THOSE who are lucky to have most of their natural teeth still should be intelligent enough to maintain their good fortune by having prophylaxis (cleaning) done at least once every three months. If not, they may suffer from periodontal disease despite regular and thorough brushing with flossing. These preventative measures cannot guarantee absolute freedom from any dental affliction because direct vision and objective procedures are essential to remember to ensure detection and remedy.

Scaling, root planing, and curettage (scraping diseased gums) were the basic procedures in periodontal therapy long before periodontics was recognised as a speciality of dentists. What are the indications, contradictions, and expectations of these treatment modalities?

The periodontal lesion consists of a pocket. The tooth aspect of this pocket is the dentin and cementum of the root. The soft tissue aspect is comprised of an epithelial lining and connective tissue. When observed under a microscope, the soft tissue displays a chronic inflammatory lesion. In other words, certain types of cells invade the gum, manifesting breakdown products and sights of repair. The pocket deepens in response to this chronic inflammatory knee process. The attachment’s atypical migration (penetration along the roots) results in a deep sulcus (grove).

Scaling removes plaque, calculus and stain, thereby eliminating all the factors causing inflammation. The supragingival ( which is visible above the gum line ) deposits are easily removed. Subgingival calculus requires the placing of the instruments below the gingival peak. Scales are used on the crown of a root to scrape off the hard calculus (tartar), while smaller and more flexible curettes fit below the crest more easily.

Root planing removes calculus and “root roughness” from the surface of the tooth. The goal is to leave a smooth, glass-like surface. This accomplishes the removal of necrotic cementum and dentin, bacterial products and endotoxins (poisons) in the decayed cementum. Curettage has a minimal effect on the fibrous or firm gingival pockets. However, in the case of spongy gums, the inner pocket lining is scraped away. The more bleeding that occurs in the process, the better the results. Deep, narrow pockets will not shrink and are difficult to cure due to the adjacent soft tissue walls, which are firmly attached. Such areas are often seen in the upper anterior region.

The most desirable outcomes to curettage, therefore, are regeneration and reattachment. Unfortunately, epithelial adaption does not produce stable results.

Healing of the pocket may occur in three different ways: regeneration, reattachment and epithelial adaption. Regeneration is the growth of new tissues. Young cells develop into specialised tissues. Regeneration is the formation of a new periodontal ligament and new cementum with the attachment of gingival epithelium to the tooth surface denuded of disease. Epithelial adaptation is the close apposition of gingival epithelium to the tooth surface. This is not firmly attached to the root surface. A probe (dental instrument) will not pass into the pocket, but breakdown can occur with the first insult from plaque and calculus.

Generally, there can never be a complete recovery from moderate to severe periodontal disease. Once the alveolar bone is destroyed in the ailment process, naturally, there is inadequate support for the tooth, and it becomes shaky. Depending on the degree of looseness, extraction may be the only solution.

On clinical level, scaling, root planing and curettage are obviously interrelated and necessary for the healing of specific types of periodontal lesions.