Dear Doctor Column, April 24, 2006

Deep Cleaning Can Help Early Periodontal Disease

Question:

My gums are tender and sometimes bleed when I brush my teeth. My dentist says I have gum disease and he recommends a two-step procedure called root planing. What does this involve?

Answer:

Scaling and root planing are often the first-line treatment for periodontal (gum) disease that has advanced beyond simple gum inflammation – called gingivitis – to a more serious condition called periodontitis. In its early stages, periodontitis, infection of the gum and bone that support your teeth, often has few symptoms. By the time you notice bleeding and swollen gums, bad breath that won’t go away, pain when chewing, or loose or sensitive teeth, serious damage to your gums and oral bone structure may have already occurred.

Gum disease develops because our mouths are loaded with bacteria that are constantly mixing with mucus and other particles, forming a sticky, soft plaque on teeth. Regular brushing and flossing can keep plaque at bay, but once it hardens into tartar or calculus, only a dentist or dental hygienist can remove it.

But the professional cleanings people should have at least twice a year can only eliminate plaque and tartar above the gumline. Once plaque and tartar form below the gums, deeper cleaning is required to remove them. There is a shallow space between the teeth and gums, called the sulcus, which should measure between 1 and 3 millimeters. When bacteria-laden plaque and tartar build up below the gumline, they can cause loss of attachment of the gums to the teeth, forming deeper infected “pockets” that collect bacteria normal cleanings cannot reach or remove. Our immune systems fight these bacteria, which cause constant inflammation. Bacterial toxins and enzymes released by our immune systems to combat infection also can break down the bone and connective tissue holding teeth in place. This type of periodontal disease is a serious threat to your overall oral health and teeth, which you can lose if too much supportive gum, connective tissue, and bone are destroyed.

Your dentist has recommended scaling and root planing because he has measured your periodontal pockets and found they are deeper than the healthy 3-millimeter limit. Using a small scaler or ultrasonic cleaner, the dentist can remove all the plaque, tartar, infection, and other contaminants from around and below the gumline down to the bottom of periodontal pockets. Your dentist will then plane, or smooth, the teeth’s root surfaces, which makes it more difficult for plaque to collect along these surfaces and also helps heal gum tissue.

The procedure is usually performed using local anesthesia and in two stages, with the dentist cleaning one side of your mouth at a time. Your dentist also may prescribe additional medications after scaling and root planing to help control infection and speed healing. A few weeks after procedures are complete, your dentist will check to see how your gums have healed and how much your periodontal pockets have decreased in size. If you still have pockets deeper than 3 millimeters, your dentist may recommend additional treatment.

Advanced periodontal disease may require surgery, so it is important to follow your dentist’s recommendations and go through with the deep cleaning, which can often stop or reverse early stage gum disease. Maintaining good oral hygiene after scaling and planing is key to keeping gum disease from recurring. Some people need to undergo scaling and root planing every 2 to 3 years to keep gum disease in check.

Controlling periodontal disease can save your teeth and may help your health in other ways: Some studies link gum disease to other serious conditions, such as increased risk of heart attack, stroke, and premature delivery, as well as difficulty controlling blood sugar levels in people with diabetes.

Here are some tips for preventing gum disease:

• Don’t smoke. Smoking is one of the most significant risk factors associated with development of gum disease. Smoking also can reduce the chances of successful treatment for periodontal disease.
• Brush twice a day with a fluoride toothpaste.
• Floss every day.
• Make regular visits to your dentists for check ups and professional cleanings.

Source: National Institute of Dental and Craniofacial Research.