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and "found a significant improvement from baseline in the scaling and root planing group at three months and six months." This study also discussed evidence-based guidelines for frequency of scaling with and without root planing for patients both with and without chronic periodontitis. The group that produced one of the main systematic reviews used in the 2016 Canadian review has published guidelines based on its findings. They recommend that scaling and root planing (SRP) should be considered as the initial treatment for patients with chronic periodontitis. They note that "the strength of the recommendation is limited because SRP is considered the reference standard and thus used as an active control for periodontal trials and there are few studies in which investigators compare SRP with no treatment." They add however that "root planing ... carries the risk of damaging the root surface and potentially causing tooth or root sensitivity. Generally expected post-SRP procedural adverse effects include discomfort."
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further damage will result. In cases of mild to moderate periodontitis, scaling and root planing can achieve excellent results if the procedure is thorough. As periodontitis increases in severity, a greater amount of supporting bone is destroyed by the infection. This is illustrated clinically by the deepening of the periodontal pockets targeted for cleaning and disinfection during the procedure. Once the periodontal pockets exceed 6 mm in depth, the effectiveness of deposit removal begins to decrease, and the likelihood of complete healing after one procedure begins to decline as well. The more severe the infection prior to intervention, the greater the effort required to arrest its progress and return the patient to health. Diseased pockets over 6 mm can be resolved through periodontal flap surgery, performed by a dental specialist known as a periodontist.
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individuals, the sulcus is no more than 3 mm deep when measured with a periodontal probe. As the gingivitis stage continues, the capillaries within the sulcus begin to dilate, resulting in more bleeding when brushing, flossing, or at dental appointments. This is the body's attempt to clear the infection from the tissues. Thus, bleeding is generally accepted as a sign of active oral infection. The swelling of the tissue may also result in deeper reading on periodontal probing, up to 4 mm. At a depth of 4 mm or greater, the vertical space between the tooth and surrounding gum becomes known as a periodontal pocket. Because tooth brush and floss cannot reach the bottom of a gum pocket 4–5 mm deep, bacteria stagnate in these sites and have the opportunity to proliferate into periodontal disease-causing colonies.
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necessary to prevent the infection from recurring. Therefore, patient compliance is by far the most important factor having the greatest influence on the success or failure of periodontal intervention. Immediately following treatment, the patient will need to maintain excellent oral care at home. With proper homecare, which includes but is by no means limited to brushing twice daily for 2–3 minutes, flossing daily and use of mouthrinse, the potential for effective healing following scaling and root planing increases. Commitment to and diligence in the thorough completion of daily oral hygiene practices are essential to this success. If the patient fails to change the factors that allowed the disease to set in – for example, not flossing or brushing only once a day – the infection will likely recur.
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continues to invade the space created by the swelling it causes. This plaque eventually transforms into calculus, and the process continues, resulting in deposits under the gum, and an increase in pocket depth. As the depth of the vertical space between the tooth and the gum reaches 5mm, a change occurs. The bacterial morphology, or make up, of the biofilm changes from the gram positive aerobic bacteria found in biofilm located supragingivally, or above the gumline. Replacing these gram positive bacteria of the general oral flora are obligate anaerobic gram negative bacteria. These bacteria are far more destructive in nature than their aerobic cousins. The cell walls of gram negative bacteria contain endotoxins, which allow these organisms to destroy gingival tissue and bone much more quickly.
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arbitrary interval; at 90 days, the healing made possible by the scaling and root planing will be complete. This will allow the practitioner to re-measure pocket depths to determine whether the intervention was successful. At this appointment, progress will be discussed, as well as any refractory periodontitis. At 90 days from the original scaling and root planing, the periodontal bacteria, if any remain, will have reached their full strength again. Therefore, if there are remaining areas of disease, the practitioner will clean them again, and may place more site-specific antibiotic. Furthermore, this appointment allows for the review of homecare, or necessary additions or education.
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environment. However, the damage caused by periodontal disease never heals completely. Bone loss due to the disease process is irreversible. The gingival tissue of the gums also tends to suffer permanent effects once the disease reaches a certain point. Because gum tissue requires bone to support it, if bone loss has been extensive, a patient will have permanent recession of the gums, and therefore exposure of the roots of the teeth in involved areas. If the bone loss is extensive enough, the teeth may begin to become mobile, or loose, and without intervention to arrest the disease process, will be lost.
