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 from progressing.

Scaling on its own simply removes built-up calculus. Root planing is a careful smoothing of your tooth roots to prevent plaque and calculus from reaccumulating.

Signs You Need Scaling and Root Planing

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

• Visible buildup of white, yellow, and/or brown tartar over your teeth and gums
• 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, which causes your teeth to become less firmly rooted in place.

Deep Gum Pockets

Another sign of more advanced gum disease is an increase in the 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 give rise to the term deep cleaning, in which your dentist will clean these spaces to allow your gum tissue to heal. For severe gum 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:

• Scaling is the removal of built-up tartar from your teeth and gums
• Root planing is the smoothing of your tooth roots 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 dentist will administer local anesthesia to prevent discomfort
2. Your dentist will perform scaling and root planing, using special tools to remove tartar above and below your gumline
3. After scaling and root planing, your dentist may flush your mouth with an antibacterialsolution (such as chlorhexidine) to further cleanse the area 
4. Finally, your dentist 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 for this is that your dentist will want to ensure you’re adequately numbed. 

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

Another reason is that deep cleaning requires the patient, skilled, and careful use of dental tools. 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 scalers have narrow ends, which makes them useful for removing tartar above the gumline (they generally aren’t used below the gumline, as this could damage the gums)
• Periodontal curettes have blunt ends and can be used both above and below the gumline

These tools may be sonic or ultrasonic, allowing the tips to vibrate to make cleaning easier and more efficient.

Recovery and Follow-Up

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 to have good oral hygiene in order to maintain the benefits of deep cleaning.

Deep cleaning may require several sessions and may be part of a larger treatment plan. With that in mind, be sure to follow your dentist’s instructions and keep your appointments.

How Effective is Scaling and Root Planing for Gum Disease?

One review looked at routine scaling and polishing (not including root planing) and found that it had little efficacy in preventing gingivitis.²

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.³

The effectiveness of deep cleaning 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. Deep cleaning may only be part of a larger treatment plan for severe gum disease.

Benefits and Risks of Scaling and Root Planing

Scaling and root planing can help treat gum disease and improve your 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
• Lower risk of tooth decay
• Elimination of bad breath 

Risks

For the first few days following the procedure, you may experience some pain, sensitivity, and gum bleeding during 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.^{4, 5} 

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.

Summary

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

Scaling removes tartar from your teeth and gums, while root planing smoothes the surface of your tooth roots.

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