Suggested treatment for bone loss in mouth, what is "scaling"?

March 7, 2007 1:27 PM

PeriodontistryFilter: My dentist tells me that I have some pretty severe bone loss around my upper molars and that I need to have a consult with a periodontist to discuss "scaling". What is this and how much does it hurt?

My dentist was incredibly unhelpful in terms of describing the process, the consult is several weeks away, and I wasn't really able to find much online with regard to this procedure, at least nothing in terms of what I can expect, pain-wise. Has anyone recently undergone this procedure and how bad was it?

posted by Tommy Gnosis to health & fitness (14 answers total)

I've had it. The (dozen) shots of local anesthetic tasted horrible and were uncomfortable but other than that the procedure is not painful. I was sore for 2 days after but not incredibly so.

I have great teeth - no cavities ever - but not such great gums and my dentist said i needed this to get them healed up. Luckily my dentist was able to do the procedure herself. From what i understand it's a pulling-back of the gum and surrounding tissue and then scraping the root of the tooth almost to the bone joint.

It sounds worse than it is. Basically, it's the mother of all teeth cleaning. Mine was called a "planing and scaling" which I assume is the same.
posted by luriete at 1:44 PM on March 7, 2007

Thanks, luriete. Doesn't sounds like a picnic, but I think I can handle it. I do have a follow up question: since bone doesn't grow back, is this the sort of thing that you'll have to have done periodically for the rest of your life? If so, how often will you need to go back?
posted by Tommy Gnosis at 1:57 PM on March 7, 2007

well theoretically you do it once then you keep it clean after that. my dentist recommends 3 month cleanings rather than 6 months to maintain the cleanliness.
posted by alkupe at 2:05 PM on March 7, 2007

The point of it is to get rid of the bacteria in the pockets between your teeth and your gums. Once the area is clean, the pockets will close up, and your gums will be tighter around your teeth. With proper maintenance, you won't need to have the root planing done again. However, if the bone loss is really that severe, the periodontist will most likely recommend an osseous graft after the root planing.
posted by Ruki at 2:07 PM on March 7, 2007

Try looking it up under "root planing" or "quad scale" or something like that.

I had it done 6 years ago. It was largely the result of not going to the dentist for about 12 years.

Since I didn't have dental coverage, I had it done at the dental school of the university I was attending at the time. It took about 6 hours, but I dozed in and out through most of it. Eventually, the picking and buzzing and chiseling and incessant chatter of the student-practitioner became strangely relaxing.

It hurt like hell for the first day or so, but after that I was back to normal. Now i go for a teeth cleaning ever couple years or so.

In my case, I had no bone loss, but I did have some gum destruction, leaving me "long in the tooth" in some spots, which I am very careful to brush well 2x a day. Still no cavities.
posted by M.C. Lo-Carb! at 2:12 PM on March 7, 2007

I've had it done too.
Take a tylenol or advil before you go.
It will still hurt and you'll be very tender, but it will hurt a little less.
posted by NoraCharles at 2:23 PM on March 7, 2007

I had it done and it didn't hurt much. I'm trying to take better care of my teeth now by flossing as much as possible. I keep dental floss by my computer and floss my teeth while reading websites. I think I'm probably flossing 3x as much by doing it that way instead of doing it in the bathroom.
posted by Melsky at 2:28 PM on March 7, 2007

I've had my roots planed twice. For me it was pretty painful so they did a quadrant of my mouth at a time. I work to do upkeep, but my family genes gave me soft teeth so I'll probably have to have it done again until I have no teeth left to plane.

I'd say how much it hurts probably depends on how sensitive your teeth and gums are. Mine are ultra sensitive, unfortunately. You may have it easier. I really, really, really hope you do.
posted by miss lynnster at 2:31 PM on March 7, 2007

I had it done about 4 years ago in preparation for getting my braces on (I'd also not been to a dentist for 10+ years, and hardly ever flossed). They did mine by quandrant as well over the course of several visits. Once the novocaine kicked in, it didn't hurt at all while they were doing it (though, as others will noted, this may vary if you have particularly sensitive teeth and gums; mine have definitely gotten more sensitive since my braces and jaw surgery). I was sore for about a day or so afterwards, but nothing that several tylenol couldn't help.

