During your routine checkup, the hygienist gently checks your gumline to measure how deep the spaces are between your teeth and gums. This is one situation where a higher score is not better! If the space has formed pockets deeper than 3 millimeters, this may be a sign of periodontal disease.

Periodontal disease

Periodontal disease is an infection of the teeth, gums, and bone surrounding the teeth. You already know it's important to brush and floss daily to remove the food particles and plaque (a sticky film of food and bacteria) that build up on your teeth or become wedged between your teeth and gums. But if you neglect to brush and floss regularly, the plaque begins to harden, becoming more difficult to remove. Then, bacteria begins to create deeper spaces between your teeth and gums, leading to even more serious complications that may result in bone and tooth loss.

To remove plaque and help prevent periodontal disease, your checkup typically includes cleaning your teeth above the gumline. If the pockets between your teeth and gums are deep, we may also want to clean below the gumline. We may do therapeutic scaling, or we may do a combination of scaling and root planing (SRP).

Therapeutic scaling

Scaling removes plaque and tartar from the top of your tooth to the bottom of the pocket. We typically use this process when pockets are approximately 3-4 mm.

Often we will use an ultrasonic instrument that uses water and ultrasonic waves to clean. You cannot hear the vibration, but it has a powerful effect in reaching deep pocket areas and removing the hardened plaque.

We finish the procedure with a handheld scaling instrument. This helps us to gently remove any fine particles of plaque that remain and to ensure that your tooth is perfectly clean and smooth.

Scaling and root planing (SRP)

If pockets are 5-6 mm deep or if infection is present, we may use a combination of scaling and root planing. Before we begin, we will numb the area with an anesthetic to ensure that you are comfortable.

Root planing deep-cleans and smoothes the roots of your teeth. This makes it harder for plaque and bacteria to cling to the root, and this also makes it easier for gums to reattach to the roots. In some cases, we may also place medicines directly under the gums after we have finished scaling and root planing.

As your swollen, puffy gums begin to heal, they should shrink back to more normal levels. To monitor your progress, we will continue to measure the depth of your pockets during your periodontal maintenance appointments.

Homecare

Usually we schedule scaling and root planing over several appointments. This makes the procedure more comfortable for you, gives your gums time to start healing, and also gives you time to develop and reinforce new oral hygiene habits at home.

After your therapeutic scaling or SRP procedure, follow these guidelines for homecare:

• Medications: If applicable, use antibiotics for the complete period of time as prescribed. Also, take pain medication as recommended, especially before the anesthetic wears off.
• Foods and beverages: For the first 2 hours, avoid chewing or eating until feeling returns to your mouth. Then, for the first 48 to 72 hours, eat soft foods and chew on the opposite side. After your gums heal, you may re-introduce hot or spicy foods back into your meals if desired.
• Tobacco and alcohol: Do not use any tobacco products, especially for the first 3 days after the procedure. Wait until your gums are healed before drinking any alcoholic beverages.
• Brushing and flossing: The first night, soften the bristles of your toothbrush with hot water, and then brush gently. The next day, begin flossing the area lightly, and then gradually begin regular brushing and flossing techniques. You may also want to use a desensitizing toothpaste if your teeth are sensitive to hot, cold, or pressure.
• Mouthrinses: Use a medicated mouthrinse as prescribed, but do not use mouthwashes containing alcohol. To help reduce discomfort or swelling, rinse your mouth gently 3 times a day with a salt water solution. (Stir 1 teaspoon of salt into a glass of warm water.)

Diligent brushing and flossing are the most important habits of your homecare routine. Otherwise, the periodontal disease will flare up again.

We may provide special tools and instructions for you to improve your oral hygiene techniques. Also, we will monitor your progress carefully over the next several visits. With our scaling and root planing procedure and your consistent oral hygiene habits at home, together we can reduce your deep pockets and avoid the serious consequences of periodontal disease.