Page Index

Scaling and Root Planing

Perio Maintenance

Periodontal Medications

Periodontal Surgery (gum surgery)

 

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Like any successful treatment for a disease, the gum treatment is based on elimination of causes. As previously discussed, the main cause for periodontal disease is bacteria.

You have to remember that the success of periodontal treatment depends not only on a doctor, but on you as well. With out proper oral hygiene at home any professional treatment of gum disease will be a failure.

So the first step in treatment of gum disease is your customized oral hygiene instructions and their follow through.

 

The home hygiene should be focused on cleaning all the debris that stays not only on the visible tooth surface, but also on the gums, and inside the pockets. Depending on the condition of your teeth and the gums and presence of different type of dental restorations, your dentist should be able to advice you on the brushing techniques and tools which should be used. From the different variety of available tools I tried to choose the ones which we recommend the most to our patients and placed the short cuts to those products (in Amazon store) on the right for you convenience

No matter how thorough you are with your brushing, there is still some plague and tartar that will build on you teeth. Our goal is to remove all the plague and tartar, and to minimize the pockets(remember that they are the trap for food remnants and bacteria). This is done with Root Planing and Scaling

Scaling and Root Planing (or deep cleaning) is done to remove tartar and hard crusty calculus (Tartar) that is loaded with bacteria, around and BELOW the gum line. (A professional polishing or prophylaxis removes only the soft sticky plaque that is above the gum line and performed on a healthy dentition).
Scaling
Scaling is procedure that meticulously removes contamination toxins, micro-organisms, plaque, and tartar that is rough and is below and under the gum line down to the bottom of the pocket.
Root Planing
Root planing involves smoothing the root surfaces of your teeth with thin curettes so gum tissue can more firmly reattach to roots that are clean and smooth to prevent tooth loss and sensitivity problems. 

Scaling and root planing is the first step in treatment of gum disease (of-course after good home oral hygiene). It can be enhanced with the local use of medications, oral rinses, but no treatment can be effective without root planing and scaling or deep cleaning. Scaling and root planing is the procedure on its own, and it can be part of gum surgery procedure as well.


This procedure involves manipulation deep under the gum, thus the patient may be numbed for comfort if necessary. Full mouth Scaling and Root Planing may take few appointments, depending on the extent of disease.

Post scaling and root planing instructions

Gingival Curretage (Gum Curretage)

Gum curretage is the procedure of remozal granulation tissue and imflamed tissue wall of a periodontal pocket (area surrounding a tooth). Gum curretage can be performed along with scaling and root planning procedure or as a separate procedure.

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Before Scaling and Roott Planning

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After the procedure was done

After this treatment is completed, a perio-maintenance appointment will be necessary in a few weeks. At this visit the pocket depths are re-evaluated and additional cleaning may be performed. Depending on the depth of the perio-pockets, you will be advised if any further treatment is necessary and frequency of you maintenance appointments.  Depending on stage of gum disease and your personal response to the treatment, Scaling and Root Planing, along with the good home oral hygiene, may be the only active treatment you will require and may prevent you from having gum surgery.

Evaluation of your perio status may reveal areas of your mouth where Scaling and Root Planing alone is not sufficient.  We believe that a conservative approach is the best route, thus there are several medicaments available on the market that can treat pocket depth locally (targeted to a specific site) in conjunction with Scaling and Root Planing and in most cases avert future periodontal surgery.

Periodontal Medications

There are few medicaments available for localazed delivery of medicine in the pockets. The principal is the local delivery of anti-microbal substanse directly into gum pocket, where it fights the bacteria and inflammation. One thing: these drugs do not work alone, they will work good in conjuction with scaling and root planing and good oral hygeine, but it is not the substituton for any of the above.

Arestin (Minocycline HCI)
- uses microsphere technology to deliver the antiobiotic directly to the infected araes in your gums
-the microspheres the gradully release the antibiotic over time, allowing it to work over the course of 14 days
- throughout that time , Arestin helps Scalling and Root Planing fight the infection, allowing your gums to heal

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Illustrations and description of product is a courtesy of OraPharma, INC

Atridox
Atridox (Doxicyline hyclate 10%) is an antibiotic gel that is used to treat chronic adult periodontitis. ATRIDOX is applied with a syringe into the infected tooth pocket by dental professional.It contains antibiotic which is mixed in a gel. After it applied into the infected pocket it hardens upon contact with oral fluids to a wax-like substance. The antibiotic is slowly released from the hardened gel into the surrounding infected pocket for 7 days.
This information provided by Collagenex Pharmaceuticals

Periostat
As we discussed before the high levels of bacteria initiate the release of tissue-destroying enzymes. These enzymes start the destructive process which results in deeper pockets and bone loss. Even after Scaling and root planing removed most of the bacteria, your body may still release these tissue-destroying enzymes and continue the cycle of periodontitis. Periostat is the medication which will reduce the production of these enzymes by your body.
Periostat is the low dose Doxycycline- antibiotic of Tetracycline group. In the lower dose it works not as antiflammatory drug, but rather as enzyme inhibitor. The treatment course with periostat is the long term commitment and can last from 3 month and longer

Periodontal Surgery (Gum surgery)
Sometimes if periodontal disease reaches advanced stages, conservative treatment may be not enough to stop it. Periodontal surgery may be considered in those cases. There are few different surgical procedures, which may be performed in order to treat the periodontitis. They all simular in the techniques and purpose served. The incision is done and gingival flap is opened, allowing doctor direct access to the bone structure, supporting the tooth. Thorough cleaning of the area is then performed and all granulated(inflamed) tissue is removed. Then depending on the particular situation bone reshaping may be done, in some cases bone grafts are used to fill in bony deffects. Excess of the gum tissue is then removed, flap placed back and sutured in place.

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Oral-B Interdental Brush Refills, Cylindrical - 6 Ea
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With out proper oral hygeine at home any professional gum treatment will be a failure.