The 5mm pockets I would NOT treat with scaling and root planing

The 5mm Pockets I would NOT Treat With Scaling and Root Planing

In a previous post, I talked about what scaling and root planing is and why someone would need it. In essence, when periodontal disease sets in and the bone holding your teeth becomes damaged, scaling and root planing will help eliminate the local factors causing the infection and can help prevent future bone loss. Usually if a patient presents with a 5mm pocket, it’s a big red flag and probably time to schedule a “deep cleaning”.  In this post, I want to talk about the conditions I would NOT treat with scaling and root planing.

Distals of Molars
The dense tissue behind the furthest tooth in your lower or upper jaw tends to be really thick. Sometimes a treasure trove of tartar, it’s one of my favorite places to scrape. With no tooth leaning up against it making a contact, flossing here rarely happens because the awkward lasso maneuver you have to master is weird at best. If I saw a single 5mm pocket depth here, I wouldn’t charge someone extra to scrape the heck out of it because that’s my job!  I would do the best I could and get them over to my dentist for a follow-up visit and a possible pocket reduction procedure to prevent further bone loss. This procedure can be done traditionally with a surgical tool, but my favorite option is a dental laser.

Partially Erupted Third Molars
Wisdom teeth are known for causing  problems. This ugly stepchild of a tooth usually doesn’t have the space to come in completely and the result is a tooth that shows only part of it’s chewing surface. As you can imagine, food and germs cause the gums to get infected easily. If a tooth can’t come in enough for the tissue to make a tight “collar” around it’s neck, it will most likely be a problem.  Why wouldn’t I treat this with root planing? Because the tooth just needs to come out. 

Overhangs on Fillings
As long as they aren’t showing signs of recurrent decay or starting to separate from a tooth, we leave fillings alone and expect them to last a really long time.  A super common problem with fillings is that they can stick out away from the natural part of the tooth and cause a food or plaque trap. When I see an isolated 5mm pocket in an area where everything else look pristine, I take a peek at the X-ray. When there’s an overhang, root planing won’t fix the pocket.

Bulky or Open Crown Margins
One of the most common ways to fix broken teeth and cavities is by crowning them.  They come in all shapes and sizes and as much as dentists try to make them perfect, hiccups can happen.  Sometimes they just don’t fit right.  If the crown is too thick at the gum line, germs are sure to hide under the margin.  Floss might shred or food might get stuck and cause inflammation.  If the crown margin is exposed because the cement came out or because a cavity is forming,  it needs to be addressed by the dentist.  Whatever the case, if a pocket is developing around a crown and every other tooth in an area seems fine, it’s time to point fingers at the crown itself.

Isolated Chunk of Tartar
The key word here again is isolated. When I’m doing an assessment of someone’s mouth trying to figure out a plan of attack, I’m making mental notes about bleeding points and where tartar is forming the heaviest.  If I find a 5mm pocket right next to a huge chunk of tartar, I’m willing to bet money the tissue will respond really well when it’s gone.  So, I would personally annihilate that piece of tartar, show the patient how to keep it from coming back and check the tissue very carefully at the next visit.  If it’s not improved at that point, it’s time to plan a different strategy.

Teamwork
So what’s the common denominator with all of these situations and why am I even writing about it?  The theme here is that they are the exceptions.  The are isolated unhealthy spots in an otherwise healthy mouth.  They are often treated with scaling and root planing when dental staff are going strictly by numbers on a full mouth periodontal screening.  My goal with this post (and the entire site) is to help patients understand WHY gum disease happens and how they can prevent or treat it.  I also want them to feel comfortable asking questions about their mouth, unique situations and why their dental providers might choose one treatment over another.  So, if you are a patient and are told that you have a 5mm pocket, I want you to walk away feeling like you have been an active participant in your dental care. If you are a provider like me, I want you to put some thought into your treatment planning and not gravitate toward root planing without doing a little investigative work.

*Readers – Do you know what your numbers have been on a periodontal screening and have you ever had root planing?  Did you know what was causing the pockets and why they were treated?

*Dental Hygienists – Do you get a voice in your patient’s treatment options? Does your office treat ALL 5mm pockets?

*Dentists – What is your office policy for treating pockets.  How many 5mm pockets before you plan for root planing? Do you make exceptions?