What is Root Planing? Can’t I Just Have my Teeth Cleaned?

Both long-standing and new patients ask these types of questions. Patients can be unhappy when presented with the fact that oral conditions indicate a “cleaning” will not be sufficient to take care of their problems. What do you say to their questions? How does your hygienist respond? Is the staff prepared to deal with the need for comprehensive treatment explanations delivered to skeptical patients? Be prepared! You can answer your patient’s questions in a matter-of-fact way. You can really address what they want to know, not just give “canned” institutional-type answers. Your explanations and those of your staff can set the tone for how patients accept or reject treatment. Keep in mind, however, that explanations alone will not be enough to keep patients happy. Differences in time spent and scope of procedures performed must also be significant for patients to accept treatment. Patients will not accept that the same person can perform a root planing service and a regular cleaning in the same amount of time, with the only perceived difference being, from their point of view, the fee!

Here are some sample questions and answers:

No dentist has ever told me that I needed to have root planing.

Can’t I just have my teeth cleaned?
Throughout a person’s life many different conditions may arise. It’s common that a person has not had high cholesterol or high blood pressure before, but at a medical check-up these conditions are discovered. Oral problems are no different; situations and circumstances change. The health of a person’s mouth is now known to be very important to his/her general health; it’s not just a matter of filling cavities or extracting teeth. Recent studies show that there is a definite relationship between “gum and bone” health and certain heart conditions and other systemic diseases. Dentists and hygienists are required to provide patients with the best information and treatment that we know—it’s our job. It isn’t right to perform treatment that is inadequate or inappropriate. Root planing and a “cleaning” just aren’t the same.

What is a “cleaning”?
A “cleaning” is the removal of plaque, calculus (also known as tartar), and stains from the tooth structures. It is accomplished using dental instruments that scrape away deposits from the teeth. This deposit removal is performed on tooth structures that have not been affected by bone loss, typically the crowns of the teeth. A “cleaning” is recommended for persons who do not have bone loss, periodontal disease, or infection around the teeth. There should also be no bleeding, mobility of teeth, receded areas where the gums have pulled away from the teeth, or gaps where spaces around the roots are exposed. In other words, the mouth should be healthy, with no gum and bone problems.

What is root planing?
Root planing and scaling are therapeutic (which means designed to heal) and time-consuming treatments to remove toxins (poisons) and bacteria from the root surfaces of the teeth. Periodontal (gum and bone) disease can be treated with root planing. Removing toxins allows the body’s immune system to begin the healing process. Calculus (sometimes called tartar, diseased cementum, and/or dentin) are also scaled away. (Cementum is the hard tissue that covers the tooth root. Dentin is that part of the tooth that is underneath the cementum.) These procedures are used as complete treatment in some stages of periodontal disease, and as part of preparing the mouth for surgery in others. Several appointments, treating sections of the mouth, and local anesthesia may be required.

What is periodontal disease?
Periodontal disease can be described as an inflammation or infection of the gums and bone that support the teeth. Bacterial plaque and its toxic by-products, plus calculus and roughened root surfaces, can overwhelm the mouth’s defenses. Typically, unhealthy gum tissue covers eroded bone, resulting in abnormal pockets around the roots. Left untreated, periodontal disease can result in loss of teeth. It is a common, and sometimes silent, condition in many adults.

How much does root planing cost? Will my insurance pay for it?
All dental treatment tends to be expensive because it is performed by hand, by extensively trained dentists, hygienists, and staff, on a service-by-service basis. Unlike items such as rugs, shoes, and shirts that can be mass-produced for retail sale, dental treatment procedures are unique and individual. Your root planing will cost $X. (The dentist fills in the amount). As far as insurance coverage, your plan may pay a portion of the fee, but there is typically an amount remaining for the patient to pay. Most plans pay a minimum amount, regardless of what you might need as an individual. The good news is, any amount insurance covers is less for you to pay out-of-pocket. Insurance can be a real help!

My employer told me that our dental benefits pay 100%. Why are you telling me I will still have a payment due?
Your employer and the insurance carrier have decided on the type of benefits you have, probably based on the cost of the premium your employer has to pay each month. That 100% is usually what the insurance carrier “allows” as payment toward the procedure based on these employer/carrier negotiations. It is not what any dentist may actually charge. For example, say a dentist charges $80 for an examination (not counting x-rays). Your carrier may “allow” $60 as the 100% payment for that examination, leaving $20 for you to pay.

After my root planing, will I be able to have regular “cleanings” again?
A person who receives root planing is a person with periodontal disease. Other treatments, including surgery, may be required to halt the condition. After the disease process is under control, a regular “cleaning” is not appropriate anymore. Instead, you will require special ongoing gum and bone care procedures, called periodontal maintenance, to keep your mouth healthy. Periodontal maintenance, which is sometimes referred to as supportive periodontal treatment, involves in-office gum and bone care that is not necessary for a healthy person. Even though a hygienist may perform regular “cleanings” and periodontal maintenance, they are not the same thing.