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Scaling and Root Planing (Treatment for Periodontal Disease)

Alyssa Hill Headshot
Written by
Alyssa Hill
Medically Reviewed by 
Dr. Lara Coseo
6 Sources Cited

Scaling and Root Planing Procedure

Scaling and root planing is a deep teeth cleaning. It's considered a restorative dental procedure. The dentist removes plaque and calculus (tartar) above and below the gumline.

The procedure is recommended if you have periodontal disease (periodontitis).

The cost of treatment depends on the dentist’s location and if you have insurance. However, it averages between $140 and $300 (per quadrant). There are four quadrants in the mouth.

What is Periodontal Disease?

Periodontal disease, also called periodontitis or advanced gum disease, is a severe inflammatory disease. It affects your gums, bones, and surrounding tissues.

Periodontitis is initiated by the long-term buildup of plaque and calculus located:

  • Beneath the gums (subgingival)
  • On the base of teeth
  • Between the gums
  • On the roots of teeth

How Periodontitis Forms

Dental plaque accumulates when you neglect oral hygiene. Brushing twice a day and flossing at least once a day can help prevent plaque.

Routine teeth cleanings are also essential. Dental hygienists use special tools to clean your teeth. They are able to remove plaque that can't be removed with a normal toothbrush.

Unremoved plaque hardens into tartar. Bacteria accumulate and spread to the gums, causing inflammation.

Gingivitis (early gum disease) forms as a result. Fortunately, this type of gum disease is reversible with professional teeth cleanings in its early stages.

If gingivitis is left untreated, periodontitis will develop with time. It's a severe type of gum disease that can't be reversed (only slowed down).

As the gums become more irritated, they separate from the teeth, Deep spaces called periodontal pockets are formed.

Plaque and tartar move into these spaces, leading to symptoms like:

  • Swollen/bleeding gums
  • Bad breath
  • Pus
  • Loose teeth

These are indicators of periodontitis.

Untreated periodontitis can lead to tooth loss. This is why prompt treatment (scaling and root planing) is necessary.

Summary

Scaling and root planing restores oral health and prevents advanced gum disease from worsening. The procedure removes plaque and calculus above and below the gumline.

Risk Factors & Symptoms of Periodontal Disease

Risk Factors for Periodontitis:

  • Poor brushing and flossing habits, which leads to plaque and tartar buildup
  • Smoking or chewing tobacco long-term
  • Poor nutrition, such as eating sugary foods and drinks often
  • Some blood pressure, heart disease, cardiovascular, bacterial pneumonia, seizure, or immunosuppressant medications
  • Crooked teeth, which makes the plaque and calculus more difficult to remove
  • Family history of periodontitis
  • Long-term stress, which causes inflammation

Symptoms of Periodontitis

  • Red and swollen gums
  • Inflammation below or around the gums
  • Gums that bleed on probing (such as flossing)
  • Loose teeth or gums that pull away from the teeth
  • Bad breath, even after brushing
  • Pus between the teeth and gums
  • Sudden teeth misalignment or an incorrect bite

Summary

Some people are more predisposed to developing periodontitis than others. If you start noticing symptoms, schedule a dentist visit immediately.

Scaling and Root Planing Procedure: Step-By-Step

Scaling and root planing removes plaque, hardened tartar (calculus), and stains from the teeth and roots.

This procedure is typically separated into two appointments. During the first appointment the upper and lower quadrants on one side of your mouth are cleaned. The other two quadrants are cleaned in the second appointment.

Scaling and root planing consists of the following steps:

1. Local Anesthesia Administration

Scaling and root planing requires local anesthesia. This is a membrane-stabilizing drug that controls pain and helps prevent hemorrhaging.

Local anesthesia is the most common type of anesthesia used in minorly invasive dental procedures.

A dentist injects the drug into the mouth and numbs the treated area. After about five minutes, you'll feel a temporary loss of sensation.

You'll remain awake and conscious during the procedure but won't feel any pain. You might feel some tenderness at the injection site during and after treatment.

2. Scaling

The second step in the procedure is subgingival scaling.

This is when a general dentist, periodontist, or dental hygienist removes plaque and calculus:

  • Beneath the gums
  • Between the gums
  • On the base of tooth crowns
  • Around the tooth roots

Scaling is either done manually or with an ultrasonic instrument, such as a Calvitron. Both techniques effectively remove plaque and hardened tartar.

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 scraped and cleaned in a vertical, circular, or horizontal motion.

3. Root Planing

Dentin, cementum, enamel, and dental pulp are the four main components of teeth.

As periodontitis persists, the disease will damage the cementum, dentin, or both. Root planing is an attempt to smooth rough surfaces and remove the subgingival bacteria.

