Root Planing & Scaling Treats Halitosis and Bleeding & Swollen Gums

There are three broad classes of periodontal (gum) therapy for treatment of gum disease:

1.  Dental cleaning (prophylaxis or prophy)
2.  Root planing & scaling (RP&S)
3.  Periodontal (gum) surgery

A dental cleaning is what one typically receives at a six-month check-up.  It is appropriate for those who maintain excellent home oral hygiene and have minimal gum pocket depths around their teeth.  Patients should be aware that calling to schedule a 'check-up' doesn't necessarily mean that one desires a cleaning.  A check-up could mean just x-rays and exam.

Root planing & scaling (RP&S) is usually recommended when one needs more work than a typical cleaning.  This may be due to lack of adequate home oral hygiene, high sugar diet, deeper gum pocket depths around teeth or more extensive dental work that might inhibit access for a regular cleaning.  Root planing & scaling is usually divided into two to four office visits.  Novocain is frequently used since this cleaning will attempt to get to the full depth of the deeper gum pockets.  This procedure usually involves minimal pain and one should expect to resume social and professional activities later that same night and certainly the next day.  Most people feel a tremendous difference in how much cleaner their mouth feels and how much fresher is their breath.  The benefit can be quite profound and immediate.

Three to six months after completing the RP&S the periodontist would perform a reevaluation examination and would usually recommend one of the following:

1) Go back to regular cleanings but at a frequency of every three, not every six months,
2) Repeat the root planing & scaling, or,
3) Periodontal surgery is indicated for either the whole mouth or just refractory sections.

Periodontal surgery is similar to that performed during root planing & scaling except that the periodontist actually cuts the gum and moves it out of the way during the procedure.  This allows him or her direct vision to really see the problem and direct mechanical access to attempt to clean and repair the diseased tissue.

Microbiologic testing will frequently provide valuable information regarding the species of pathogens that compose a gum infection.  When appropriate, it should be done before RP&S or surgery.  Local or systemic chemotherapy, typically antibiotics, can be very beneficial in these cases.

--Dr. Jeffrey Dorfman, Director
The Center for Special Dentistry
NYC