Plaque and its effects
- Plaque is a soft yellow-grayish substance that adheres to tooth surfaces.
- It is an organised biofilm primarily composed of bacteria in a matrix of glycoproteins and extracellular polysaccharides.
- Plaque cannot be removed by rinsing or using sprays.
- Regular brushing and flossing can disturb and eliminate plaque from the oral cavity.
- If plaque remains undisturbed, it absorbs minerals from saliva and transforms into calculus (tartar), which cannot be removed by brushing or flossing.
- Plaque accumulation along the gumline leads to gum infection known as gingivitis.
- Gingivitis causes swelling, redness, and bleeding gums.
- In gingivitis, the space between the tooth and gum (sulcus) allows new plaque to migrate and form periodontal pockets.
- Bacterial plaque in the pockets transforms into calculus, resulting in ulceration and breakdown of gum attachment.
- As the pocket depth increases, gram negative bacteria replace gram positive bacteria, leading to periodontitis and bone loss.

Periodontal disease progression
- Radiographs show blunted, slanted, or scooped out appearance of crestal bone in periodontal disease.
- Chronic inflammation stimulates osteoclasts, causing them to break down bone faster than osteoblasts can build it.
- This imbalance leads to bone loss and attachment tissue loss.
- Periodontal disease damage persists until plaque and calculus are removed.
- Brushing and flossing are ineffective in cleaning pockets deeper than 3mm and removing calculus.

Scaling and root planing procedure
- Scaling and root planing is a non-surgical periodontal therapy or deep cleaning procedure.
- It involves removal of dental plaque and calculus (scaling) and smoothing of root surfaces (planing).
- Periodontal scalers and curettes are used in the procedure.
- Scaling and root planing helps establish a periodontium in remission of periodontal disease.
- It is recommended when brushing and flossing are no longer sufficient to remove causative factors of periodontal disease.

Healing and long-term effects
- After scaling and root planing, the tissue can begin to heal and inflammation decreases.
- The gums form an effective seal between the tooth root and the outside environment.
- However, bone loss due to periodontal disease is irreversible.
- Extensive bone loss can result in permanent recession of the gums.
- The damage caused by periodontal disease may have permanent effects on gum tissue.

Additional considerations and techniques
- Treatment of periodontitis involves removing local causative factors to create a biologically compatible environment between the tooth and surrounding tissues.
- The use of dental lasers after scaling and root planing may promote tissue healing.
- Prophylactic scaling and polishing can be done to prevent oral diseases.
- Oral irrigation with chlorhexidine gluconate and site-specific antibiotics can aid in disinfecting periodontal tissues and facilitating healing.
- Full mouth treatment using ultrasonic debridement may reduce treatment time and the need for anesthesia.
- Evidence-based dentistry reviews provide mixed results on the effectiveness of scaling and root planing.
- Maintenance and follow-up visits are crucial for sustaining periodontal health after scaling and root planing.