Long-term results: I now floss religiously and see my dentist three times a year.
posted by scody at 2:49 PM on March 7, 2007

Mine was done in quadrants as well. If I ever have to do it again, I think I'll suggest halves, but I wouldn't want to get the whole thing done at once. It wasn't at all painful other than the Novocaine shots, which weren't nearly as bad as I'd expected - possibly because my dentist swabs some anaesthetic gel on your gums before she ever comes near you with a needle. Afterwards I was maybe a little sore for the next couple of hours, by by evening I was fine.

She had me do three-month cleaning/checkups for the next year, then sent me back to a regular six-month schedule. In theory I won't have to have it done again if I keep up regular cleanings, but it's not something I dread having done again if necessary.

I maxed out my dental insurance for that year because I had to pay a big hunk of the planing cost and then the cost of the extra cleanings and checkups, but I had a bunch of fillings to do too and I'm sure that helped. The expense hurt more than the procedure.r
posted by Stacey at 3:07 PM on March 7, 2007

I had planing and scaling done about two years ago in halves; my dentist rocked the anesthetic/Novocaine/happy gas so it was painless, and almost enjoyable.
As Stacey said, the majority of the pain is in the pocketbook. I do not regret the expense and would do it again in a heartbeat.

On the numerical scale my dentist uses to measure gum loss (I'm sure there's a more technical term for this), before the procedure, it was getting mostly 4's and 5's on each tooth; the last time I saw the dentist the highest I had was a 3, mostly twos, which I attribute to my rigorous flossing regimen/switch to the SonicCare toothbrush after the procedure.
posted by Dr. Zira at 6:37 PM on March 7, 2007

I've done scaling three times over the course of the last twenty years. The first time I was home from school and had limited time so they did the whole mouth in one afternoon. I was numb from the eyeballs down to the neck. Not recommended.

The second time, I did halves in two appointments, with novocaine.

Third time, I did quadrants, in four appointments, with no novocaine. (By this time, we discovered that I'm one of those people that novocaine doesn't really work well for - they have to give me huge amounts for it to be effective. See numb face incident above.) Surprisingly, this was the easiest. Only one quarter of your mouth is sore afterwards, so it has minimal impact on your ability to go about your life.

If you have a high pain tolerance*, and your dentist will do it, go for quadrants with no novocaine.

*It really isn't that painful. If you don't mind teeth cleaning (I often doze during routine cleaning), then you won't mind this. It's not that much worse.
posted by ereshkigal45 at 10:34 PM on March 7, 2007

I had this done about six months ago. My teeth were sound but I had gum erosion and a lot of calculus in the spaces where the gums had receded. I was petrified, having neglected the dentist for years, but by going for as close to total sensory deprivation as I could it was manageable.

I'm very short-sighted, so my glasses came off, I was numbed as much as they could and I wore my CD player (am I the only person on here who doesn't own an iPod?) and played it as loud as I could.

The sound of the scraping is horrible, which is why the music was essential. The actual CD I took with me that first appointment was not exactly my wisest pick - the first track was Steve Earle's "Cocaine Cannot Kill My Pain"!

My mouth was very sore afterwards and for a day or so afterwards, and for the final session (I was booked in for four, but got them to do it in three) for some reason the novocaine wouldn't numb my mouth enough, despite me being given the max dose, so that was unpleasant to say the least.

I've had three-monthly check-ups and am now fairly diligent about brushing (the dentist recommended Sonicare or, a good and cheaper alternative, Pulsar), flossing and using those little inter-dental brushes.
posted by essexjan at 3:54 PM on March 8, 2007

Huh! Is this a cultural thing? What they call "scaling" back in Malaysia is rather different.

My scalings have no anesthetic shots. I don't know if there is some sort of anaesthetic cream - the dentist does put something on your teeth beforehand. Then he takes a high-pressure water spray and just sprays your teeth and gums like crazy. There's another tube in your mouth to collect all the water, and you're ask to spit out a few times during the scaling.

It's painful when the spray hits a sensitive spot, but otherwise it's not too bad. I actually rather enjoy it (and I hate pain!).
posted by divabat at 1:49 PM on March 9, 2007