Scaling & Oral Prophylaxis

1. What  is scaling?
Scaling and root planning is the process of removing or eliminating the etiologic agents such as dental plaque, its products, and calculus – which cause periodontal disease.

2. What are the types of scaling? 
a) Supragingival

3. What are the equipments and instruments used for scaling?
Scalers –
o Hand scalers Universal scaler, Supragingival scalers, Subgingival root planning instruments
o Sonic scalers – Handpiece scaler – used in the air rotor coupler on the chair and used at the same speed as the air rotor
o Ultrasonic    
Magnetostrictive Eg: Dentsply Cavitron  Tip oscillation Elliptical motion - generates pathogen-destroying cavitation bubbles 360 degrees around the tip. In contrast, the piezo design creates them only at the two ends of their back-and-forth cycle.... Heat More heat is generated To prevent overheating, you must scale with plenty of water irrigation 
Piezoelectric Eg: Satellac 
Magnetostrictive Piezoelectric Tip oscillation Linear oscillation -  less likely to abrade the tooth
*Heat generation * doesn't generate much heat can run the device with very little water irrigation.

Curettes – Standard Gracey Curettes (area specific), Universal Curettes

4. How often can we undergo scaling?
Recommended frequency of scaling is once in 6 months. Scaling is an operative procedure. Patient compliance is a very crucial factor in the success of scaling procedure. Hence a lot of emphasis should be placed on the role of the patient and maintenance of meticulous oral hygiene. Periodontal recall post scaling is thus important. It is recommended that recall be fixed 3 months after the procedure to evaluate patient compliance and if found to be good can be moved to review every 6 months and then 1 year if patient is following it well, similarly if it is not up to the mark, patent may be demoted back to 6 month/ 3 month recall as is deemed necessary. Again this is theoretical, how far this can be done practically is very doubtful.. though putting all patients on a 6 month followup is generally followed by most clinics.

5. What are the instructions for after scaling?
Usually patients feel sensitivity and bleeding in gums (esp when there is severe inflammation) for 1 or 2 days post scaling. Patient must be made aware of these signs and explained that they are transient symptoms and will be relieved in 2-3 days time. Desensitising paste may be prescribed if sensitivity is very severe, explicitly informing the patient of the correct way to use the paste – apply on teeth, leave on for few minutes and then brush. 

6. Role of antibiotics in normal scaling procedure – Considering that antibiotic resistance is a major factor these days, we should exercise caution and use antibiotics judiciously. A routine scaling procedure (Chronic gingivitis, mild periodontitis (<4mm pocket depth) with no suppuration or medically compromised conditions) does not advocate use of systemically administered antibiotics. The cause of gingival inflammation is calculus and soft deposits so unless these are removed, the gums will not heal. Utmost care should be taken to eliminate the subgingival calculus and soft deposits as well. 

7. Post scaling, a warm salt water rinse can be advised in most routine cases. In cases like hypertensive patients, saline rinses are contraindicated. Mouthrinses are also only adjuncts in treatment and should be used judiciously. Many chlorhexidine mouthrinses also contain alcohol which causes dry mouth in patients. Chlorhexidine mouthrinse is advised to be used for upto 2 weeks at a time, beyond which side effects of discoloration of teeth and mucosa as well as altered taste sensation may set in. Mouthrinses are very helpful in cases where patient is not very thorough with his oral hygiene. Usually I have observed that when we prescribe mouthrinses patients become slightly lax with the brushing.

8. For the black stains which are found on teeth, I had a few cases where I advised them to use H2O2. H2O2 mouthrinses are not very easily available in India. So I advised patient to use H2O2 solution, 2 drops in a glass of water. Patients were very happy with the results because this reduced the black stain formation.