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use. A recent
European study suggests a link between the long-term use of the mouthrinse and high blood pressure, which may lead to a higher incidence of cardiovascular events. In the United States, it is available only through a doctor's prescription, and in small, infrequent doses it has been shown to aid in tissue healing after surgery. Current research indicates the irrigation of CHX after SC/RP may inhibit the re-attachment of periodontal tissues. Specifically preventing the formation of fibroblasts. An alternate irrigation with povidone-iodine may be used - if no contra-indications exist.
518:, with equivalent results to scaling and planing. One study found that the average time to treat each pocket with full-mouth ultrasonic debridement was 3.3 minutes, whereas it took 8.8 minutes per pocket for quadrant scaling and root planing (SRP). Differences in improvement were not statistically significant. Studies by the Leuven group, using somewhat different protocols, found that the one-stage treatment (i.e. in 24 hours) gave better results than the quadrant-by-quadrant approach (taking six weeks). They also had the patients use
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factors, the most important to note being the depth of the periodontal pocket. Brushing and flossing are effective only at removing the soft materia alba and biofilm in supragingival areas, and in pockets up to 3 mm deep. Even the best brushing and flossing is ineffective at cleaning pockets of greater depths, and are never effective in removing calculus. Therefore, in order to remove the causative factors that lead to periodontal disease, pocket depth scaling and root planing procedures are often recommended.
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family history of periodontal disease, and immunocompromised individuals. For such patients, the practitioner may take a sample from the pockets to allow for culture and more specific identification and treatment of the causative organism. Intervention may also include discontinuation of medication that contributes to the patient's vulnerability or referral to a physician to address an existing but previously untreated condition if it plays a role in the periodontal disease process.
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of infection. These antibiotics are placed directly into the periodontal pockets and release slowly over a period of time. This allows the medication to seep into the tissues and destroy bacteria that may be living within the gingiva, providing even further disinfection and facilitation of healing. Certain site specific antibiotics provide not only this benefit, but also boast an added benefit of reduction in pocket depth.
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324:. Usually these work at the same speed and keep each other in balance. In periodontitis, however, the chemical mediators, or by-products, of chronic inflammation stimulate the osteoclasts, causing them to work more rapidly than the cells that build bone. The net result is that bone is lost, and the loss of bone and attachment tissues is called periodontal disease.
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there is a difference in effectiveness between ultrasonic scalers and hand instruments. Of particular importance to hygienists themselves is that the use of an ultrasonic scaler may reduce the risk of repetitive stress injury, because ultrasonic scalers require less pressure and repetition compared to hand scalers.
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Once bacterial plaque has infiltrated the pocket, the transformation from biofilm into calculus continues. This results in an ulceration in the lining of the tissue, which begins to break down the attachment of the gum to the tooth. Gingival attachment begins to loosen further as the bacterial plaque
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The long term effectiveness of scaling and root planing depends upon a number of factors. These factors include patient compliance, disease progress at the time of intervention, probing depth, and anatomical factors like grooves in the roots of teeth, concavities, and furcation involvement which may
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should be removed from the roots. Bacterial contamination of root surfaces is limited in depth, so extensive planing away of cementum – as advocated by traditional scaling and root planing – is not necessary to allow periodontal healing and the formation of new attachment. In contrast to traditional
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Patients who present with severe or necrotizing periodontal disease may have further steps involved in their treatment. These patients often have genetic or systemic factors that contribute to the development and severity of their periodontitis. Common examples include diabetes type I and type II, a
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Treatment of periodontitis may include several steps, the first of which often requires the removal of the local causative factors in order to create a biologically compatible environment between the tooth and the surrounding periodontal tissues, the gums and underlying bone. Left untreated, chronic
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As the gingival tissue swells, it no longer provides an effective seal between the tooth and the outside environment. Vertical space is created between the tooth and the gum, allowing new bacterial plaque biofilm to begin to migrate into the sulcus, or space between the gum and the tooth. In healthy
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However, if, after 24 hours in the oral environment, biofilm remains undisturbed by brushing or flossing, it begins to absorb the mineral content of saliva. Through this absorption of calcium and phosphorus from the saliva, oral biofilm is transformed from the soft, easily removable form into a hard
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The process which allows for the formation of deep periodontal pockets does not occur overnight. Therefore, it is unrealistic to expect the tissue to heal completely in a similarly short time period. Gains in gingival attachment may occur slowly over time, and ongoing periodontal maintenance visits
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Site specific antibiotics may also be placed in the periodontal pocket following scaling and root planing in order to provide additional healing of infected tissues. Unlike antibiotics which are taken orally to achieve a systemic effect, site specific antibiotics are placed specifically in the area
