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Scaling and root planing (deep cleaning) is a restorative dental procedure involving the removal of plaque and calculus (tartar) stuck above and below the gumline. The procedure is necessary after a patient’s gums, bones, and surrounding tissues become damaged due to periodontal disease (periodontitis).
Periodontitis, also called periodontal disease, is a severe inflammatory disease that affects the gums, bones, and surrounding tissues in the oral cavity.
Periodontitis is initiated by the long-term buildup of dental plaque and calculus.
When teeth aren’t cleaned properly at home twice a day, and professionally at least twice a year by a dental professional, plaque is not removed completely. Over time, the plaque hardens into tartar and bacteria spread to the gums. This process leads to gingivitis (early gum disease) and eventually periodontitis.
When the gums become irritated, they separate from the teeth and deep spaces form. These spaces are called “periodontal pockets.” The tartar is typically located beneath the gums (subgingival), on the base of teeth, between the gums, and on the roots of teeth.
The most common risk factors associated with periodontitis include:
Symptoms of periodontitis range from mild to extreme and can include:
Scaling and root planing involves the removal of plaque, hardened tartar (calculus), and stains from a patient’s teeth and roots. The cost of scaling and root planing (deep cleanings) depends on the dentist’s location and whether or not the patient has insurance.
Your dentist typically separates the procedure into two appointments. During the first appointment, they clean the upper and lower quadrants of one side of your mouth. Then the other two quadrants are cleaned in the second appointment.
The cost of the procedure averages between $140 and $300 (per quadrant).
Scaling and root planing procedure steps typically include:
Scaling and root planing requires the administration of local anesthesia, also referred to as a membrane-stabilizing drug, to help control pain and hemorrhage. Local anesthesia is the most common type of anesthesia used during minorly invasive dental procedures.
Firstly, your dentist injects the drug into your mouth and numbs the treated area. Then, after about five minutes, a temporary loss of sensation occurs. You'll remain awake and conscious during the entire procedure but will not feel any pain. You might feel tenderness at the injection site during and after treatment.
The second step in the procedure is performing subgingival scaling, which is when a general dentist, periodontist, or dental hygienist removes plaque and calculus beneath the gums, between the gums, and on the base of teeth crowns. Scaling is either done manually or with an ultrasonic instrument, such as a Calvitron. Both techniques loosen plaque and remove hardened tartar.
To remove plaque and bacteria, the scaler is placed in the pocket with the bevel at an angle between 45 and 90 degrees to the tooth. The teeth and root surfaces are then scraped and cleaned in a vertical, circular, or horizontal motion.
Dentin, cementum, enamel, and dental pulp are the four main components of teeth. As periodontitis persists, the disease typically damages the cementum, dentin, or both. Root planing is an attempt to smooth rough surfaces and remove any subgingival bacteria.
During the procedure, a dentist cleans deep below the gums to remove plaque and tartar buildup on the roots of teeth where the bones are affected by the infection. Planing involves the complete removal of cementum, which is the calcified film that covers a tooth’s root. The procedure may also involve the removal of a small superficial layer of dentin, which is the second layer of teeth that develops below the enamel.
After the procedure is complete, your dentist flushes the area to remove any remaining bacteria. Then they apply digital pressure to ensure proper tissue adaptation if the area has been disrupted.
Patients typically experience minor pain after the procedure. Properly healed gums appear as well-adapted, firm, and normally shaped tissue.
Common symptoms after treatment typically resolve within a few days and may include:
Practicing good oral hygiene is necessary to prevent the development of chronic periodontitis. Periodontitis is the most serious form of gum disease that results in permanent bone loss that cannot grow back. Severe periodontitis also typically requires invasive surgery.
To prevent the need for surgery, it is crucial to practice good oral hygiene at home. These habits include brushing twice a day with fluoride, flossing, and rinsing with mouthwash.
Follow-up appointments are also necessary a few weeks after treatment. This is when dentists examine the healing gums and ensure the periodontal pockets have decreased in size. If the pockets are deeper than 3mm, another procedure may be needed.
Cohen, Edward S. Atlas of Cosmetic and Reconstructive Periodontal Surgery. Peoples Medical Publishing House, 2009.
Hollins, Carole. Basic Guide to Dental Procedures. John Wiley & Sons, Inc., 2015.
“Periodontitis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 6 Mar. 2018, www.mayoclinic.org/diseases-conditions/periodontitis/symptoms-causes/syc-20354473.
Syrbu, John DDS. The Complete Pre-Dental Guide to Modern Dentistry. 2013.