Outcomes+of+Incomplete+Scaling+vs.+Complete+Scaling

**1. Subgingival calculus harbors bacteria and should be removed completely. RK 7** Scaling is the process by which plaque and calculus are removed from both supra-gingival and sub-gingival tooth surfaces. The objective is to restore gingival health by completely removing elements that aggravate gingival inflammation such as plaque, calculus, and endo-toxins from the tooth surface. Gross scaling is a method used to remove the large pieces of calculus above or slightly below the gum line. Often this is done before scaling and root planning.

Incomplete removal of deposits from above and below the gumline can lead to several problems: 1) If bacteria deposits are not completely removed, the bacteria continue to multiply and the disease process is not stopped. 2) When deposits are not removed from the base of the pocket, the tissue will shrink and tighten around the neck of the tooth, and bacterial toxins are trapped in the pocket. This can result in a periodontal abscess. 3) When healing and tissue shrinkage occur at the neck of the tooth, the tissue becomes tighter, and it is more difficult to place an instrument in the pocket for removal of remaining deposits.

Intermittent exudation, Fistulous tract often associated with a deep pocket; and Usually without systemic involvement.
 * //Acute Abscess://** Mild to severe discomfort**//;//** Localized red, ovoid swelling**//;//** Periodontal pocket**//;//** Mobility**//;//** Tooth elevation in socket**//;//** Tenderness to percussion or biting**//;//** Exudation**//;//** and Elevated temperature.
 * //Chronic Abscess://** No pain or dull pain**//,//** Localized inflammatory lesion**//,//** Slight tooth elevation
 * //Periodontal Abscess://**Primarily related to incomplete calculus removal.

Throughout the procedure and several weeks later the tissue should be evaluated in order to observe the healing process. Since subgingival calculus is porous and harbors bacteria and endo-toxins, its complete removal during scaling is necessary for the health of the adjacent soft tissue. Current research reported by rdhmag.com, supports that periodontal diseases are infections initiated by microorganisms within oral biofilm, combined with the body’s host response. Partially removing the bacteria will only reduce the infection to a degree. In turn, incomplete removal of calculus deposits allows the thriving bacteria to continue. After gross scaling, the remaining calculus can increase the incidence of further periodontal infections such as abscesses.

An Advantage of completely removing calculus is that there will be a decrease in the patients gum inflammation. It also eliminates periodontal pockets, which can trap plaque. Therefore, if treatment is successful, the swelling will reduce and the gums will shrink or recede. The extent of shrinkage depends on the initial depth of the pocket and the severity of periodontitis. The more severe the disease, the more your gums will recede after successful therapy. As a result, some part of the root is exposed. This makes the tooth look longer. A disadvantage is that the exposed teeth will be more sensitive to heat and cold, however a fluoride treatment should provide some comfort to the patient.

References Nathe, C. (2011). A quick fix to access to care. RDH: the national magazine for dental hygiene professionals, Retrieved from http://www.rdhmag.com/index/display/article-display/373503/articles/rdh/volume-30/issue-3/columns/public-health/a-quick-fix-to-access-to-care.html

Mastering scaling and root planing is detrimental for the success of periodontal therapy. However, many have argue that even with proficiency it is impossible remove calculus at the root surface. When this situation occurs the patient is referred to a periodontitis for treatment. A great concern is when surgery is contraindicated for the patient. Complete scaling is the goal for each patient to have the best resolution to their periodontal disease. The success of phase I therapy is evaluated at the 4 week re-evaluation and scaling can occur at this appointment if residual calculus was left. Some patients will require surgical interventions to achieve complete scaling. Patients that will require surgical therapy include 5 mm or greater pocket depths, severe periodontal disease, and patients with short root. MC#3
 * 2. Periodontal surgery is necessary to gain access to the root surfaces in order to achieve complete scaling.**

It is important to remove the endtoxins in the periodontal pocket in order to ensure that the healing process can begin. However, after a certain point in scaling the strokes are not longer benefiting the patient. Rather they are removing parts of the cementum and dentin and may cause the the roots to have an hour glass appearance.
 * 3. Complete removal of endtoxins can cause trauma to the cementum and dentin. LM # 11**

4. The use of an ultra sonic scaler with a thin tip for heavy or tenacious calculus on low power may cause burnishing. KT4
The use of an explorer and site specific instruments are suggested with the ultra sonic scaler for optimal removal of subgingival calculus. With the danger of burnishing calculus and therefore continue to harbor plaque in the pocket, it is necessary to explore carefully to be sure that burnished calculus is not present. In correct technique with ultra sonic scalers can cause burnish calculus.

