Can you the patient know for sure that you really need scaling and root planing? Why did your dentist prescribe periodontal therapy (often called deep cleaning or scaling and root planing)?
With modern dental technology you can see that you need gum treatment . Here we show you how to look at photos from your mouth to verify that you need periodontal treatment.
Dentist: “You need Gum Therapy”
You are surprised to hear your hygienist or dentist say you need scaling & root planing. You did not know you had problems with your gums.
Scaling and root planing is removing dental plaque or calculus and then smoothing (or planing) the exposed root surfaces. This removes the toxins that cause inflammation and controls periodontal disease.
With modern technology we can show our patients what is going on with their teeth and gums. Patient education is key in explaining gum problems. With recognition and proper treatment, patients should not lose teeth as they age.
Dr. Bill Cranford
How to Know you Need Scaling & Root Planing
Your dentist or hygienist will show you problem areas. Look in the mirror as she points to areas of concern.
Ask your dentist to show you areas in your mouth that meet the ADA guidelines for periodontal treatment. (See guidelines below)
Below I use photos from Cranford Dental patients who had gum problems. Use these examples to analyze the condition of your gums. Ask your dentist:
Show me the bleeding areas
You may know when you visit the dentist that certain areas bleed when you brush and floss. Ask your dentist to explain with a mirror or photos if bleeding is cause for alarm.
Left photo: bleeding gums, heavy calculus, inflamed gums: Gum treatment required. Right photo: bleeding and slight calculus: Improve home care and recheck.
Show me the deepest pocket on your probe
Your hygienist will use a small ruler (periodontal probe) to measure pocket depths in the gums around your teeth. She will record the depths of your gums on a chart. She will review the chart with you and describe her findings.
Periodontal Probe Measurement: 1st silver area = healthy gums; 1st black area = 4-6 mm pockets
If the probe goes down more than 4 mm, your hygienist will discuss pockets. She will recommend gum therapy to stop disease progression.
Show me what you see with intraoral camera
Your dentist will point out calculus build-up along the gumline. This calculus (or tartar) will irritate and infect the gums. The bacterial calculus will deepen the pocket and loosen the tooth from the gum.
Excessive Calculus 
Minimal Calculus
Left photo: Calculus damaged gums: Gum therapy required; Right photo: Hygienist advised on proper home care.
Show me the build-up of calculus on the radiograph
Radiographs show calculus build-up that is under the gumline. A registered dental hygienist has the tools and training to go under the gums to remove the calculus.
Calculus under Gumline 
Calculus removed by Scaling
The patient could not see this calculus. He was not aware that he had gum disease until his hygienist informed him.
Show me the Bone Level
Evidence of gum disease damage in radiographs is a slanted or scooped out jaw bone. Your hygienist will explain where you are in the progression of gum disease.
The green lines are where the bone level should be with healthy gums. The space between the red and green lines is the amount of bone loss.
Show me Healthy Teeth and Gums
Ask your dentist to compare your radiographs and photos to pictures of healthy teeth and gums. This will help you understand the problems in your mouth that indicate need for gum treatment.
Healthy gums – No calculus; Bone level lines up with gum line.
Guidelines for Scaling & Root Planing
Your dentist will prescribe treatment in quadrants of the mouth where gum disease is present. The American Dental Association and American Academy of Periodontology has complex guidelines dentists use to diagnose gum disease. Warning signs are:
- Bleeding sites
- Pockets greater than 4 mm
- Visible calculus or bone loss on radiographs
I value all the training our hygiene team did on gum disease. We are on the same page about what causes concern—and how to best treat these patients. It is important that we get this right.
Hannah Hopper, RDH
Understanding Gum Treatment
You will need a general understanding of gum disease and treatment before making a decision on moving forward with your gum therapy.
First, recognize that gum disease is a very serious problem. Please address this right away once your hygienist explains your diagnosis to you.
Second, read our hygienists’ blog posts to understand gum disease:
- What is gum disease?
- Gum disease warning signs
- How does dentist diagnose gum disease?
- Treating gum disease
- Studying gum disease
Third, determine the condition of your mouth and a plan of treatment. You want to avoid the bone loss and loosening of teeth that gum disease causes.
Are there Optional Treatments?
Ask your dentist for a thorough evaluation of the health of your gums. You may be able to improve your gums with home care alone.
The treatment he prescribes will depend on the severity of gum disease and your age and overall health.
She will use the photos and radiographs in your chart to evaluate bone levels and gum health as you age. He will keep you posted on the progression of gum disease in your mouth.
Your dentist will be pleased that you are aware of how serious gum disease is. Let him know that you want to do all you can to keep your teeth and gums healthy.
Experienced, Local Dentists
Dr. Cranford and Dr. Robinson and their hygienists emphasize preventive dental care. They have special training in diagnosing and treating gum disease.
If you have questions about the gum disease or dental health, contact our office at 803-324-7670 or contact us online.
At Cranford Dental we value long time relationships. This allows us to evaluate changes in gum health as patients age. We will inform you when radiographs show changes in bone levels or gum condition.
With modern technology and consistent dental care, you will be able to keep your teeth strong and healthy for a lifetime.
Leave a Reply