Scaling and Root Planing (Treatment for Periodontal Disease)

What is Scaling and Root Planing?

Scaling and root planing is a deep cleaning of the gum tissues. It’s a common non-surgical treatment for gum disease that removes accumulated tartar or calculus (hard, calcified plaque) above and below the gumline. It can help stop gum disease (periodontal disease) from progressing.

Scaling simply removes built-up calculus, while root planing smooths the tooth roots. It helps the gums reattach to the teeth, thereby reducing gingival pocket depth.

Why is Scaling and Root Planing Important?

Harmful oral bacteria produce plaque, a sticky, clear film covering teeth. Brushing and flossing can remove plaque, but poor diet and oral hygiene allow it to remain and build up over time.

Eventually, plaque hardens and becomes calculus. The accumulation of dental calculus is a major factor in tooth decay and gum disease. It can provide an easy place for bacteria and other oral microbes to settle and cause infections in your teeth and gums.

Scaling and root planing removes calculus from the teeth. It also smooths the rough surfaces of tooth roots so the gums can reattach. This makes it easier to practice good oral hygiene and prevent further damage to your teeth and gums.

How Effective is Scaling and Root Planing for Gum Disease?

One review looked at routine periodontal scaling and polishing (not including root planing) and found that it had little efficacy in preventing gingivitis.⁴

However, thorough scaling and root planing is a careful, challenging, and meticulous procedure.1 It’s more in-depth than a routine cleaning.

Scaling and root planing has been shown to be effective at reducing gum pocket depth, which is an important indicator of gum disease.⁵

The effectiveness of scaling and root planing will partly depend on the quality of your oral hygiene after the procedure is complete. Brushing, flossing, and maintaining a balanced diet will help prevent plaque and tartar from building up again.

Gum disease is also linked to systemic conditions, such as diabetes, which can play a role in determining the best treatment plan. A deep cleaning may only be part of a larger treatment plan for severe gum disease.

Who Needs Scaling and Root Planing?

Your dentist will likely recommend a deep cleaning if you show signs of gum disease. These include:

• Visible buildup of tartar over your teeth and gums (may be white, yellow, and/or brown)
• Red, swollen gums
• Gums that bleed easily
• Recessed gums that expose your tooth roots, making your teeth appear longer
• Persistent bad breath

In more advanced gum disease, teeth may feel loose. This is due to attachment loss, in which your teeth lose the connective tissue that holds their roots in place.

Deep Gum Pockets

Another sign of more advanced gum disease is increased space between your teeth and gums. These spaces are referred to as periodontal pockets. People with gum disease have deeper periodontal pockets than people with healthy gums.

These deeper pockets indicate the need for a deep cleaning, in which your dentist will clean these spaces to allow your gum tissue to heal. For severe periodontal disease, scaling and root planing may be considered the first step in a more extensive course of treatment.

What Happens During Scaling and Root Planing?

Scaling and root planing are two separate procedures that are done together to treat gum disease:

• Periodontal scaling is the removal of built-up tartar from your teeth and gums
• Root planing treats your tooth root surfaces to achieve a smooth finish, which makes it less likely for plaque and calculus to reaccumulate 

The entire deep cleaning process will involve the following:

1. Your dental professional, either a dentist or hygienist, will administer local anesthesia to prevent discomfort
2. Your dental professional will perform scaling and root planing, using special dental instruments to remove tartar above and below your gumline
3. After scaling and root planing, your dental professional may flush or irrigate your mouth with an antibacterial solution (such as chlorhexidine) to further cleanse the area 
4. Finally, your dental professional may place local antibiotics within the periodontal pockets

The entire cleaning may take place in multiple sessions, one for each half or quarter of your mouth. One reason is that your dentist wants to ensure you’re adequately numbed. 

Numbing your entire mouth for one session could cause trouble eating, swallowing, and talking. In addition, completing a full mouth scaling and root planing can result in significant discomfort afterward. 

Another reason deep cleaning requires multiple appointments is because ample time is needed to ensure all areas of gum disease, including tartar and plaque removal, are treated. A lighter cleaning may not take as long but won’t be as effective.¹

Types of Dental Scaling Tools 

Dentists use special tools for scaling and root planing. Periodontal treatment instruments, including the sickle scalers and periodontal curettes, are used for hand instrumentation. 

Ultrasonic instruments utilize sonic vibrations of water to remove tartar and make the cleaning easier and more efficient.  

What to Expect After the Procedure

While deep cleaning may require multiple appointments, recovery shouldn’t be too intense. You may notice the following during the first few hours or days after treatment:

• Mild pain in the area that was cleaned
• Tooth sensitivity, especially to hot and cold
• Gums that bleed easily during toothbrushing

Your dentist will give you recovery instructions. Take it easy on your teeth and gums by:

• Avoiding foods that require a lot of chewing
• Avoiding very hot or cold food and drinks
• Using a desensitizing toothpaste

Long-term, you’ll need good oral hygiene to maintain the benefits of deep cleaning.

A deep cleaning may require several sessions and may be part of a larger treatment plan. With that in mind, follow your dentist’s instructions and keep your follow-up appointments.

Benefits and Risks of Scaling and Root Planing

Scaling and root planing can help treat gum disease and improve oral health. It also has some potential downsides, most of which are temporary.

Benefits

Benefits of scaling and root planing may include:

• Reduced gum pocket depth
• Lower risk of advanced gum disease (also known as periodontitis)
• Lower risk of tooth decay
• Elimination of bad breath 

Risks

For the first few days following the procedure, you may experience pain, sensitivity, and gum bleeding while brushing. These should go away quickly.

However, there are two other risks to scaling and root planing.

One is that bacteria may be introduced into your gums and bloodstream, causing an infection. Your dentist may prescribe antibiotics to help prevent this if you have certain medical conditions.

The other risk is that root planing may remove more of the surface of your tooth roots (cementum) than necessary.^{2, 3} 

Other Treatments for Gum Disease

Advanced gum disease may require more than deep cleaning. Surgery may be needed to restore gum health and prevent tooth loss.

There are also alternative methods of deep cleaning to avoid unnecessary damage to your tooth roots. For example, full-mouth debridement with an ultrasonic scaler may be able to remove tartar below the gumline without removing an excessive amount of root tissue.⁶

Talk to your dentist or periodontist about what your options are. They may prefer certain treatments over others based on your oral health needs.

Summary

Scaling and root planing is a common non-surgical treatment for gum disease. It’s also referred to as deep cleaning.

Periodontal scaling removes tartar from your teeth and gums, while root planing smooths the surface of your tooth roots.

Your dentist may recommend scaling and root planing if you show signs of gum disease. However, it may be the first part of a more extensive treatment plan.