disease is caught in time, its progression can be halted and improved upon, and that is the key.
To stop gum disease from progressing, your dentist may advise periodontal therapy, or deep cleaning. This gets rid of the bacteria in the pocket and provides the necessary conditions for healing to occur.
There is some confusion about the difference between scaling and root planing. Scaling is basically the process of removing dental tartar (calculus) from the surfaces of the teeth. Root planing is the process of smoothening the root surfaces and removing any infected tooth structure. If you have gum disease or gum pocketing, the gum pockets around the teeth will have deepened, thereby allowing tartar deposits to form under the gum line.
The two processes tend to blur together since during the cleaning process, the dental hygienist scales away tartar (calculus) and performs any necessary root planing at the same time. Any roughness can be planed away to result in a silky smooth surface.
Depending on the depth of the pocket and severity of the root surface irregularity, the dental hygienist may wish to make the area numb so that the process is comfortable for you. Don’t hesitate to discuss with your dentist or hygienist how to best manage any discomfort.
As an alternative to injectable anesthetics, Oraquix might be an option to try with deeper pocket cleaning. It is a special non-injection device that delivers topical anesthetic gel gently into the gum pockets thereby avoiding numbing of the lips and or tongue as can occur with injected local anesthetics. Oraqix mostly numbs the gum pocket itself so it may not be effective in eliminating sensations in the teeth themselves.
Sometimes if the pockets are not too deep, there may be little or no discomfort during the procedure – even without numbing. The only sensation may be the physical scraping feeling along the teeth as the area is cleaned and smoothened. A root planed root surface free of tartar (calculus) has a better chance of allowing the gum tissues to heal and reattach to it. As a result, some deep gum pockets can be reduced after a deep cleaning.
Pockets increase in depth Your dental professional will measure the depth of your pockets using a tiny probe.
A pocket of 4 or more millimeters is a sign that you have gum disease.
If you wait to treat your gum disease, it could lead to periodontal surgery in the future.
A pocket depth of 4 mm or more may mean you have an infection.
A pocket depth of 7 mm or more has the highest risk of permanent damage.
Typically with deeper pockets and extensive rough root surfaces, the deep scaling and root planing procedure might be broken down into quadrants of work per appointment. For example, the upper right side of the mouth might be worked on one day, and the three other parts worked on separate appointments. Or alternatively, one half of the mouth (right or left, upper or lower) might be cleaned per appointment. This also allows for only a part of the mouth being frozen at a time and makes for more manageable, shorter appointments.
Dr. Graves takes extreme care to provide fillings and crowns and bridges on natural teeth or on dental implants with a high emphasis on quality. We have an E4D in our practice which will create long term crowns in one sitting using high strength ceramics which in the very near future will also create bridges. We find this capability very exciting.
Dr. Graves loves to provide cosmetic dentistry in the form of crowns, bridges, veneers and cosmetic reshaping of teeth. He offers the latest dental techniques and utilizes the latest in dental technology to improve your treatment and reduce your chair time.
The philosophy of our practice is prevention. The statement "An ounce of prevention is worth a pound of cure" is well-known. The prevention of dental caries and gum disease is the key to long term dental health. An analogy one can look at is to keep a vehicle running in good condition regular service is vital. Regular check ups and cleanings are essential to catch the onset of an early cavity and the early process of gum disease. Head neck and oral cancer screening is done with each examination as well as the use of a velscope.
We use only digital x-rays in our office. Dental x-rays are used in the dental office to assist us in finding things that are not visible to the naked eye. With the use of x-rays, the dentist can find initial cavities, decay occuring underneath restorative work such as root decay, hidden teeth such as wisdom teeth as well as bone loss from gum disease. This reduces the exposure to radiation by 75 % as compared to the conventional film x-rays. Digital x-rays are taken by sensors and displayed onto the computer screen within seconds which means that you will be able to see your teeth in moments right in front of where you sit. There will be minimal wait for images to develop and there will be no chemical byproducts used to develop the image as were used previously in the conventional film dental x-rays.
Digital Panoramic X-Ray system
The panoramic x-ray is a picture of all the teeth and jaw structures on one large x-ray. It is different than the regular intra oral films called Bite-wings or Peri-apical x-rays. The purpose of a panoramic x-ray is for finding cysts, tumours, bone loss due to gum disease or periodontal disease as well as proximity of the wisdom teeth to the mandibular nerve (main nerve to the lower jaw).