Non-Surgical Therapy 

I.  Scaling

Most Periodontal lesions are brought about by the reaction of the host to the presence of the right combination of bacteria in sufficient quantities in the right places.  This “sheltered” niche is located in the space between the gums and the teeth – the sulcus, which forms a normally shallow furrow around each tooth.  It is the perfect setting for bacteria to hide, adhere to the tooth surface, colonize and mature, and eventually, elicit a host response, which normally protective, may actually lead to tissue destruction when present in poorly regulated instances. 

As such, the most obvious treatment modality is to rid the tooth surfaces of these adherent bacterial colonies.  This matrix of bacteria and other substances is called plaque, and periodontal treatment starts with one objective – the removal of this plaque, which often times is enveloped in a hard, calcified, cement-like medium called calculus, not unlike carbuncles found on the hulls of ocean liners and sail boats. 

Scaling of teeth involves using various hand held picks and curettes, as well as high frequency vibrating tips to dislodge these deposits from the tooth surfaces.  Usually, this is performed twice a year during regular dental check-ups.  Except for the associated high pitched squeaking sound the ultrasonic tips make, and some momentary sensitivity of the teeth in contact with the tips, the procedure is usually pain-free.  The average working time is half an hour for a full dentition.  When all the tooth surfaces above the collar of gums are thoroughly debrided, the teeth are then polished with rotating rubber cups and some flavored paste.   

II.  Root Planing 

Occasionally, the deposits of plaque extend below the margin of the gums, and creep down into tooth surfaces within the sulcus, now termed “sub-gingivally” located plaque and calculus.  At this stage, the appropriate treatment includes scaling off these deposits, as well as rendering the root surface  of affected teeth clean and smooth.  Similar picks and curettes are used to do this.  The ability of the periodontist to remove as much of these bacterial deposits lay in part on in the accessibility of these hard accretions.  However, once a majority of the plaque is removed, the tissues usually are able to bounce back to health within a few weeks.  It is then imperative that patients who have been treated successfully be aware of their role in preventing the bacteria from reattaching to the teeth. 

Thus it is clear that conservative treatment of Periodontally involved teeth demands a multi-factorial approach involving the Periodontist, and equally important, the patient.  Patients should realize that within half an hour of thorough cleaning of teeth, the ever present bacteria which cause Periodontal disease are present, and are inherently programmed to reattach to the heretofore clean surfaces of teeth.  It is not unusual then, that treated cases suffer recurrence, in the same , or new sites in the dentition, once there is a long enough lapse in home oral hygiene on the patient's part. 

With regards to the actual Scaling and Root Planing procedure though, it is a fairly simple procedure.  The slight discomfort felt from the ultrasonic or hand held scalers is easily erased from the patient's consciousness by the Periodontist's judicial use of the appropriate local anesthetic agents, more often than not of the same family as those used during routine filling of cavities.  A quadrant of teeth usually takes30 to 45 minutes for the specialist to treat thoroughly, with manageable post operative discomfort which may last just a few hours, or none at all in many cases.