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Although the final result of ultrasonic scalers can be produced by using hand scalers, ultrasonic scalers are sometimes faster and less irritating to the client. Ultrasonic scalers do create aerosols which can spread pathogens when a client carries an infectious disease. Research differs on whether
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Prior to beginning these procedures, the patient is generally numbed in the area intended for instrumentation. Because of the deeper nature of periodontal scaling and root planing, either one half or one quarter of the mouth is generally cleaned during one appointment. This allows the patient to be
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Once the bacteria and calculus are removed from the periodontal pocket, the tissue can begin to heal. The inflammation dissipates as the infection declines, allowing the swelling to decrease which results in the gums once again forming an effective seal between the root of the tooth and the outside
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These processes will persist, causing greater damage, until the infectious bacterial agents (plaque) and local irritating factors (calculus) are removed. In order to effectively remove these at this stage in the disease process, brushing and flossing are no longer sufficient. This is due to several
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First and foremost, periodontal scaling and root planing is a procedure that must be done thoroughly and with attention to detail in order to ensure complete removal of all calculus and plaque from involved sites. If these causative agents are not removed, the disease will continue to progress and
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in 2016. It made a number of findings, including (1) In five randomized controlled trials, scaling and root planing "was associated with a decrease in plaque from baseline at one month, three months, or six months;" and (2) Four studies analyzed changes in the gingival index (GI) from the baseline
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entirely numbed in the necessary area during treatment. It is usually not recommended to have the entire mouth scaled at one appointment because of the potential inconveniences and complications of numbing the entire mouth- i.e., inability to eat or drink, likelihood of self injury by biting, etc.
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in the oral tissues. This means that unlike other mouthwashes, whose benefits end upon expectorating, the active antibacterial ingredients in chlorhexidine gluconate infiltrate the tissue and remain active for a period of time. However effective, chlorhexidine gluconate is not meant for long-term
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Since it is of the utmost importance to remove the entirety of the deposit in each periodontal pocket, attention to detail during this procedure is crucial. Therefore, depending on the depth of the pocket and amount of calculus deposit versus soft biofilm deposit, hand instruments may be used to
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refer to the same procedure. The term "deep cleaning" originates from the fact that pockets in patients with periodontal disease are literally deeper than those found in individuals with healthy periodontia. Such scaling and root planing may be performed using a number of dental tools, including
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Generally, the first step is the removal of dental plaque, the microbial biofilm, from the tooth, a procedure called scaling. Root planing involves smoothing the tooth's root. These procedures may be referred to as scaling and root planing, periodontal cleaning, or deep cleaning. These names all
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The first evidence of periodontal disease damage becomes apparent in radiographs as the crestal bone of the jaw begins to become blunted, slanted, or scooped out in appearance. This destruction occurs as a result of the effect of bacterial endotoxins on bone tissue. Because the bone is alive, it
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that is primarily composed of bacteria in a matrix of glycoproteins and extracellular polysaccharides. This matrix makes it impossible to remove the plaque by rinsing or using sprays. Materia alba is similar to plaque but it lacks the organized structure of plaque and hence easily displaced with
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Although everyone has a tendency to develop plaque and materia alba, through regular brushing and flossing these organized colonies of bacteria are disturbed and eliminated from the oral cavity. In general, the more effective one's brushing, flossing, and other oral homecare practices, the less
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Although healing of the soft tissues will begin immediately following removal of the microbial biofilm and calculus that cause the disease, scaling and root planing is only the first step in arresting the disease process. Following initial cleaning and disinfection of all affected sites, it is
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Since the patient may still have pockets that surpass the effective cleaning ability of a brush or floss, for long-term success of their treatment they should return every 90 days in order to ensure that those pockets remain free of deposit. Patients should be counseled that 90 days is not an
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device, known as an ultrasonic scaler, sonic scaler, or power scaler may be used during scaling and root planing. Ultrasonic scalers vibrate at a high frequency to help with removing stain, plaque and calculus. In addition, ultrasonic scalers create tiny air bubbles through a process known as
514:(FMUD). The rationale for full mouth debridement is that quadrants that have been cleaned will not be reinfected with bacteria from quadrants that have not yet been cleaned. Other advantages of full mouth ultrasonic debridement include speed/reduced treatment time, and reduced need for
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complete the fine hand scaling that removes anything the ultrasonic scaler left behind. Alternatively, power scalers may be used following hand scaling in order to dispel deposits that have been removed from the tooth or root structure, but remain within the periodontal pocket.