During root planing, the 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 completely removes the cementum, the calcified film covering a tooth’s root.

The procedure may also involve the removal of a small superficial layer of dentin, which is the second layer of a tooth located below the enamel.

4. Post Surgery

After the procedure is complete, your dentist flushes the area to remove any remaining bacteria. Then they will apply pressure to ensure proper gum tissue growth.

You'll likely experience some discomfort after the procedure. Properly healed gums appear as well-adapted, firm, and normally shaped tissue.

Summary

Scaling and root planing typically requires two visits to your dentist's office. It's a relatively safe and painless procedure.

Side Effects of Scaling and Root Planing

The following side effects typically resolve within a few days:

  • Bleeding gums
  • Irritated gums
  • Tooth discomfort such as sensitivity to hot, cold, and sugary substances
  • Swelling and inflammation around the treated area
  • Allergies to some of the materials used during the procedure
  • Mild aching and throbbing

Aftercare Tips

Good oral hygiene is crucial for preventing chronic periodontitis.

Periodontitis is the most serious form of gum disease that causes permanent bone loss that can't grow back. Severe periodontal disease also requires invasive surgery.

To prevent the need for surgery, practice good oral care at home. This includes:

  • Brushing your teeth with a toothbrush twice a day (for two minutes at a time)
  • Using fluoride
  • Flossing at least once a day
  • Rinsing with mouthwash

Follow-up appointments are also necessary a few weeks after treatment. The dentist will examine your healing gums and ensure the periodontal pockets have decreased in size. If the pockets are deeper than 3mm, another procedure may be needed.

How Often Do You Need Scaling and Root Planing?

If you have severe periodontal disease, your dentist may recommend scaling and root planing treatment at least twice a year.

However, if your gums and teeth are healthy after the first procedure, you'll only need dental checkups twice a year. During these appointments, you'll undergo a regular teeth cleaning and exam.

Summary

Scaling and root planing can have minor side effects, normally resolving after a few days. It's important to practice good oral hygiene to prevent the recurrence of periodontal disease.

Scaling and Root Planing FAQs

Can root planing loosen teeth?

The long-term buildup of plaque and tartar below the gum line can loosen your teeth from the gum pockets.

Scaling and root planing doesn't loosen your teeth.

How long does teeth scaling take?

Teeth scaling takes one to two hours to complete. The treatment is done in one office visit.

How long does it take for gums to heal after scaling?

Your teeth and gums will heal quickly after a deep cleaning.

You may feel some discomfort for a few days post-op and tooth sensitivity may occur for up to six weeks after treatment. This is a normal part of the healing process.

Is deep cleaning the same as scaling and root planing?

Scaling and root planing is also known as a deep cleaning.

Is root planing painful?

No, not usually.

You won't feel pain because a local anesthetic is administered before the procedure. Minor discomfort and sensations after treatment are completely normal.

Is scaling and root planing necessary?

To prevent the progression of periodontal disease (advanced gum disease), scaling and root planing treatment is necessary.

Left untreated, the disease can cause tooth loss.

How long will it take my gums to heal?

Your gums should heal within one to two weeks post-op.

Last updated on April 4, 2022
6 Sources Cited
Last updated on April 4, 2022
All NewMouth content is medically reviewed and fact-checked by a licensed dentist or orthodontist to ensure the information is factual, current, and relevant.

We have strict sourcing guidelines and only cite from current scientific research, such as scholarly articles, dentistry textbooks, government agencies, and medical journals. This also includes information provided by the American Dental Association (ADA), the American Association of Orthodontics (AAO), and the American Academy of Pediatrics (AAP).
  1. Cohen, Edward S. Atlas of Cosmetic and Reconstructive Periodontal Surgery. Peoples Medical Publishing House, 2009.
  2. Hollins, Carole. Basic Guide to Dental Procedures. John Wiley & Sons, Inc., 2015.
  3. “Periodontitis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 6 Mar. 2018, www.mayoclinic.org/diseases-conditions/periodontitis/symptoms-causes/syc-20354473.
  4. Syrbu, John DDS. The Complete Pre-Dental Guide to Modern Dentistry. 2013.
  5. Yaghini, Jaber, et al. “Root Surface Roughness After Scaling and Root Planing with Er:YAG Laser Compared to Hand and Ultrasonic Instruments by Profilometry.” Journal of Dentistry (Tehran, Iran), Tehran University of Medical Sciences, Dec. 2015.
  6. Waghmare, Alka S, et al. “Bacteremia Following Scaling and Root Planing: A Clinico-Microbiological Study.” Journal of Indian Society of Periodontology, Medknow Publications & Media Pvt Ltd, Nov. 2013.
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