Periodontal Scaling and Root Planing (SRP)

Periodontal Scaling and Root Planing (SRP) is the initial, non-surgical treatment for periodontal (gum) disease. When gingivitis (gum disease) is left untreated, the infection will spread deeper into the bone and periodontal ligaments (structures supporting the tooth), causing bone loss and eventually generalized tooth loss. During SRP, the bacteria below the gum line will be removed and antibiotic may be placed inside the periodontal pockets. The main purpose of SRP is to stop the spread of infection and lower the inflammation. This allows for attachment back between the teeth, bone and gums to recover.


Periodontal disease is a serious gum infection that damages the gums and bones supporting the teeth. It is very common – approximately 40-50% of the adult population over the age of 30 in the United States suffers from some form of periodontal disease. This number increases with age: 70% of adults 65 years and older suffer from this disease and the tooth loss caused by it.  Periodontal disease – not tooth decay – is the cause of generalized tooth loss in patients over 45 years of age, with over 70% of lost teeth being a direct result of gum disease. 

Because periodontal disease develops gradually over many years, and because it is rarely accompanied by pain or other severe symptoms, it goes unnoticed and underestimated by the patient until the latter, advanced stages – once severe bone loss and tooth mobility occur. 

There are multiple risk factors for periodontal disease. The main cause of periodontal disease is plaque and calculus (tartar) accumulation caused by poor oral hygiene and inadequate professional dental cleanings.  Smoking, genetics, diabetes, localized trauma, stress, medications, clenching or grinding, poor nutrition and some systemic disorders are other risk factors of this disease. Periodontal disease can be generalized (affecting all teeth), or localized (limited to certain areas in the mouth). 


At your initial and periodic checkups, Dr. Natour and his clinical team will review your radiographs with you, and discuss the presence of any abnormalities, such as bone loss, tartar build-up or cavities. Your gums will also be evaluated. In cases of chronic inflammation caused by tartar build-up, the ligaments attaching the teeth to the gums are lost. This creates a space between the teeth and the gum called periodontal pockets. For periodontal pockets exceeding 4 mm, any presence of tartar and / or bone loss, Scaling and Root Planing (a.k.a. Deep Cleaning) is necessary.

Scaling and Root Planing is done in one or more sessions depending on the severity of periodontal disease:

  • The area is numbed by topical gel and / or local anesthesia.
  • Soft and hard deposit from under the gums are removed using ultrasonic and hand scalers.
  • The depth of periodontal pockets is re-measured. For pockets 4 mm or deeper, localized antibiotic must be placed.


Arestin, minocycline hydrochloride antibiotic, is a yellow microsphere agent that is placed directly into periodontal pockets with a needle-less syringe. It reduces the depth of pockets by lowering bacterial count and disinfecting the tissue. 

Peridex, chlorohexidine gluconate rinse, is an antibacterial mouthwash that might be prescribed before or after Scaling and Root Planing to lower bacterial count and inflammation in the gums.


The combination of Scaling and Root Planing and therapeutics such as Arestin and Peridex, is a proven, powerful tool in combatting periodontal disease. However, the progress achieved must be diligently maintained. Periodontal disease will come back with negligence.

After the completion of Scaling and Root Planing, it is important to maintain the health of your gums by proper home care, correct brushing, effective daily flossing and coming for regular, professional periodontal teeth cleanings. Typically, periodontal cleanings must be repeated every 3-4 months until sufficient gum health improvement is achieved. At each cleaning your gums will be checked. Should inflammation or deep pockets persist, localized antibiotics may be necessary again at your periodontal maintenance appointments.


Virtually all dental insurance plans cover Scaling and Root Planing under the basic category. Typically, coverage is at 80-90%, with the premium plans covering Scaling and Root Planing at 100%. The office of Dr. Mazen Natour will handle all insurance matters for its patients. Please call us if you have any questions about your coverage.