Teeth Scaling and Root Planing

Teeth scaling and root planning are dental treatments for plaque and tartar (calculus) buildup above and below the gumline. It is also known as deep cleaning. The buildup of these substances occurs in advanced gum disease or chronic periodontal disease (periodontitis). It causes the gums to pull away from surrounding structures, leading to tooth and bone loss.

Teeth scaling and root planning is a standard dental procedure that is a highly effective approach to periodontitis, improving the health of both teeth and gums.

This article provides a quick overview of periodontal disease, how teeth scaling and root planning work, as well as what you can expect when you get treatment.

When Is Teeth Scaling and Root Planing Needed?

Primarily, teeth scaling and root planing procedures remove tartar and plaque buildup from chronic periodontal disease. The techniques can get below the gumline to the roots of teeth, making them essential for taking on this common cause of dental issues.

Consequences of Chronic Periodontal Disease

Chronic periodontal disease is an advanced bacterial infection of the gums or gingivitis. The latter is reversible, but the former can only be slowed with more extensive treatment. This condition is very common. About half of the adults in the United States have some form of the condition, with 8.5{fc1509ea675b3874d16a3203a98b9a1bd8da61315181db431b4a7ea1394b614e} experiencing severe periodontal disease.

When it’s allowed to progress, the condition is a leading cause of tooth decay, loosening, and loss. Chronic periodontal disease can also cause weakening and deterioration of the thick layer that surrounds and anchors the teeth (alveolar bone).

Causes of Periodontal Disease

Gingivitis and periodontal disease are caused by a buildup of a thin film of bacterial matter that sticks to your teeth called plaque. This can not only turn into a hard substance called tartar, but it also causes inflammation and infection of the gums. This causes spaces or pockets to form between the gums and the tooth and bone. Plaque can build up in these spaces below the gums and at the root of teeth.

Several risk factors are known to lead to chronic periodontal disease, including:

• Poor oral hygiene: Insufficient or improper tooth brushing and not flossing allows plaque to build up on the teeth.
• Tobacco: Smoking or chewing tobacco can severely affect tooth health and increases the chances of plaque and tartar formation. It also affects the health of the gums.
• Dietary habits: Consuming foods and beverages that are high in sugar can also contribute to plaque formation.
• Some medications: Certain prescribed medications for conditions like high blood pressure, heart disease, other heart conditions, seizures, or autoimmune diseases can also affect dental health.
• Crooked teeth: Irregular alignment of teeth can make some spaces harder to reach with brushing and flossing. Inadequate cleaning can allow plaque to form.
• Diabetes: Diabetes has been identified as a significant risk factor for chronic periodontal disease.
• Genetics: People with a family history of gum disease are more likely to develop it.  

Symptoms of Periodontal Disease

Periodontal disease is a significant dental issue that is characterized by:

• Swelling and/or bleeding in the gums
• Halitosis (chronic bad breath)
• Soreness and tenderness in the gums
• Painful chewing
• Sensitivity in the teeth
• Pus or discharges from the gums
• Tooth loosening and loss  

What Happens During Teeth Scaling and Root Planing

Teeth scaling and root planing is a standard dental treatment that can be performed by a general dentist or a gum specialist (periodontist). Depending on the severity of the tartar and plaque build-up, you may need to have multiple appointments. During the first appointment, the dentist focuses on removing plaque, tartar, and stains in a specific quadrant(s). At subsequent appointments, they will work on the rest of the remaining quadrant(s).

Here’s a breakdown of what you can expect during the procedure:

• Local anesthetic: Since this procedure involves work below the gumline, you’ll be given a local anesthetic (Novacaine) to make sure you do not feel pain. You’ll feel a pinch when the medicine is injected, but within five minutes, your mouth will be numb.
• Scaling: Using either manual tools or ultrasonic instruments, the dentist will scrape or remove plaque and tartar buildup from the teeth. They will focus on areas below the gum line, between the gum and the tooth, as well as at the root of the tooth.  
• Root planing: This procedure removes plaque and tartar buildup and infection where the teeth and bones meet. Following the removal of bacterial buildup at these sites, the cementum layer of teeth that coats their roots is removed. Dentin, portions of the layer of the tooth just beneath the outer shell (enamel), may also need to be taken out.
• Recovery: After the treatment, the dentist or periodontist fully cleans the area with an antibacterial solution and applies pressure to promote healing. You may feel discomfort or tenderness after teeth scaling and root planing.