The effectivness of calculus removal is influenced by the pocket depth. The greater the pocket depth the greater the chance of having residule calculus. Patients with pockets that measure 5mm from the CEJ to the base of the pocket should be refered to a periodontist.
 * 5. The pocket depth influences the removal of calculus. MT #18**

The primary use of files is to fracture or crush large deposits of tenacious calculus or calculus that has been burnished. Many times the improper use of a power scaler or the improper use of a hand scaler can burnish calculus. The use of a file can help break up the burnish piece of calculus which will then can result in the complete removal of the calculus. Complete scaling can be also achieve by sharp instruments, and correct angulation and adaptation. by preventing burnished calculus, helps ensure that the calculus is completely removed. In order for the gingiva to completely heal the tooth surface should be completely smooth with no residual calculus. The term gross scaling is sometimes performed to remove supra gingival calculus in order for proper evaluation of the tissue, however incomplete scaling or "gross scaling" can be detrimental to the total health of the patient and has no therapeutic affect. After gross scaling the calculus left over can increase the incidence of periodontal infections.
 * 6. The use of files can help remove burnished calculus. GE#6**

There is no therapeutic value if the subgingival calclulus is not removed.
 * 7. Incomplete scaling or scaling only supragingivally can be detrimental to the patient. TL #8**

8. The selection of an ultrasonic scaler or hand scaling should be determined by the clinician. AP#12
Because the efficacy of both hand scaling and ultrasonic devices, the clinician should have the choice on selection which instrument to use because the result of treatment is determine by the thoroughness of the scaling. But many clinicians use both to achieve thorough debridement.


 * 9. Healing cannot occur unless deposits of calculus have been adequately removed. MW 19**

Gingival and periodontal inflammation occur in response to bacteria that are present in the oral cavity, and in periodontal pockets. In order for inflammation to subside and optimum healing to occur local irritants must be removed. Once removed, a long junctional epithelium will begin to form in the pocket, allowing for reattachment of the periodontal tissue. Incomplete scaling, or gross scaling, does not remove calculus below the gingival margin. This means that inflammation will still be present in the pocket, preventing adequate healing.

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**10. Patient with active periodontitis have an increase chance of periodontal abscess. Performing an incomplete scaling can worsen the condition.** ======

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The difference between incomplete scaling and complete scaling is the amount of calculus that is left behind. In complete scaling all the all supra gingival and sub gingival is removed as best as possible. With incomplete scaling only supra gingival calculus is removed. The outcome between these two treatments in patients that have an active case of periodontitis is different. Patient that receive incomplete scaling have a higher chance of periodontal abscess. The residual calculus or dislodge calculus releases endotoxins that cannot escape the sulcus and so forms an abscess. A complete scaling on the other hand can reduce the chance of residual calculus forming an abscess by removing both supra and subgingival calculus. It has been noted by research the effect residual calculus has on the patient especially if they have an active case of periodontitis. SR14 ======

Due to the excruciating pain of the disease, subgingival scaling is not recommended at the initial visit. A supragingival debridement is recommended, followed by an antibiotic regimen to reduce the inflammation. The patient then returns 1-3 days later, when the pain has lessened, to have the scaling completed.
 * 11. There are some cases when incomplete (supragingival scaling) may be implemented. Such cases include patients with NUG. CE5**

12. Complete removal of subgingival calculus and plaque could difficult to achieve even if the clinician was thorough with proper instrumentation and the probability of complete removal decreases in pocket depths measuring 5 mm or more. Even though complete scaling and root planing is highly recommended to prevent lesions subgingivally, there might be times when incomplete scaling such as gross debridement might be needed such as removal of suprginigval calculus in order for the dentist to be able to diagnose the area or areas properly. LL#9.