Scaling and root planing: a deep cleaning for gum disease

What is scaling and root planing?

Scaling and root planing is a nonsurgical deep cleaning for gum disease. Scaling removes plaque and tartar from the teeth and roots, down to the bottom of each gum pocket. Root planing then smooths the root surfaces, so the gums can heal and fit more snugly against the teeth.

It is usually recommended when an exam finds periodontitis. The typical reasons are pockets of 4 millimeters or deeper that bleed when measured, tartar below the gumline, and bone loss on X-rays. Your stage of gum disease and the number of teeth involved shape how much cleaning you need.

The goal is to take away what feeds the infection. With the roots clean and smooth, inflammation usually settles, the gums tighten and pockets often get shallower.

How is a deep cleaning different from a regular cleaning?

A regular cleaning is prevention for healthy gums or mild gingivitis. It cleans the teeth above the gumline and just below it. A deep cleaning treats periodontitis by reaching down the root to the bottom of each pocket, which is why it takes longer and usually needs numbing.

The two treat different problems. A regular cleaning in a mouth with deep pockets would leave behind the tartar that keeps the disease going.

If you doubt that you need a deep cleaning, ask to see your gum chart. The pocket numbers and bleeding points show which teeth need it, and many people need it in only some areas.

What happens during a deep cleaning?

First, the area is numbed with a local anesthetic, much like for a filling. Tartar is then removed with an ultrasonic scaler, which uses vibration and water, and with thin hand instruments. Finally, the roots are smoothed. You may feel pressure and hear the scaler, but the numbing should keep it from hurting.

At Perio One, the cleaning can be guided by a periodontal endoscope: a tiny camera, 1 mm across, that fits gently below the gums and magnifies the root surface 24–48 times. A traditional deep cleaning relies on touch alone; the endoscope lets the clinician see the tartar being removed. Studies comparing the two have found more tartar removed and better healing with the endoscope.

The mouth is usually treated in sections, such as one side or one quarter at a time. That keeps each visit shorter and leaves you a side to chew on. Each visit often takes an hour or two, depending on how many teeth are treated.

In some pockets, a small amount of antibiotic may be placed after cleaning, or you may be given a medicated rinse. These add to the cleaning; they don't replace it.

If dental work makes you nervous, tell us at the start. Knowing what each step will feel like often makes it easier.

How will your mouth feel afterward?

Expect your gums to feel tender for a few days, and your teeth may be sensitive to cold for a few days or weeks. Some bleeding when you brush is normal at first. Most people go back to work and their usual routine the same day.

Your gums keep changing over the next few weeks. As the swelling goes down, they tighten and may sit a little lower on the teeth. Bleeding usually lessens as they heal.

Daily cleaning protects the result. A steady cleaning routine at home keeps plaque from building up again in the healing pockets.

• Wait until the numbness wears off before you eat, so you don't bite your cheek or tongue.
• Choose soft foods for a day or two if your gums are sore, and skip very hot, spicy or crunchy foods.
• Keep brushing gently and cleaning between your teeth, even if your gums bleed a little.
• Rinse with warm salt water if it soothes your gums.
• Take an over-the-counter pain reliever only if you need one and it is safe for you.
• Avoid tobacco, which slows healing.

Are there risks or side effects?

Scaling and root planing is a low-risk treatment, and its side effects are usually short-lived. The most common are tenderness, bleeding and sensitivity to cold. Gums can also look like they have receded once the swelling goes down.

That gum change is not damage from the cleaning. The swelling had been hiding gum and bone loss that was already there. You may notice more of the roots, or small gaps between teeth near the gumline.

Less often, an area becomes infected, or a tooth feels slightly loose until the gums firm up. Call us right away if swelling spreads or keeps worsening, or if you get a fever or bleeding that firm pressure won't stop. If symptoms are severe, or swallowing or breathing is difficult, go to an emergency room or call 911. Tell us about your health conditions and medicines, including blood thinners, since some affect how treatment is planned.

Leaving periodontitis untreated carries the bigger risk, because pockets and bone loss tend to worsen. Some patients ask about laser gum treatment for pockets that stay deep afterward. Cleaning the roots is still part of that approach, and of surgery too.

What happens after your deep cleaning?

A few weeks to about two months later, you come back for a re-evaluation. Your pockets are measured again and checked for bleeding. The results show which areas have healed and which, if any, need more care.

If your pockets have shrunk and stopped bleeding, you move on to periodontal maintenance. These visits clean below the gumline and recheck your pockets, and they usually come more often than routine cleanings.

If some pockets stay deep, the next step depends on where they are and how deep they remain. Options include cleaning that area again or periodontal surgery to reach roots that a cleaning can't.

Many people need a deep cleaning only once, as long as maintenance and home care keep the disease in check. If it becomes active again, some areas may need another round.

What affects the cost of scaling and root planing?

The cost depends mainly on how many areas of your mouth need deep cleaning. A plan for one or two sections costs less than a plan for all four. Your exam decides that, so any figure given before your gums are measured is only an estimate.

Ask for the cost of each part of the plan before you start. Deep cleaning at this stage is usually simpler, and less costly, than the care that advanced disease can require.

• How many sections of the mouth are treated, and how many teeth in each
• Whether new X-rays or a full gum exam are needed first
• Whether medicine is placed in any pockets
• The re-evaluation visit and the maintenance visits that follow
• What your dental plan covers, since plans differ in how they handle deep cleaning

Care at Perio One

At Perio One, scaling and root planing is recommended only after an examination shows it is needed. Dr. Randal Comeaux, DDS, Diplomate of the American Board of Periodontology, reviews your pocket measurements and X-rays with you in plain language.

You will see which teeth need deep cleaning and why, before any treatment is scheduled. Referrals from dentists in and around Lafayette are welcome, and we coordinate with your general dentist before and after treatment.

Once the re-evaluation shows your gums have healed, our periodontal maintenance program helps Dr. Comeaux follow your pockets over time.

What to expect

1. Exam and measurements

   Your gums are measured, your X-rays are reviewed, and the areas that need deep cleaning are marked on your chart.

2. Numbing

   Each section is numbed with a local anesthetic before cleaning begins.

3. Cleaning and smoothing

   Tartar is removed from the roots, and then the roots are smoothed. Each visit covers one or more sections of the mouth.

4. Healing at home

   Soreness settles over a few days. Keep brushing gently and cleaning between your teeth.

5. Re-evaluation

   A few weeks to about two months later, your pockets are measured again to see how they responded.

6. Maintenance

   Regular maintenance visits keep the pockets clean and catch any return of the disease early.

Sources

• American Academy of Periodontology: Non-surgical treatments
• Cleveland Clinic: Scaling and root planing
• MouthHealthy (American Dental Association): Scaling and root planing

This page is general education, not a diagnosis. Your periodontist will recommend care after an examination.