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 anaesthesia. - 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.