Periodontal scaling

Current treatment for periodontitis involves scraping dental plaque, the polymicrobial biofilm, off the tooth, a procedure called scaling. Root planing involves scaling the tooth’s root. Scaling and root planing are often referred to as deep cleaning.

The objective for periodontal scaling and root planing is to remove dental plaque and calculus (tartar), which house bacteria that release toxins which cause inflammation to the gum tissue and surrounding bone. According to Brentwood periodontists, Dr. Alina Krivitsky and Dr. Alexandre Aalam, scaling and root planing is one of the most effective periodontal methods of treating gum disease before it becomes severe.

However, according to the Evidence-Based Dentistry website, the Cochrane Oral Health Group in 2005 found two relevant studies, with neither showing any clinical benefit to scaling.^[3] In 2013 the Cochrane Oral Health Group examined three new studies. The most pertinent study found no benefit for regular scaling treatments when compared to a no-scale regimen.

Also, cleaning pockets deeper than 2mm is difficult, and the deeper the pocket, the harder it is to clean effectively. Since a periodontal pocket is defined as 4mm or more, scaling and root planing are ineffective at cleaning the deep pockets associated with periodontitis. Thus, the deep cleaning that scaling and planing is supposed to provide is not deep at all, and probably has little impact, if any, on gum disease.

Because in periodontal disease pockets form that are deeper than the usual gingival depth, such scaling and root planing are often referred to as deep cleaning, and may be performed using a number of dental tools, including ultrasonic instruments and hand instruments, such as periodontal scalers and curettes.

A dental hygienist demonstrates scaling.

Removal of adherent plaque and calculus with hand instruments can also be performed prophylactically on patients without periodontal disease. A prophylaxis refers to scaling and polishing of the teeth in order to prevent oral diseases. Polishing does not remove calculus, but only some plaque and stains, and should therefore only be done in conjunction with scaling.

Often, a device may be electric, known as an ultrasonic or sonic scaler. Ultrasonic scalers vibrate at a frequency that breaks down bacterial cell membranes and removes both plaque and calculus. Hand instruments are used to complete the fine hand scaling that removes anything the ultrasonic scaler left behind.

Two ultrasonic instruments.

Sonic and ultrasonic scalers are powered by a system that causes the tip to vibrate. Sonic scalers are typically powered by an air-driven turbine. Ultrasonic scalers typically use either magnetostrictive or piezoelectric systems to create vibration. Magnetostrictive scalers use a stack of metal plates bonded to the tool tip. The stack is induced to vibrate by an external coil connected to an AC source. Ultrasonic scalers also include a liquid output or lavage, which aids in cooling the tool during use, as well as rinsing all the unwanted materials from the teeth and gum line. The lavage can also be used to deliver antimicrobial agents.

Although the final result of ultrasonic scalers can be produced by using hand scalers, ultrasonic scalers are sometimes faster and less irritating to the client. Ultrasonic scalers do create aerosols which can spread pathogens when a client carries an infectious disease. Research shows no difference in effectiveness between ultrasonic scalers and hand instruments. Of particular importance to dentists themselves is that the use of an ultrasonic scaler will greatly decrease their likelihood of getting carpal tunnel syndrome (or other similar forms of RSI).

^{http://en.wikipedia.org/wiki/Scaling_and_root_planing}