Q: What are the procedures for scaling and planing on root periodontics?

A: Because of the Laser Protocol available, we have virtually eliminated the scaling and root planing procedure and incorporated it in a FDA cleared laser protocol known as LANAP.

Q: Yesterday, I went for my first periodontal planing and scaling (3 and 1/2 months after LANAP) session. I was shocked to hear from the periodontist that my back right molar still had a deep pocket depth on the buccal side. It was a 7-8 mm just before LANAP. Anyway, the hygienist said that a water irrigator would help. I said that I hope that it did not delay or stop the gingival reattachment process since the water force may further separate my gum from the tooth root. Then, the pocket will still remain. She did not think so. Is her suggestion for an irrigator credible? The Periodontist was too busy for me to ask.

A: In our specialty practice of Laser Periodontal Surgery, which includes LANAP, we sometimes see areas that have not responded as anticipated. If I understand you correctly, you have an isolated area of 7-8mm pocketing that has not changed since the procedure was performed. I would suggest speaking to the treating periodontist and discussing what the prognosis was pre-operatively and what can be done to enhance the results. In some instances, we do an isolated re-treatment of the area. There are many factors involved and it would be important that the periodontist speak with you when he is not so busy. The irrigator is helpful if there is plaque and if used correctly should not affect the LANAP process of healing. I am more concerned about the pocket and also the fact that we don’t probe LANAP cases until one year post LANAP surgery.

Q:

1. Yes, it is an isolated area.
2. In regard to not probing for one year—I feel that a planing and scaling at 3 months is, in effect, probing. The hygienist will never be so exact as to not detach new gingival re-attachment. Maybe, instead of a perio cleaning, there should be a regular cleaning only at and not under the gumline at 3months or even 6 months?
3. By the way, would you charge for a one tooth LANAP re-treatment? Thank-you for spending your time on this matter.

A: I would feel more comfortable if you spoke to your treating Periodontist and ask what he/she feels should or should not be done. However, please feel free to keep me informed of your progress.

Q: I got gum disease from smoking. Pockets are 5mm. I was warned it would happen. I need to get my teeth cleaned three times a year because of excessive tarter. I received one scaling and deep cleaning, but that did not remove the tarter. They said they couldn’t clean my teeth. How can I get this tarter removed if nobody will clean my teeth? I can’t believe my hygienist would leave me with massive amounts of tarter on my bottom teeth. What can I do to get routine cleaning and polishing? Perhaps a college will do it? I’m in the prime of my life. My confidence has gone down. This is wrong. Please help.

A: Can you get to a Periodontist (gum specialist)? Do you live in an area with a dental school? It sounds like you need another opinion for an appropriate treatment plan. Don’t give up hope.

Q: I am a 72 year old male. I have several gum pockets at 5mm and others 4+. My dentist suggests deep root planing and cleaning. I’m OK with this. I had deep cleaning about 5 and 2 years ago, with maintenance cleanings 2-3 times a year. I’m bad about flossing. Three additional treatments have been recommended after deep cleaning:

1. irrigation at $75/quadrant
2. laser at $50/quadrant
3. arestin implants 6@$45 each.

I’m ok with this, but are any of these really necessary? If so, which, and in what priority?

A: I would go to a Laser trained Periodontist who does LANAP and get an evaluation. They should be able to diagnose you and give you a treatment plan that makes sense.

Q: Do I need to have deep cleaning before laser surgery?

A: If you are having LANAP, then you don’t have to go through any scaling before the laser surgery. If it is not LANAP, then you should consider getting a second opinion from a qualified laser periodontist that offers the FDA cleared protocol known as LANAP.

Q: My dentist wanted me to be evaluated by a periodontist for possible bone loss. I went for an evaluation and he said I had bone loss and recommended osseous surgery 4+ per quad. I have no pain, no bleeding while brushing, but chronic bad breath.  I thought periodontal scaling and root planing would be done first before osseous surgery. Also, I was advised that I needed crown lengthening to prep a tooth for a crown. I am hesitant to have the surgery without trying the scaling and root planing. What are your thoughts?  Thank You.

A: This question seems to come up quite often from patients, doctors, students and residents, so I will try to explain how things have changed over the last 29 years in our approach to treating gum disease.

First, an accurate diagnosis is necessary.   Once we review the clinical information and full set of quality digital radiographs, we can determine how to treat the disease in the least invasive but most effective way possible with the best long term results.

We utilize laser therapy, which eliminates the need for separate scaling and root planing appointments and aggressive surgery (see our web site for more detailed information). We try to eliminate the need for conventional osseous surgery, when possible, and treat the entire mouth with the FDA-cleared laser approach (LANAP).

The advantages of this are to:

• Eliminate scaling and root planing as a separate procedure and eliminate the need for multiple appointments involving local anesthesia.
• Utilize the laser surgery instead of the conventional osseous surgery, where possible.
• If crown lengthening is needed, the area of conventional surgery is limited to the area in question.

We find that we can treat about 85% of our patients with the laser approach and in many cases, eliminate the need for cutting, suturing, scaling and root planing. In a worst case scenario, we can just do the conventional osseous surgery in very limited areas for crown lengthening. This comprehensive approach in treating periodontal disease makes for a pleasant post-operative experience for the patient with excellent results.

I would suggest a second opinion with a Periodontist trained in LANAP surgery.

Best of luck,+

Dr. Eric Linden

Q: I just came back from the dentist and was told I have advanced periodontal disease. The doctor I went to wants me to have one tooth pulled w/bone grafting. She then wants to do root/scale cleaning and then gum surgery to further clean I guess. I truly hate the dentist, hence the reason I’m where I’m at. Would laser surgery be something I could consider?

A: I would get an opinion from a well-qualified, experienced, Laser Periodontist (specialist) that is trained in the LANAP procedure before you do anything.  You should be presented with all your options.

Q: I’m having a scaling and the DDS says I need six laser treatments. Is this necessary?

A: It may or may not be necessary. It’s hard to say without a proper examination. I would recommend that you get a second opinion, preferably from a periodontist trained and approved in the use of LANAP (the FDA-approved laser technology revolutionizing the treatment of gum disease).

Q: Is it normal to have LANAP done before trying planing and scaling?  Can dentists do scaling/planing or only periodontists?

A: The best qualified professional to do any periodontal therapy is a Periodontist. The LANAP protocol includes scaling and root planing. In our laser periodontal practice, if a patient has a diagnosed periodontal condition, we recommend the most effective treatment to stabilize the disease. There is little research and clinical data to support scaling and root planing as a definitive treatment.

Q: I just had osseous surgery for gum disease. Do I need to have scale planing too?

A: If someone has osseous surgery, they should not need scaling and root planing in the same location.