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567:, updated in 2018 considered only scaling and polishing of the teeth, but not root planing. After examining two studies with 1711 participants they concluded that routine scale and polish treatment for adults without severe periodontitis makes little to no difference for
296:, which literally means inflammation of the gingiva, or gums. Gingivitis is characterized by swelling, redness and bleeding gums. It is the first step in the decline of periodontal health, and the only step which can be fully reversed to restore one's oral health.
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are usually recommended every three to four months to sustain health. The frequency of these later appointments is key to maintaining the results of the initial scaling and root planing, especially in the first year immediately following treatment.
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or oral health quality of life when compared to no scheduled care. Oral hygiene instruction was found to help as well. Another inconclusive review of scaling and polishing (without planing) was published by the
British Dental Association in 2015.
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The objective for periodontal scaling and root planing is to remove dental plaque and calculus (tartar), which house bacteria that release toxins which cause inflammation to the gum tissue and surrounding bone. Planing often removes some of the
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Plaque accumulation tends to be thickest along the gumline. Because of the proximity of this area to the gum tissue, the bacterial plaque begins to irritate and infect the gums. This infection of the gum causes the gum disease known as
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Enamel cracks, early caries and resin restorations can be damaged during scaling. A study conducted in 2018 recommended that teeth condition and restorations should be identified before undergoing the ultrasonic scaling procedures.
454:. Lasers of differing strengths are used for many procedures in modern dentistry, including fillings. In a periodontal setting, a laser may be used following scaling and root planing in order to promote healing of the tissues.
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A scaling and root planing procedure is to be considered effective if the patient is subsequently able to maintain their periodontal health without further bone or attachment loss and if it prevents recurrent infection with
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Sculean, A; Schwarz, F; Berakdar, M; Romanos, GE; Brecx, M; Willershausen, B; Becker, J (Apr 15, 2004). "Non-surgical periodontal treatment with a new ultrasonic device (Vector-ultrasonic system) or hand instruments".
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refers to scaling and polishing of the teeth in order to prevent oral diseases. Polishing does not remove calculus, but only some plaque and stains, and should therefore be done only in conjunction with scaling.
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Christopher Smiley; et al. (Jul 2016). "Evidence-based clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts".
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404:, meaning unable to survive in the presence of oxygen, these bubbles help to destroy them. The oxygen helps to break down bacterial cell membranes and causes them to lyse, or burst.
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283:. Commonly known as 'tartar', calculus provides a base for new layers of plaque biofilm to settle on and builds up over time. Calculus cannot be removed by brushing or flossing.
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surgery done by a periodontist (a dentist who specializes in periodontal treatment) may be necessary for severe cases or for patients with refractory (recurrent) periodontitis.
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Contrary to old beliefs, it is not a normal part of aging to lose one's teeth. Rather, it is periodontal disease that is the main cause of tooth loss in the adult population.
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systems to create vibration. Magnetostrictive scalers use a stack of metal plates bonded to the tool tip. The stack is induced to vibrate by an external coil connected to an
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that is impregnated with calculus, toxins, or microorganisms, the agents that cause inflammation. It is a part of non-surgical periodontal therapy. This helps to establish a
1007:
Marc
Quirynen; et al. (1995). "Full- vs. partial-mouth disinfection in the treatment of periodontal infections: short-term clinical and microbiological observations".
