& root planing - Dentsply

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how to
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scaling
& root planing

how to guide
Scaling & root planing
Bal Chana
Deputy Principal Hygiene
and Therapy Tutor.
Bart’s and The London.
I used to regularly have patients reluctant to have scaling
carried out because of the discomfort caused by deep scaling.
Having discovered Oraqix ® (the needle free 25/25 mg
per g periodontal gel: Lidocaine, Prilocaine) and Slimline ®
inserts (40% slimmer than traditional tips), my patients now
experience a more comfortable visit.
Oraqix ® is placed in to the periodontal pockets, resulting in
anaesthesia of the gingivae for about twenty minutes. I started
by hand scaling the first patient that I tried Oraqix ® on, regularly
stopping to see if the patient was okay. Her response was
positive throughout, and so gave me confidence to move on to
the ultrasonic scaler. Having completed the treatment, we were
both extremely happy with the result. Her final words as she
left the surgery were; “I will not dread a visit to the practice for
scaling again!” Patients now actually request future procedures
to be carried out using Oraqix ® .
The Slimline ® inserts have a probe-like slim diameter and feel.
They allow for easy insertion, exploration and instrumentation,
and adapt to complex root anatomies and furcations. The
technique shown in this guide demonstrates how they can be
used quickly and for thorough subgingival scaling; by moving
from quadrant to quadrant with just two different tips.
Indications for use - Oraqix ®
In adults for localised anaesthesia in periodontal pockets for diagnostic and treatment procedures
such as probing, scaling and/or root planing.
Dosage
For adults one cartridge (1.7 g) or less is sufficient for one quadrant of dentition. Maximum
recommended dose is five cartridges (8.5 g gel). Oraqix ® has not been studied in paediatric
patients.
Contra-indications:
Hypersensitivity to lidocaine, prilocaine, amide-type local anaesthetics or any excipients.
Congenital or idiopathic methaemoglobinaemia, recurrent porphyria. Precautions: Oraqix ®
must not be injected. Use with caution in patients with severe impairment of renal function,
hepatic function, impulse initiation and conduction of the heart, patients in remission from
porphyria or asymptomatic carriers of mutated genes responsible for porphyria. Patients
with glucose-6-phosphate dehydrogenase deficiency are more susceptible to drug-induced
methaemoglobinaemia. Do not apply to ulcerative lesions or during acute infections of
oral cavity.
Always read the manufacturer’s full directions for use
Indications for use - Cavitron Slimline ® inserts
All general supra and subgingival scaling applications.
Periodontal debridement for all types of periodontal diseases.
The left and right tips can be used in pockets greater than 4mm.
The straight tip can be used in pockets less than 4mm.
Contra-indications/Warnings
Should not be used for restorative dental procedures involving condensation of amalgam.
Do not use if the insert tip is worn.
Always use a LOW power setting or the Blue Zone.
Always read the manufacturer’s full directions for use
Oraqix ® , along with the use of the Slimline ® tips is
advantageous to both patient and clinician: full mouth scaling
and root planing can be carried out in just one visit; the
contra-angled left and right Slimline ® inserts provide optimal
subgingival access; there is a decrease in discomfort for the
patient; and quickness in which the treatment can be carried
out in one go.
The Slimline ® tips should angle
away from the root
Objectives
Upon completion of this guide, the clinician will be able to do
the following:
A Understand how to use Oraqix® and the benefits it gives
for SRP procedures.
B Appreciate the benefits of subgingival scaling using
Oraqix ® and Slimline ® inserts.
C Understand the method in which to use the left, right and
straight insert tips for complete mouth scaling in a quick
and easy manner.
D Recognise the need to check insert tips regularly to ensure
optimum efficiency.
Cavitron Wear Guide Business Card 27/3/07 09:45 Page 1
Example of a wear guide
Cavitron Inserts
Wear Evaluator
Are your Cavitron
inserts worn
TFI ® -1000
FSI ® -1000
30K 25K
1. Line up insert - tip must be flat against card
2. Evaluate insert shape using following guide:
Tip extends beyond blue line = Optimum efficiency
Tip touches blue line = 25% efficiency loss (replace)
Tip touches red line = 50% efficiency loss (discard)
TFI ® -10 FSI ® -SLI-S FSI ® -100 FSI ® -10
Inserts will last approximately 8-15 months depending on the type of tip
and hours used. Periodically check Inserts for wear with the Cavitron
Insert Efficiency Indicator.
Note: Not to scale

