This article will be a simple write-up about periodontics and what I’ve learned so far.
I’m not sure why, but I’ve always had the preconceived notion that periodontics is bloody, scary and most of all, painful. If you just go to Google Images and type “periodontal disease”, you’d see pictures that you wish you didn’t ever have to see. But now that I’m in third year, I find myself enjoying the periodontal clinic sessions. Periodontics is genuinely exciting.
Periodontology is the specialty of dentistry that deals with structures that surround the tooth – gums, bone and periodontal ligament – not so much the tooth itself. Most of the patients we see in the periodontal department are referred because they have gum health problems. Examples of gum diseases are gingivitis and periodontitis. I will explain gum diseases in further detail in a future article. In periodontics, there is some overlap with oral surgery in that some of the work that a periodontist does may be surgical and involve surgery into the gums (flap surgery) and bone (implants and alveoplasty).
However, as a 3rd year dental student, my current skillset only covers scaling, and doing a full periodontal assessment. In a full periodontal assessment, we use a Williams probe (as shown in the picture below) to check the depths of the “pockets” of gum surrounding the tooth to assess general gum health. The probe tip has length markings that indicate the depth of the pocket. The deeper your pocket, the worse your gum health, the more you need periodontal treatment.
Scaling on the other hand is by far the more exciting one. This picture below illustrates an ultrasonic scaler. In periodontal diseases, there is usually an issue with plaque building up on the surfaces of teeth and around the gums. Over time if the plaque accumulates and isn’t dealt with, they calcify and become calculus. Calculus is composed of hardened bacteria colonies and is difficult to remove with a toothbrush. The ultrasonic scaler is simple metal instrument that vibrates at a very high frequency. When this scaler tip touches the calculus, the calculus explodes off the surface of the tooth. When ultrasonic scaling is being carried out, there will be a lot of water jetting off the end of the tip – this is to cool down the highly vibrating tip – your dentist is not trying to drown you! This is why the nurse and suction control must be good.
Besides the ultrasonic scaler, there are other hand scaling instruments that are less interesting, but they serve the same function – to clean the tooth surface from plaque and calculus. Rather than a vibrating tip, the dentist uses them manually to scrub calculus build-ups from above and beneath the gum. Hand scaling is the preferred method for cleaning subgingival (meaning below the gum) calculus.
Scaling + polishing is done for patients coming for a routine check-up or review, in that case scaling is done only supragingivally (above gums) and does not require local anaesthesia. Scaling to intentionally remove calculus is known as non-surgical periodontal treatment (NSPT), as is the go-to treatment plan for mild to moderate periodontal diseases. NSPT is usually done under local anaesthesia, as scaling subgingivally might be painful. Severe periodontal diseases may require surgery.
Periodontics is a department in dentistry where it usually involves a bit of blood, even if the procedures done are non-surgical. The tiny vibrations from scaling may cause some gum bleeding, but because the scaler tip is vibrating and not drilling, it hardly ever cuts the gum or soft tissues. So be at ease, scaling won’t give you open wounds. Certain types of ultrasonic scalers may interfere with the actions of a pacemaker, so if you have a heart disease with a pacemaker installed in your body, be aware and ask your dentist if the scaler will affect the pacemaker in any way.
As what my peers and I agree, there is a certain sense of reward (dopamine release in the brain?) when we see large calculus formations explode off the surface of teeth when we do our scaling. It’s the sense of satisfaction we get when we do our job properly, and it’s me knowing that I’m in the right line of work.
So the next time you go for a scaling, sit back and relax. Think about the vibrating tip of the scaler cleaning the gunk out of your gum, and you’ll be a happy patient!
KAI DENTAL 