Tooth scaling

Scaling and root planing
Intervention
Close-up image of a hand scaler.
ICD-9-CM	96.54
MeSH	D012534
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Scaling and root planing, otherwise known as conventional periodontal therapy, non-surgical periodontal therapy, or deep cleaning, is the process of removing or eliminating the etiologic agents – dental plaque, its products, and calculus – which cause inflammation, thus helping to establish a periodontium that is in remission of periodontal disease. Periodontal scalers and periodontal curettes are some of the tools involved.

Scaling and root planing usually follows, if necessary, dental x-rays and an ultrasonic debridement ("cleaning"), frequently as part of a normal periodic oral examination. It may refer to both of the following procedures:

Or "cleaning" (debridement) may refer to the first and "deep cleaning" to the second.

Plaque is a soft yellow-grayish substance that adheres to the tooth surfaces including removable and fixed restorations. It is an organised biofilm that is primarily composed of bacteria in a matrix of glycoproteins and extracellular polysaccharides. This matrix makes it impossible to remove the plaque by rinsing or using sprays. Materia alba is similar to plaque but it lacks the organized structure of plaque and hence easily displaced with rinses and sprays.

All individuals develop plaque and materia alba. Through regular brushing and flossing, these organized colonies of bacteria are disturbed and eliminated from the oral cavity. In general, the more effective one's brushing, flossing, and other oral homecare practices, the less plaque will accumulate on the teeth.

However, if, after 24 hours in the oral environment, biofilm remains undisturbed by brushing or flossing, it begins to absorb the mineral content of saliva. Through this absorption of calcium and phosphorus from the saliva, oral biofilm transforms from the soft, easily removable plaque into a hard substance known as calculus. Commonly known as 'tartar', calculus provides a base for new layers of plaque biofilm to settle on and builds up over time. Calculus is harder than bone and cannot be removed by brushing or flossing.

Plaque accumulation tends to be thickest along the gumline. Because of the proximity of this area to the gum tissue, the bacterial plaque begin to irritate and infect the gums. This infection of the gum causes the gum disease known as gingivitis, which literally means inflammation of the gingiva, or gums. Gingivitis is characterized by swelling, redness and bleeding gums. It is the first step in the decline of periodontal health, and the only step which can be fully reversed to restore one's oral health.