When a dentist takes on a new patient, it is necessary for them to assess the patient’s periodontal health. The dentist will inspect the teeth, looking for any plaque or calculus (a hardened form of mineralized plague). The gums are also checked for any bleeding, redness or swelling. If any of these signs of disease are found, the patient will require a treatment known as initial periodontal therapy. The goal of initial periodontal therapy is to remove the pathogenic micro-organisms that form plaque and calculus, in order to stop the progression of disease. This is done by removing the plaque and calculus from the tooth, both above the gum-line as well as below it, using hand and ultrasonic instruments. In addition, the patient is also instructed in appropriate oral hygiene procedures.
The first step in initial periodontal therapy is the assessment of the patient’s teeth and gums. The assistant will seat the patient comfortably in the dental chair, so that the doctor can have an unobstructed view of the patient’s mouth. The patient’s teeth are then inspected for any calculus and plaque, and the gums are checked for any bleeding, swelling or redness.
To help identify the presence of plaque, the dentist will have the patient use a disclosing solution. This solution usually comes in tablet form, and once chewed, identifies any plaque that has been allowed to form on the teeth for longer than two days, by staining it red.
Identifying calculus under the gums is more of a challenge, as it can’t be done visually. The dentist will use an instrument called a ‘Periodontal Probe’ to detect any calculus deposits found under the gums in the gingival pockets.
Intra-oral radiographs, taken as part of the initial dental examination, are also valuable aids for the detection of calculus that may be hidden below the gum-line.
Depending on the type of cleaning needed, and the dental sensitivity of the respective patient, the dentist may provide some form of anesthesia prior to initiating the scaling and root planing. When a patient is not overly sensitive, a topically applied anesthetic is used. However, in cases where the patient’s teeth and gums are extremely sensitive, a local anesthetic is used to freeze the area.
Once the areas of plaque and calculus have been identified, and the anesthetic has taken effect, the cleaning can begin.
An instrument called a ‘sickle scaler’ is used to clean the tooth above the gum-line, and the ‘curette’ is used to clean the tooth below the gum line. Unlike scalers, curettes have a rounded tip, making them safe to use below the gum-line. In addition to hand instruments, ultrasonic scalers can also be used. They operate using a high frequency vibration which allows for the efficient removal of stubborn calculus deposits. The dentist will often use both the ultrasonic and manual instruments, in order to achieve a smooth, and calculus-free, tooth surface.
Periodically during the procedure, the dentist will check the extent of the calculus removal. He or she does this visually, as well as with the help of the ‘Periodontal Probe’. The probe is used to feel the surface texture of the root, below the gum line. The cleaning is deemed to have been completed, once the root surfaces feel smooth. Initial therapy may require more than one appointment, when large plaque and calculus deposits are present.
Six to eight weeks after the completion of the initial therapy, the patient will return for a re-evaluation appointment. The dentist will examine the condition of the patient’s gums, comparing it to the gingival condition found at the initial examination. If, as a result of healing of the gums, previously inaccessible calculus deposits become accessible, these can be removed during this appointment.
If necessary, oral hygiene instructions are reinforced during the re-evaluation. Depending on the results of the re-assessment, a post-initial treatment diagnosis is established. This new diagnosis will serve as a baseline for determining guidelines for any future surgical and/or non-surgical periodontal treatment or, if no additional periodontal treatment is required, as the baseline for the development of an individualized maintenance program.
Special thanks to Drs. Abbassali Hassanali, Vanessa Mendes and Quyen Su.