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Untreated gingivitis can evolve into periodontal disease. The fibers that support your teeth become damaged or lost, and the tooth-supporting bone becomes infected. The loss of these fibers causes the gum pockets around your teeth and gums to become deeper and collect more bacteria. These deeper pockets accumulate bacteria-rich plaque, which hardens into tartar and accelerates the progression of your disease.

Scaling and root planing is a non-surgical treatment for early to moderate periodontal disease. The dentist or hygienist will use mechanical or electric instruments to scrape tartar deposits from the surface of tooth roots where the attachment fibers connected and smooth the root surface to help make it harder for bacteria to form.

If your dentist makes a diagnosis of "generalized" periodontal disease, you may need scaling and root planing on most or all of your teeth. If the diagnosis is localized, then only the affected teeth and gums will require treatment.

Although scaling and root planing may seem similar to a professional tooth cleaning, it is fundamentally different. Scaling and root planing treats disease, while a professional tooth cleaning is a preventive procedure. Scaling and root planing is a more time-consuming procedure, frequently requires local anesthetic, and may require multiple appointments to complete. The length of time depends on the extent of your periodontal disease and other overall health factors and habits.

Scaling and root planing:

• Removes existing tartar deposits and plaque.
• Smooths root surfaces, reducing their ability to retain plaque.
• Eliminates bacteria from the pockets around your teeth, allowing the tissues to heal.
• Reduces inflammation and eliminates bleeding and swelling of your gums.
• Delays or prevents the progression of periodontal disease and helps preserve tooth-supporting bone and teeth.
• Prevents or delays the need for periodontal surgery.

Before the procedure

• Review your health status: You will share information to ensure that your dentist and their staff can provide safe and effective treatment and provide appropriate post-care guidance. Get important information here: Health history and current health status.
• Anesthesia: Your dentist or hygienist may give you a local anesthetic to reduce the discomfort associated with cleaning tooth root surfaces. Local anesthetic can also reduce the amount of bleeding that will occur during the procedure.
• Antiseptic rinse: Your dentist may ask you to swish your mouth with an antiseptic oral rinse to minimize the number of live bacteria and viruses in the mouth. This also reduces the level of potentially infectious aerosols the procedure may release into the treatment area. Rinsing can also help prevent the development of cold sores and infections after the procedure.

During the procedure

• Scaling: Your dentist or hygienist will identify deposits of tartar and rough areas of the tooth root. Then they will remove the tartar above and below the gum line.
• Root planing: After scaling, your dentist will use tools to smooth the root surfaces of the affected teeth. This will make those areas less likely to retain plaque.

After the procedure

• Before you leave your appointment, your dentist or hygienist should give you specific post-treatment and home oral care instructions to manage your situation.

Recovery and follow-up care

• When scaling and root planing is complete, you may experience some discomfort around the teeth for several days and increased sensitivity to hot, cold, or sweet foods for up to a few weeks. Over-the-counter pain medications and desensitizing toothpaste may help relieve any discomfort.
• Your dentist will generally schedule a follow-up appointment four to six weeks later to re-evaluate your periodontal disease and the effectiveness of the scaling and root planing procedure.
• At your re-evaluation, your dentist will examine your mouth for areas that have accumulated new tartar and areas with inflammation or bleeding. They may treat areas of tartar with additional localized scaling and root planing. They may also place local antibiotics in the gum pockets around teeth where inflammation exists.
• Your dentist or hygienist will discuss an effective schedule for future periodontal maintenance visits so your dentist can monitor your periodontal condition and ensure it does not worsen over time. It is important that you stick to this schedule.

Additional treatment you may need

Depending on your situation, there may be other steps or procedures needed.

• Prior to treatment, a full-mouth debridement may be necessary, so your dentist can conduct an effective examination. This is necessary when significant amounts of plaque and tartar build-up prevent your dentist from making a complete assessment of the extent of your periodontal disease. This treatment occurs in a separate appointment before the scaling and root planing procedure.
• A local antibiotic may be used to help eliminate the bacteria in your gum pockets and reduce inflammation. This service may be delivered in conjunction with the scaling and root planing, at the re-evaluation visit, or at the time of periodontal maintenance. In some cases, you may need multiple applications.

• After you receive treatment for periodontal disease, you may need periodontal maintenance appointments more frequently than typical exams and professional tooth cleanings.

• Scaling and root planing may cause your teeth to be sensitive for a while. Your dentist may provide desensitizing medications which reduce the duration and amount of sensitivity following the procedure.
• If there are locations in your mouth that remain inflamed, the inflammation may be a result of other factors such as:

• Poorly-shaped dental restorations may need to be reshaped or replaced.
• Loose or misaligned teeth can cause secondary occlusal trauma. If moderate to severe periodontal disease causes your teeth to become loose, your dentist may recommend periodontal stabilization splints.
• If your periodontal disease is severe or does not respond to non-surgical treatment, you may require periodontal surgery.

• Scaling and root planing may cause a temporary rise in bacteria in your bloodstream. If you have a compromised immune system, transplanted organs, or certain heart conditions, you make sure your dentist knows this before the procedure.
• Other concerns include:
  • After scaling and root planing, you may experience receded gums that make the tooth root surfaces visible.
  • You may develop chapped or cracked lips and cold sores following scaling and root planing. You can minimize these risks by rinsing with an antiseptic oral rinse before the procedure. You can also ask your dentist or hygienist to apply lip balm during treatment.
  • Scaling and root planing may not be completely effective at removing tartar and disease from the root surface of affected teeth.
  • While your dental team can help you control periodontal disease, your personal habits are the most important. If you are not committed to maintaining your oral health, periodontal treatment will likely be unsuccessful.

• If you are diagnosed with periodontal disease, scaling and root planing is generally the first course of treatment. If the disease is severe or continues to progress, you may require periodontal surgery.
• Tooth removal may be an option, although one that comes with significant consequences. If you control your periodontal disease and your oral hygiene is good, bridges and dental implants may also become options for replacing missing teeth. If you lose some or all of the teeth in your upper or lower jaws, your dentist can replace them with dentures, but this will significantly compromise your chewing efficiency.

• If you delay or refuse treatment, your periodontal disease will ultimately result in infections, pain, swelling, tooth and bone loss.
• If you choose not to have periodontal maintenance following treatment of periodontal disease, your dental team will not be able to monitor and treat areas of inflammation.
• Periodontal disease may cause bad breath and an unattractive smile.
• Not treating chronic periodontal disease may contribute to general health problems, including life-threatening conditions.

• Before I have scaling and root planing, you need to know I have [medical condition] and/or take [medication]. Are there precautions we need to take?
• What can I do to ensure my gum tissues heal properly after the procedure?
• What is the likelihood of having tooth sensitivity or receding gums after the procedure?
• Other than scaling and root planing, are there other options to treat my periodontal disease?
• Are there specific locations in my mouth that remain inflamed or are not healing properly? Could other medical conditions cause this? What should I do?
• What do I need to do to have the best chance of successfully managing my disease?
  • What personal risk factors are affecting my periodontal disease? Can I control them?
  • Besides brushing and flossing, are there other hygiene and oral care strategies I can employ to manage my periodontal disease?