What Is Scaling and Root Planing?
Scaling and root planing is a non-surgical deep cleaning that removes plaque, tartar, and bacteria from tooth surfaces below the gum line. It is the standard first treatment for periodontitis. [1]
The name describes two steps. Scaling means scraping away hardened deposits (calculus or tartar) from the tooth surface, both above and below the gums. Root planing means smoothing the rough spots on the root surface where bacteria tend to collect. A smooth root surface helps the gum tissue reattach to the tooth more easily.
Your dentist or periodontist (a specialist in treating gum disease) may recommend this procedure when a regular cleaning is not enough. Regular cleanings, also called prophylaxis, focus on the tooth surfaces above the gum line and just slightly below it. Scaling and root planing goes deeper into the pockets that form between the gum and tooth when gum disease is present. [3]
The goal is to remove the source of infection so the gums can heal. Research supports the effectiveness of this approach. A systematic review and meta-analysis of 72 studies found that scaling and root planing significantly reduced pocket depths and improved clinical attachment levels compared to no treatment. [4] In many cases, scaling and root planing alone is enough to control gum disease and prevent it from worsening. Some patients with more advanced disease may need additional treatments after deep cleaning.
When Is Scaling and Root Planing Recommended?
Scaling and root planing is recommended when you have periodontal pockets measuring 4 millimeters or deeper with signs of bone loss or attachment loss. [1]
Gum disease starts as gingivitis, which is inflammation of the gums caused by plaque buildup. Gingivitis is reversible with good oral hygiene and professional cleanings. When gingivitis is not treated, it can progress to periodontitis. In periodontitis, the gums pull away from the teeth and form pockets. Bacteria settle into these pockets and cause infection that breaks down bone and connective tissue. [1]
During a periodontal exam, your dentist or hygienist uses a small probe to measure the depth of the space between your gums and teeth. Healthy gums typically have pocket depths of 1 to 3 millimeters. Pockets of 4 millimeters or more usually indicate periodontitis and signal the need for scaling and root planing rather than a standard cleaning.
- Bleeding gums during brushing, flossing, or eating
- Red, swollen, or tender gums that do not improve with better home care
- Persistent bad breath (halitosis) that does not go away
- Gum recession, where teeth appear longer than they used to
- Pocket depths of 4 mm or greater found during a periodontal exam
- Visible tartar buildup below the gum line on dental X-rays or during probing
Regular Cleaning vs. Deep Cleaning
A regular cleaning (prophylaxis) is a preventive procedure for patients with healthy gums or mild gingivitis. It removes plaque and tartar from above the gum line and slightly below it. Most adults get a regular cleaning every six months. [3]
A deep cleaning goes further. It cleans the full length of the tooth root within the periodontal pocket. It also smooths the root to discourage future bacterial growth. A deep cleaning is a therapeutic treatment for diagnosed disease, not a routine maintenance visit. This distinction matters for insurance coverage, which is discussed below.
What to Expect: Before, During, and After the Procedure
The procedure is performed in your dentist's or periodontist's office, typically over two visits with local anesthesia to keep you comfortable.
Before the Procedure
Your provider will take a full medical and dental history. Be sure to mention any medications you take, especially blood thinners, as these can affect bleeding during treatment.
A periodontal charting will be done if it has not been completed already. This records the pocket depths at six points around every tooth. X-rays will show whether bone loss has occurred. Together, these records help your provider determine how severe the disease is and plan the treatment.
If you have dental anxiety, talk to your provider ahead of time. Options may include nitrous oxide (laughing gas) or, in some cases, oral sedation to help you stay relaxed.
During the Procedure
Most scaling and root planing treatments are divided into two appointments. At each visit, one half of the mouth (two quadrants) is treated. Some providers may treat the full mouth in one visit if the disease is mild or the patient prefers it.
Local anesthetic is injected into the gums to numb the treatment area. Once you are comfortable, the hygienist or periodontist uses ultrasonic instruments and hand instruments called curettes to remove tartar deposits from the tooth roots. Ultrasonic scalers vibrate at a high frequency and spray water to break apart and flush out calculus and bacteria.
After scaling, the root surfaces are planed smooth. This step removes tiny grooves and rough patches in the root surface where bacteria can reattach. The entire process typically takes 45 minutes to an hour per side of the mouth.
In some cases, your provider may place a local antibiotic, such as a small chip or gel, directly into the deepest pockets after the cleaning. This helps kill remaining bacteria and supports healing. A 2005 systematic review of 985 patients across 28 trials found that adjunctive locally delivered antimicrobials provided a small but statistically significant additional improvement in pocket depth reduction compared to scaling and root planing alone. [5] A 2013 Cochrane review reached a similar conclusion, confirming modest additional benefits from local antimicrobials when used alongside deep cleaning. [8] Your provider will decide whether this step is appropriate based on the severity of your pockets.
Immediately After the Procedure
Your mouth will remain numb for one to three hours after the appointment. Avoid eating until the numbness wears off so you do not accidentally bite your cheek or tongue.
Some bleeding and mild discomfort are normal for the first 24 to 48 hours. Your provider may recommend an over-the-counter pain reliever such as ibuprofen. A warm salt water rinse (half a teaspoon of salt in eight ounces of warm water) several times a day can soothe the gums and promote healing.
You may be given a prescription antimicrobial mouth rinse to use for a week or two after treatment. Follow the instructions exactly as directed.
Recovery and Aftercare Timeline
Most patients recover fully within four to six weeks. Mild soreness and sensitivity are common in the first few days but improve steadily.
