Non-Surgical

Non-surgical therapy (NST) of periodontal therapy includes oral hygiene instructions (OHI) and scaling and root planing (SRP).  Understanding that periodontal disease is caused by plaque (bio-film) requires that the dentist give the patient a means to practice good plaque control at home.

SRP  (Deep Cleaning)

SRP or Scaling and Root Planing is often referred to as “deep cleaning” in most dental offices.  SRP is usually done as a part of the initial, non-surgical phase of a periodontal therapy.  When there is severe gum disease or periodontitis, the root surfaces of teeth become rough with dental calculus or tartar deep within the periodontal “pockets.”  Calculus or tartar is known to not cause gum disease directly.  Calculus rather attracts and allows dental plaque (mass of bacteria and other things) to attach on it.  Thus, dieased root surfaces must be cleaned of the dental plaque and dental calculus.  Once the root surface is cleaned, the soft tissue or gum around the root heals and becomes healthy again. 

SRP is usually done under local anesthesia using ultrasonic insturuments and finished off with hand scalers.  Hand scalers can make the root surfaces smooth after dental calculus is removed.  The process can take up to one hour or more for a quadrant of the mouth (1/4 of the mouth).  Most patients do not require any pain medication after SRP although some may feel transitory sensitivity when drinking something cold.  This sensitivity if present usually goes away within a few days or a few weeks.

Re-evaluation

After deep cleaning or SRP, the results are usually checked about 6 weeks after the cleaning.  Soft tissue pocket depth is usually measured to assess the effect of the SRP.  Six weeks of waiting period is usually required to allow the soft tissue or gum to heal around the teeth.  At the re-evaluation appointment, the dentist or periodontist will make measurements and assess the effectiveness of the treatment and come up with further plans.  This phase is called the initial phase or initial treatment because some cases require more definitive periodontal treatment, such as surgery.  At the re-evaluation appointment, the dentist will inform the patient what will be the next step, usually either periodontal maintenance (every 3 months or so) or gum surgery. 

What results to expect after NST

After the deep cleaning (SRP), assuming that the patient is doing good plaque control at home, the soft tissues should have improved in color (from red to light pink), consistency (from swollen to firm), bleeding tendency (easily bleeding to hardly bleeding) and so on.  If there were any foul smells coming from the mouth because of the gum disease, there should be less or none of the foul smell.  But remember not all patients and not all areas in a patient will respond this way.  Some patients or some areas in a patient will require further treatment, such as gum surgery.