What is SRP, scaling and root planing, or more commonly known as a deep cleaning?

Scaling and root planing is a procedure we do for individuals with some level of periodontal disease. So first off we will describe what periodontal disease is.

What is periodontal disease?

Periodontal disease is an infection, and the number one reason adults lose teeth. Without treatment this infection destroys the bone that supports your teeth.

What are the symptoms you may notice?

If you have periodontal disease—
❖ Your gums may bleed when you brush or floss.
❖ Your gums may be soft, swollen, or tender.
❖ You may have persistent bad breath.

It is also possible that you do not have any noticeable symptoms, which is why routine screenings at your dental checkups are so important. In fact, most people who have periodontal disease are not even aware of it.

What are the symptoms your dentist will see?

If you have periodontal disease—
❖ Your dentist will see bone loss on your x-rays that they can show you.
❖ Your hygienist may notice bleeding and/or exudate (pus) when cleaning your teeth.

What causes periodontal disease?

The main cause of periodontal disease is the long term build-up of plaque, an extremely sticky, deposit of bacterial biofilm that forms on your teeth. When plaque stays on your teeth for two or three days, it hardens into calculus, or tartar. The bacteria in plaque and calculus invade the spaces between your teeth and gums and produce toxins. These toxins, combined with your body’s reaction to them, destroy the bone around your teeth.  If periodontal disease is allowed to progress untreated, the disease will advance and continue to destroy the bone until the teeth become loose and are lost.

Diagnosis and treatment, this is where scaling and root planing come in.

To determine if you have periodontal disease, we perform a periodontal exam, which includes measuring the depth of the sulcus (the space between the tooth and gum) with a probe. A reading of more than 3 millimeters could be a sign of periodontal disease, and we further evaluate those areas for signs of bone loss, which can be seen on your x-rays. A healthy sulcus measures 1-3mm with a probe. An inflamed or infected sulcus measures 4mm+ with a probe.

The first step in treating periodontal disease usually involves a special cleaning, called Scaling and Root Planing (or a “deep cleaning”). This procedure removes tartar from the deep pockets surrounding the teeth and helps gum tissues to heal and periodontal pockets to shrink.

Scaling and Root Planing (SRP)

A scaling and root planing procedure (deep cleaning), removes plaque, calculus (tartar), and bacterial toxins from the tooth surfaces below the gumline. The goal is to eliminate the source of periodontal infection. If you have just a few pockets of infection, we will treat just those teeth. However, if the infection is more widespread, we may treat one or two sections of your mouth at a time, spacing the treatment over several appointments.

To keep you comfortable, we usually numb the area with anesthetic. Using special instruments, we remove the plaque and tartar around the tooth and then smooth the root surfaces.

What are the benefits of scaling and root planing (SRP)?

Scaling and root planing removes the source of infection, which helps your gums heal and tighten around the teeth. This is important because your gums protect the roots of your teeth and prevent dangerous bacteria from reaching your bloodstream. By reducing the pockets that develop between your teeth and gums through scaling and root planing, you will reduce your risk of tooth loss.

After Scaling and Root Planing

The majority of patients will simply require extra cleanings, which we call periodontal maintenance, during the year to maintain gum health. Typically, we see those prone to periodontal disease 3-4x a year, instead of just 2. The success of your treatment is largely dependent on being consistent with these visits as well as your oral hygiene habits.

Cost of Scaling and Root Planing

This cost varies based on how many teeth are impacted by periodontal disease and need treatment. If only a few teeth need treatment the cost is around $250. However, if the entire moth needs treatment it is close to $1500. If you have dental insurance, it will likely cover part of this cost.

Iatrogenic damage from a cavitron or piezo unit.

This is not a periodontal disease patient but these cases show what an overly aggressive hygienist can do.

Some minor cavitron damage

Severe damage that can be seen on this DT thread.

Adjunct treatments for SRP

Lasers have not shown to have any benefit in comparison to SRP alone. Systemic and local drug delivery, photodynamic therapy and probiotics yield modest improvements in comparison to SRP alone. Albeshri GD 2022