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The "traditional" debridement procedure involves four sessions spaced two weeks apart, doing one quadrant (one quarter of the mouth) each session. In 1995 a group in
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In cases of severe periodontitis, scaling and root planing may be considered the initial therapy prior to future surgical needs. Additional procedures such as
439:, which aids in cooling the tool during use, as well as rinsing all the unwanted materials from the teeth and gum line. The lavage can also be used to deliver
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cavitation. These bubbles serve an important function for periodontal cleanings. Since the bacteria living in periodontically involved pockets are mainly
479:, a popular site specific brand of the antibiotic minocycline, is claimed to enable regaining of at least 1 mm of gingival reattachment height.
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Following scaling, additional steps may be taken to disinfect the periodontal tissues. Oral irrigation of the periodontal tissues may be done using
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Removal of adherent plaque and calculus with hand instruments can also be performed prophylactically on patients without periodontal disease. A
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1057:"Full-mouth ultrasonic debridement versus quadrant scaling and root planing as an initial approach in the treatment of chronic periodontitis"
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Plaque is a soft yellow-grayish substance that adheres to the tooth surfaces including removable and fixed restorations. It is an organised
1337:
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Kim, S-Y; Kang, M-K; Kang, S-M; Kim, H-E (2018-03-13). "Effects of ultrasonic instrumentation on enamel surfaces with various defects".
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officially begins when these bacteria begin to act, resulting in bone loss. This bone loss marks the transition of gingivitis to true
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1193:"Dental Scaling and Root Planing for Periodontal Health: A Review of the Clinical Effectiveness, Cost-effectiveness, and Guidelines"
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N. M. Nakib; et al. (Jun 1982). "Endotoxin
Penetration Into Root Cementum of Periodontally Healthy and Diseased Human Teeth".
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Sonic and ultrasonic scalers are powered by a system that causes the tip to vibrate. Sonic scalers are powered by an air-driven
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547:, without removing cementum. Typically, root planing will require the use of hand instruments such as specialized dental
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proposed doing the whole mouth in about 24 hours (two sessions). When done using ultrasonic instruments this is called
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887:"Preservation of root cementum: a comparative evaluation of power-driven versus hand instruments"
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Several systematic reviews have been made of the effectiveness of scaling and root planing as
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instead of the scaler tips used in FMUD to debride the root surface and periodontal pocket.
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inflammation of the gums and supporting tissue can raise a person's risk of heart disease.
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Lamont, Thomas; Worthington, Helen V.; Clarkson, Janet E.; Beirne, Paul V. (2018-12-27).
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1195:. CADTH Rapid Response Reports. Canadian Agency for Drugs and Technologies in Health.
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scaling and root planing, the aim of some FMUD procedures is to disturb the bacterial
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939:"The Cavitron® family of inserts offers the right tools for any scaling environment"
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217:) and then smoothing, or planing, of the (exposed) surfaces of the roots, removing
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312:. In other words, the term periodontal disease may be synonymous with bone loss.
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Grant, DS, Stern IB Periodontics, 6th
Edition, CV Mosby and Co. St. Louis 1988.
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An extensive review that did involve root planing was published by the
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A new addition to the tools used to treat periodontal disease is the
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Robert J. Genco; Henry
Maurice Goldman; David Walter Cohen (1990).
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Newman, M.G.; Takei, H.; Klokkevold, P.R.; Carranza, F.A. (2011).
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1100:"Impact of antiseptics on one-stage, full-mouth disinfection"
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695:"Routine scale and polish for periodontal health in adults"
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A regular, non-deep teeth cleaning includes tooth scaling,
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limit visibility of underlying deep calculus and debris.
435:. Ultrasonic scalers also include a liquid output or
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Periodontitis as a manifestation of systemic disease
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Dentistry involving supporting structures of teeth (
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has accumulated, but does not include root planing.
60:. Unsourced material may be challenged and removed.
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530:Another question in dental cleaning is how much
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316:contains cells in it that build bone, known as
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1097:
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229:that is in remission of periodontal disease.
1365:"Code Information - Periodontal Maintenance"
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1048:
986:"Gingivitis As An Early Form Of Gum Disease"
880:
878:
1136:
1055:Jan Wennström; et al. (Jun 30, 2005).