What is scaling and root planing
Scaling is a procedure that meticulously removes contamination
toxins, micro-organisms, plaque, tartar, cementum, dentin that is
rough and/or permeated by calculus from around, below and
under the gum line down to the bottom of the pocket. This is done
to remove biofilm, calculus, and toxin down to the bottom of each
periodontal pocket in order to obtain a healing response.
Root planing involves smoothing the root surfaces of teeth with
thin curettes so gum tissue can more firmly re-attach to roots that
are clean and smooth to prevent tooth loss and sensitivity
problems. The procedure makes it more difficult for plaque to
accumulate along the root surfaces.
Application of periodontal local anaesthetic gel
1 Place a new blunt-tipped applicator
onto the dispenser.
2 Fill the dispenser barrel with a new
cartridge of Oraqix ® .
3 Ensure the internal-ratchet mechanism is
reset by pressing the re-set mechanism.
4 Assemble the body and tip of the
dispenser together.
7 Note: Because of its thermosetting
properties, it is important to apply
Oraqix ® beginning at the base of the
pocket. This will prevent Oraqix ® from
setting to a gel before it reaches the
depth of the pocket.
5 Apply with the blunt-tip applicator first
at the gingival margin.
6 Wait 30 seconds, then using the applicator
tip like a probe, go to the depth of the
pocket and fill the pocket with Oraqix ® .
7 Wait another 30 seconds, then begin
scaling and/or root planing.
8 The applicator tip can be bent using
the cap to improve access to the
periodontal pockets.
Subgingival scaling using the Cavitron Slimline ® inserts
1 The left, straight and right inserts should
be used as a set.
2 Turn power level control to the low
power setting or the Blue Zone.
3 Place the insert into the handpiece
remembering to ensure that there is a
steady flow of water through the
handpiece as the insert is slotted in.
4 Using light pressure with a pen or
modified pen grasp, adapt the insert
tip so the point is not directed into the
root surface. Using the left Slimline ®
insert, start at the lower right buccal.
5 Move onto the lower left lingual.
6 Move up to the upper right palatal. 7 And finally the upper left buccal. 8 Using the right Slimline ® insert start at
the lower left buccal.
9 Move to the lower right lingual.
10 Move up to the upper right buccal. 11 Finally the upper left palatal. 12 The straight Slimline ® tip can be
used for light calculus removal and
deplaquing of pockets which are
less than 4mm.

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6. How long after applying Oraqix ®
1. On average, how long does Oraqix ®
D All of the above give anaesthesia
should you wait before scaling
A 30 seconds B 10 minutes
A 10 seconds B 30 seconds
C 20 minutes D 30 minutes
C 10 minutes D 30 minutes
2. The benefits of Oraqix ® are:
A A more comfortable scaling procedure
7. The Cavitron Slimline® insert tips are
% slimmer than traditional tips
for the patient
A 10% B 20%
B Full mouth scaling and root planing in one visit C 30% D 40%
C A faster treatment time
D All of the above
3. Can Oraqix ® be used when
8. Cavitron Slimline® tips should only
be used in a…
A High power setting B Low power setting
ultrasonic scaling
A Yes
B No
9. The right Slimline® insert is used for
subgingival scaling in the:
4. What is the maximum number of
A Lower left buccal B Lower right lingual
Oraqix ® cartridges to be used on
C Upper right buccal D Upper left palatal
any 1 patient
E All of the above
A 1 B 3
C 4 D 5
10. The right and left Slimline® insert
tips an be used in pockets …than
5. What are the contra-indications
for Oraqix ®
4mm
A Greater B Less
A Hypersensitivity to lidocaine and/or prilocaine
11. Insert tips need to be checked
B Hypersensitivity to amide-type local
periodically to ensure their
anaesthetics
efficiency:
C Congenital or idiopathic
methaemoglobinaemia
A True B False
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Prescribing information
ORAQIX ® 25/25 mg per g periodontal gel: Lidocaine, Prilocaine.
Prescribing information
for ORAQIX ® 25/25 mg per g periodontal gel: Lidocaine,
Prilocaine.
PRESENTATION:
Clear, colourless gel with 1g containing 25mg lidocaine and
25mg prilocaine.
USES: Indicated in adults for localised anaesthesia in
periodontal pockets for diagnostic and treatment procedures
such as probing, scaling and/or root planing in adults.
DOSAGE AND ADMINISTRATION:
For adults one cartridge (1.7 g) or less is sufficient for one
quadrant of dentition. Maximum recommended dose is
five cartridges (8.5 g gel). Oraqix ® has not been studied
in paediatric patients. Apply with metric dental syringe or
Oraqix ® Dispenser. Fill the periodontal pockets with Oraqix ®
until the gel becomes visible at the gingival margin. Wait 30
sec before starting treatment.
CONTRAINDICATIONS, PRECAUTIONS,
WARNINGS ETC:
Contraindications:
Hypersensitivity to lidocaine, prilocaine, amide-type local
anaesthetics or any excipients. Congenital or idiopathic
methaemoglobinaemia, recurrent porphyria.
Precautions:
Oraqix ® must not be injected. Use with caution in patients with
severe impairment of renal function, hepatic function, impulse
initiation and conduction of the heart, patients in remission
from porphyria or asymptomatic carriers of mutated genes
responsible for porphyria. Patients with glucose-6-phosphate
dehydrogenase deficiency are more susceptible to druginduced
methaemoglobinaemia. Do not apply to ulcerative
lesions or during acute infections of oral cavity.
Side-effects:
Headache, local pain, soreness, numbness, ulcer, irritation,
redness, reaction, taste perversion, dizziness, pulsation,
vesicles, oedema, burning, nausea. Allergic reactions.
Methaemoglobinaemia, consider giving slow i.v. injection of
methylene blue.
Pregnancy:
Avoid use in pregnancy.
Interactions:
With sulphonamides. Observe caution in combination with
other local anaesthetics or agents structurally related to amidetype
local anaesthetics.
PRECAUTIONS: Do not freeze.
PACKAGE QUANTITIES:
Box of 20 cartridges and 20 dental applicators.
LEGAL CATEGORY: POM.
PRODUCT LICENCE NUMBER: 18344
DATE OF PREPARATION:
April 2007
FOR FURTHER INFORMATION CONTACT THE
PRODUCT LICENCE HOLDER:
DENTSPLY Ltd Hamm Moor Lane, Addlestone, Weybridge,
Surrey, KT15 25E, England
Adverse events should be reported to DENTSPLY Ltd
or the MHRA.
More information can be found at: www.yellowcard.gov.uk
G1459
Telephone +44(0)1932 853422 I Or visit www.dentsply.co.uk
DENTSPLY Limited I Hamm Moor Lane I Addlestone I Weybridge I Surrey KT15 2SE