Day 1 to Day 3
Expect mild to moderate soreness in the gums. Some swelling and minor bleeding when brushing are normal. Teeth may feel more sensitive to hot, cold, and sweet foods.
Stick to soft foods like yogurt, scrambled eggs, soup, and mashed potatoes. Avoid spicy, crunchy, or very hot foods. Brush gently with a soft-bristled toothbrush. Do not skip brushing, as keeping the area clean supports healing.
Week 1
Soreness typically decreases noticeably by the end of the first week. Gums may appear slightly pink and less swollen. You can usually return to your normal diet within a few days, but continue to avoid hard or sharp foods that could irritate healing gums.
Continue using any prescribed mouth rinse. Resume gentle flossing as directed by your provider. A desensitizing toothpaste can help reduce tooth sensitivity during this period.
Week 4 to Week 6
By this point, gum tissue has typically tightened around the teeth. Pocket depths should begin to decrease as inflammation resolves. Your provider will schedule a follow-up appointment, usually four to six weeks after treatment, to re-measure pocket depths and evaluate healing.
Results vary from person to person. Patients who maintain good oral hygiene at home generally see the best outcomes. Smoking significantly slows healing and reduces the effectiveness of the treatment. Research consistently shows that smokers experience less pocket depth reduction after scaling and root planing compared to non-smokers. A 2005 systematic review found that smoking has a clear negative impact on non-surgical periodontal treatment outcomes. [6] A later meta-analysis by Kavval et al. quantified the difference, finding that smokers had a mean of 0.33 mm less pocket depth reduction than non-smokers. [9] If you smoke, talk to your provider about cessation resources before or during treatment. [1]
Normal Symptoms vs. Call the Office
Knowing what is normal and what warrants a phone call can ease your mind during recovery.
- Normal: Mild soreness, slight bleeding when brushing for the first few days, and increased tooth sensitivity for one to two weeks.
- Call the office: Heavy or prolonged bleeding that does not stop with gentle pressure after 20 minutes.
- Call the office: Severe pain that does not respond to over-the-counter pain medication.
- Call the office: Significant swelling, pus, or a foul taste that develops several days after treatment, which could indicate an infection.
- Call the office: Fever over 101°F (38.3°C) within a few days of the procedure.
Cost of Scaling and Root Planing
Scaling and root planing typically costs between $150 and $350 per quadrant, or roughly $600 to $1,400 for a full mouth. Costs vary by location, provider, and case complexity.
Your mouth is divided into four quadrants: upper right, upper left, lower right, and lower left. Dental offices charge per quadrant because the severity of disease can differ from one area to another. Some patients may only need treatment in two quadrants rather than all four.
Additional costs may apply for local anesthesia, antimicrobial treatments placed in pockets, or sedation if requested. Ask your provider for a detailed treatment estimate before starting.
Insurance and Financing
Most dental insurance plans cover scaling and root planing when periodontitis has been diagnosed. The procedure is classified as a therapeutic service rather than a preventive one. Coverage typically falls under your plan's basic or major services category. Many plans cover 50% to 80% of the allowed fee after the deductible, though the exact percentage depends on your specific plan. Always verify your benefits with your insurance carrier before treatment.
Check with your insurance carrier to confirm your coverage, annual maximum, and any frequency limitations. Some plans allow scaling and root planing only once per quadrant within a certain time frame, such as every 24 months.
If you do not have insurance, ask about in-office payment plans or third-party financing options. Many dental offices offer these to help spread the cost over several months. Dental schools and community health clinics may offer the procedure at reduced fees.
Should You See a Periodontist or a General Dentist?
Both general dentists and periodontists perform scaling and root planing. The right choice depends on the severity of your gum disease.
General dentists and dental hygienists handle the majority of scaling and root planing cases, especially for mild to moderate periodontitis. A general dentist is often a good starting point, particularly if you already have an established relationship and the disease is caught early.
A periodontist is a dentist who has completed an additional two to three years of specialized training in diagnosing and treating gum disease, placing dental implants, and performing gum surgery. You may benefit from seeing a periodontist in the following situations:
- Advanced periodontitis with deep pockets (typically 6 mm or greater) or significant bone loss.
- Gum disease that has not responded to initial scaling and root planing performed by a general dentist.
- Complex medical history, such as uncontrolled diabetes, immunosuppression, or use of medications that affect healing.
- Need for surgical treatment, such as flap surgery or bone grafting, in addition to deep cleaning.
- Aggressive or rapidly progressing disease, particularly in younger patients.
Ongoing Periodontal Maintenance
After scaling and root planing, you will need periodontal maintenance cleanings rather than standard prophylaxis. These are typically scheduled every three to four months. Periodontal maintenance visits include re-measuring pocket depths, removing any new tartar buildup below the gum line, and monitoring your gum health over time. [1]
Consistent maintenance is one of the most important factors in preventing gum disease from returning. A long-term retrospective study of 505 patients followed over a mean of 11 years found that patients who adhered to regular periodontal maintenance schedules had significantly fewer tooth losses than those who did not maintain their recall visits. [7] Skipping these visits allows bacteria to re-colonize the pockets and restart the cycle of tissue destruction. Your general dentist and periodontist may alternate maintenance visits to provide coordinated care.
Find a Periodontist Near You
If you have been told you need scaling and root planing, or if you are experiencing bleeding gums, gum recession, or persistent bad breath, a periodontist can evaluate your condition and recommend the right treatment plan. Visit the periodontics page on My Specialty Dentist to search for a board-certified periodontist in your area and take the next step toward healthier gums.
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