699:The Cochrane Database of Systematic Reviews
554:
338:
1415:
1401:
1218:Journal of the American Dental Association
1098:Marc Quirynen; et al. (Dec 8, 2005).
786:
356:instruments and hand instruments, such as
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1338:"Periodontal Pocket Reduction Procedures"
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1045:
914:
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821:"Periodontal Disease and Systemic Health"
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320:, and cells that break down bone, called
120:Learn how and when to remove this message
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366:
1560:Combined periodontic-endodontic lesions
1254:International Journal of Dental Hygiene
1175:"BDA evidence summary: routine scaling"
931:
892:International Journal of Dental Hygiene
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371:A dental hygienist demonstrates scaling
14:
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205:, is a procedure involving removal of
1949:Subepithelial connective tissue graft
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978:
793:Nagelberg, Richard H. (Dec 9, 2009).
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275:plaque will accumulate on the teeth.
1535:Generalized aggressive periodontitis
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688:
686:
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522:for two months after the treatment.
58:adding citations to reliable sources
29:
525:
24:
1530:Localized aggressive periodontitis
1104:Journal of Clinical Periodontology
1062:Journal of Clinical Periodontology
839:
795:"Is gingivitis really reversible?"
762:Carranza's Clinical Periodontology
25:
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1853:Full mouth ultrasonic debridement
1388:
1372:from the original on Apr 27, 2016
827:from the original on May 11, 2015
801:from the original on May 10, 2015
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512:full mouth ultrasonic debridement
1550:Necrotizing periodontal diseases
1116:10.1111/j.1600-051X.2005.00868.x
1076:10.1111/j.1600-051X.2005.00776.x
861:10.1111/j.1600-051X.2004.00496.x
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457:
423:. Ultrasonic scalers use either
237:are some of the tools involved.
199:non-surgical periodontal therapy
195:conventional periodontal therapy
34:
1245:
1207:
1191:CADTH, H.V. (17 October 2016).
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885:E. Bozbay; et al. (2018).
146:Close-up image of a hand scaler
45:needs additional citations for
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711:10.1002/14651858.CD004625.pub5
592:Effectiveness of the procedure
13:
1:
1555:Abscesses of the periodontium
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287:Plaque build up and bone loss
1023:10.1177/00220345950740080501
765:. Elsevier Health Sciences.
7:
1340:. perio.org. Archived from
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10:
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1909:Guided tissue regeneration
1231:10.1016/j.adaj.2015.01.026
1010:Journal of Dental Research
415:Two ultrasonic instruments
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69:"Scaling and root planing"
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1986:
1879:Coronally positioned flap
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1306:Contemporary periodontics
1153:10.1902/jop.1982.53.6.368
1140:Journal of Periodontology
466:solution, which has high
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1934:Pocket reduction surgery
1914:Enamel matrix derivative
1904:Guided bone regeneration
1869:Apically positioned flap
1843:Scaling and root planing
1749:Treatment and prevention
1710:Linear gingival erythema
1665:Clinical attachment loss
1579:A. actinomycetemcomitans
966:. dentaldeepcleaning.com
964:"Dentaldeepcleaning.com"
561:evidence-based dentistry
555:Evidence-based dentistry
339:Periodontal intervention
191:Scaling and root planing
135:Scaling and root planing
1987:Important personalities
1848:Full mouth disinfection
1811:Host modulatory therapy
1776:Chlorhexidine gluconate
1756:Periodontal examination
464:chlorhexidine gluconate
1705:Horizontal bony defect
416:
372:
1929:Open flap debridement
1924:Lateral pedicle graft
1525:Chronic periodontitis
1485:Mucogingival junction
1480:Junctional epithelium
599:periodontal pathogens
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2126:Dentistry procedures
2059:Paul Roscoe Stillman
2034:Willoughby D. Miller
2004:Per-Ingvar BrĂĄnemark
1831:Conventional therapy
1740:Vertical bony defect
1685:Gingival enlargement
1635:Entamoeba gingivalis
1490:Periodontal ligament
1460:Free gingival margin
1368:. Practice Booster.
657:Debridement (dental)
502:Full mouth treatment
235:periodontal curettes
54:improve this article
2074:James Leon Williams
1939:Socket preservation
1889:Free gingival graft
1771:Bleeding on probing
1725:Periodontal disease
1495:Sulcular epithelium
944:. 12 September 2012
662:Periodontal disease
358:periodontal scalers
310:periodontal disease
279:substance known as
271:rinses and sprays.
