This article is based on an original article in Swedish which can be found here

BACKGROUND

Scaling and root planing/debridement is now referred to as Non-surgical periodontal treatment (NSPT), which includes the removal of calculus as well as dental biofilm/plaque by disrupting the biofilm structure and inhibiting bacterial growth (1,2). The mechanical phase of infection control/Non-surgical periodontal treatment is a key component in periodontal therapy (3).

Bacterial biofilm consists of a complex ecology of microorganisms from various ecosystems that grow on a solid surface. Dental plaque is a typical microbial biofilm where formation occurs gradually. The dynamic process begins with freely floating bacteria attaching to the surfaces of the teeth and forming a thin film, known as a pellicle, which mainly consists of proteins from saliva. As these bacteria grow, they secrete extracellular polysaccharides, creating a protective layer around the bacteria. Over time, the microbial biofilm becomes more complex and forms communities that contain fluid channels for nutrient transport and waste management, which benefits bacterial survival. Additionally, bacteria in a biofilm are less sensitive to antimicrobial agents than bacteria living in liquid cultures, making them more difficult to treat (4).

If the biofilm remains undisturbed on the teeth, it can eventually mineralize and transform into calculus. This process occurs as calcium and phosphate ions in saliva bind to biofilm/plaque. There are two types of calculus: salivary calculus/supragingival calculus and exudate calculus, serumal calculus/subgingival calculus.

In supragingival plaque, a precipitation of calcium phosphate crystals can occur, leading to mineralization of plaque and the formation of supragingival calculus. The salivary environment creates conditions for the mineralization process, hence the name salivary calculus.

Supragingival calculus/salivary calculus primarily forms near the openings of the major salivary glands, lingually of the mandibular anterior teeth and buccally of the first molars in the maxilla, where the major salivary ducts enter the oral cavity.

Mineralization of plaque varies greatly among individuals. In some individuals, mineralization of supragingival plaque can occur after just a few days. Factors that can influence calculus formation include oral hygiene, saliva composition, diet, medications, and smoking (1,4,21,22).

Subgingival calculus, also termed serumal calculus, is a brownish to black mineralized biofilm. It mainly consists of a collection of bacteria mixed with products from inflammatory exudate (of serumal origin) and blood, hence the dark color. The mineralization process of subgingival calculus is slow and occurs in patches, making it difficult to detect. It is not the calculus itself that causes the inflammatory process in gingivitis/periodontitis, but rather the biofilm that the calculus retains. Like supragingival calculus, subgingival calculus provides a surface for bacterial retention (1). Therefore, the removal of biofilm/plaque and calculus is an important part of non-surgical periodontal treatment to reduce pocket depth, inflammation level, and achieve pocket closure (3).

TREATMENT

Mechanical infection treatment involves the professional removal of plaque/biofilm and calculus using polishing, ultrasound, and/or hand instruments (1). There is another method to remove plaque/biofilm through so-called "Air polishing" (23).

Scaling and root planing (SRP) is the English term traditionally used for mechanical infection treatment. However, it is important to note that the concept and execution have evolved over time. While the term SRP is still common in English-language literature, treatment methods have been adjusted to minimize the removal of tooth substance. The removal during scaling depends on the time factor and the force used.

Expect an average of 3-6 minutes of scaling per tooth to achieve good results (5). According to studies, there is no significant difference between ultrasound and hand instruments regarding treatment outcomes (6,7).

Some patients may experience increased sensitivity in their teeth after scaling/debridement; therefore, it is important to inform the patient about possible side effects and to prevent them by increasing sodium fluoride intake, for example, through sodium fluoride varnish after instrumentation (8).