 What Are the Risks and Benefits of Teeth Scaling?

Generally speaking, the risks of not having teeth scaling and root planing outweigh the risks of the procedure. There are some possible side effects, but the treatment is usually well-tolerated and highly successful at restoring oral health.

Benefits of Teeth Scaling

Chronic periodontal disease is progressive so it gets worse if it isn’t treated. Teeth scaling gets at the root causes of the condition by removing the tartar and plaque that brushing, flossing, or even other dental treatments cannot. This procedure has several benefits:

• Treating disease progression: When followed up with good oral health habits, this therapy allows gum tissue to reattach to the tooth, slowing or stopping the progression of periodontitis.
• Oral health: Treating periodontitis improves oral health, prevents tooth and bone loss, and improves stability while also promoting overall gum health.
• Attractive smile: Teeth scaling removes tartar build-up and stains on the teeth, which improves the appearance of your smile.
• Overall health: Poor gum health has been linked to heart disease, Alzheimer’s disease, and certain cancers. Studies have found that the bacteria that cause periodontal disease can be inhaled, contributing to lung infections (pneumonia).

What to Expect After Teeth Scaling and Root Planing

Teeth scaling and root planing involve significant work below the gumline and between the gums and surrounding tooth or bone. There can be side effects but they will generally get better within two to three days. Possible side effects of tooth scaling and root planing include:

• Bleeding or irritation in the gums
• Swelling in the gums around treated teeth
• Tooth sensitivity to temperature, sweet foods
• Aches, tenderness, or mild pain

To help with discomfort, your dentist or periodontist may recommend over-the-counter (OTC) pain medications, such as Motrin or aspirin.

You might be prescribed antibiotics or an antibacterial mouthwash to help prevent infection after the treatment. To help your gums heal, you might be asked to swish with a solution of warm salt water throughout the day.

Keeping up with good oral health practices is key for the success of teeth scaling and root planing. Here are some important things to keep in mind:

• Follow-up: Generally, you will need to have a follow-up appointment one to two weeks after the treatment. At this appointment, your dentist will see how your gums are healing and whether the pockets have started to shrink.
• Dental care: You and your dentist or periodontist will figure out a plan for regular dental cleanings to prevent periodontitis from returning.
• Brushing properly: Make sure you are brushing twice a day for at least two minutes. Consider using an electric toothbrush. If using a manual toothbrush, replace it regularly.
• Flossing: Flossing gets at plaque and food buildup between teeth that brushing can miss. Make sure to floss once a day.
• Fluoride toothpaste: Your dentist may recommend that you use fluoride toothpaste which can help promote the health of tooth enamel.
• Mouthwash: You might be prescribed special mouthwash or your provider may recommend you use OTC rinses. Use the product as they recommended to combat plaque formation.

When to Call the Dentist

Some tooth sensitivity, bleeding, and gum tenderness, and other side effects are expected in the days following treatment. However, call your dentist or periodontist if you experience:

• Continued bleeding after 48 to 72 hours
• Lingering tooth sensitivity after a week of healing
• Pain and other side effects get worse after three days

Summary

Teeth scaling and root planing are procedures that treat chronic periodontal disease, an advanced form of gum disease. Performed with a local anesthetic, a dentist or periodontist uses tools to remove plaque and tartar buildup below the gumline and at the roots of teeth.

It is a well-tolerated, standard treatment, but keeping up with positive oral hygiene habits after the treatment and going to follow-up appointments is key to preserving the health of your teeth and gums.

A Word from Verywell

Dental treatments like teeth scaling and root planing are essential for preserving the health and appearance of your smile. By stopping the progression of periodontal disease, the treatment works to prevent tooth and bone loss. This can help prevent the need for more extensive surgery later on. When it comes to your oral health, it’s important to be proactive. If you’re experiencing symptoms of gum disease, get dental care as soon as you can.