231:Periodontal scalers
1720:Periodontal pocket
1695:Gingival recession
1586:Capnocytophaga sp.
849:J Clin Periodontol
545:periodontal pocket
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402:obligate anaerobes
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18:Prophylaxis dental
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2088:Other specialties
2044:John Mankey Riggs
2029:Preston D. Miller
1994:Tomas Albrektsson
1982:
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1919:Implant placement
1894:Gingival grafting
1884:Crown lengthening
1819:
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1786:Hydrogen peroxide
1643:Trichomonas tenax
1316:978-0-8016-1935-9
1266:10.1111/idh.12339
906:10.1111/idh.12249
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2009:Robert Gottsegen
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43:This article
41:
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19:
2131:Oral hygiene
2069:Hom-Lay Wang
2054:Jørgen Slots
2024:Brian Mealey
1899:Gingivectomy
1842:
1801:Tetracycline
1796:Oral hygiene
1641:
1633:
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1621:T. denticola
1619:
1614:T. forsythia
1612:
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1593:F. nucleatum
1591:
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1440:Periodontium
1374:. Retrieved
1358:
1346:. Retrieved
1342:the original
1332:
1322:20 September
1320:. Retrieved
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1110:(1): 49–52.
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829:. Retrieved
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213:(scaling or
202:
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110:January 2014
107:
97:
90:
83:
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52:Please help
47:verification
44:
2049:Jay Seibert
1999:Frank Beube
1838:Debridement
1628:Red complex
543:within the
516:anaesthesia
389:prophylaxis
322:osteoclasts
318:osteoblasts
246:debridement
215:debridement
2120:Categories
2019:Jan Lindhe
1944:Sinus lift
1874:Bone graft
1761:Ante's law
1700:Gingivitis
1670:Edentulism
673:References
569:gingivitis
395:Often, an
354:ultrasonic
294:gingivitis
80:newspapers
1824:Treatment
1806:Triclosan
1791:Mouthwash
1638:(amoebic)
1570:Infection
1517:Diagnoses
1500:Stippling
1309:. Mosby.
1274:1601-5029
719:1469-493X
490:, and/or
433:AC source
1962:Membrane
1781:Flossing
1766:Brushing
1675:Fremitus
1660:Calculus
1455:Cementum
1376:13 April
1370:Archived
1348:13 April
1282:29532597
1239:26113100
1201:27929624
1124:16367856
1085:15998268
1039:31660701
992:13 April
988:. Oral-B
970:13 April
948:13 April
925:27860247
869:15142210
831:13 April
825:Archived
805:13 April
799:Archived
778:13 April
737:30590875
625:See also
549:curettes
532:cementum
443:agents.
397:electric
378:cementum
362:curettes
281:calculus
219:cementum
211:calculus
153:ICD-9-CM
1957:Curette
1862:Surgery
1509:Disease
1465:Gingiva
1433:Anatomy
1290:4921379
1161:7050340
1031:7560400
728:6516960
541:biofilm
536:dentine
477:Arestin
421:turbine
382:dentine
268:biofilm
223:dentine
171:D012534
94:scholar
1972:Scaler
1953:Tools
1735:Plaque
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508:Leuven
437:lavage
256:Plaque
250:tartar
244:, and
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1967:Probe
1653:Other
1286:S2CID
1178:(PDF)
1035:S2CID
942:(PDF)
179:[
158:96.54
101:JSTOR
87:books
1378:2015
1350:2015
1324:2011
1311:ISBN
1278:PMID
1270:ISSN
1235:PMID
1197:PMID
1157:PMID
1120:PMID
1081:PMID
1027:PMID
994:2015
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950:2015
921:PMID
865:PMID
833:2015
807:2015
780:2015
767:ISBN
733:PMID
715:ISSN
563:. A
360:and
233:and
209:and
165:MeSH
73:news
1262:doi
1227:doi
1223:146
1149:doi
1112:doi
1071:doi
1019:doi
911:hdl
901:doi
857:doi
723:PMC
707:doi
534:or
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380:or
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56:by
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