While some patients are not enthusiastic about their twice-yearly cleaning visits to the dentist, most can agree that their teeth feel clean, look great, and are less sensitive when they leave. Sometimes, though, a simple cleaning is not enough. Scaling and root planing are two procedures that can provide a more in-depth and thorough cleaning. Not everyone needs this kind of deep cleaning, but if you do, here’s what you need to know.

What is a scaling and root cleaning?

Scaling and root cleaning literally goes deeper than the average tooth cleaning, all the way below the gumline. While most semi-annual cleanings are adequate to remove plaque and tartar, for some people, scaling and planing is necessary.

When plaque buildup is not removed regularly, the bacteria in plaque can cause gums to become inflamed. This inflammation pulls the gum away from the tooth, forming a periodontal pocket. This gap allows plaque and bacteria to travel below the gumline into these pockets. Once there, the plaque can continue to build up, causing more serious problems.

The first stage of this type of gum disease is gingivitis. Generally, gingivitis can be treated with a basic cleaning and improved oral hygiene. Once plaque has built up below the gumline, your dentist will need to go deeper.

Scaling and root planing are two separate procedures that use the same tool – a handheld arched scaler. Scaling scrapes plaque and tartar (plaque that has hardened) from above and below the gumline. Planing then uses the same tool to smooth the rough edges of the tooth’s roots. This allows the teeth to reattach to the gums, preventing further bacterial invasion.

Scaling can also be done with an ultrasonic tool that removes some plaque and tartar below the gumline. A manual scaling is usually needed to remove whatever remains.

What can you expect? Scaling and root planing before and after

Depending on the extent of the pockets, you may need more than one appointment for scaling and root cleaning.

You may or may not need a topical or local anesthetic. Your dentist may also use a mild dose of lidocaine if you are nervous about pain. Some “pain-free” dental practitioners offer nitrous oxide or prescribe a mild relaxant for their patients to take prior to the procedure. Other dental practices offer a numbing gel that can be injected into the pockets themselves, thereby eliminating the numb lips and cheeks that come with lidocaine injections.

For most people, the procedure is more or less like a regular cleaning with a bit more attention to certain areas of the mouth. Some dental offices break the work into quadrants of the mouth. This is typically done when there is extensive scaling and root planing needed and the patient requires lidocaine or a numbing agent. Your dentist doesn’t want to send you out in the world with a completely numb face!

What else can you expect after this procedure?

Will my teeth look different after scaling and root planing?

Because plaque and tartar build up occurs below the gumline, you may not notice any difference after your scaling and root planing. If the plaque and tartar was causing swelling and redness in the gums, that should diminish noticeably after your procedure.

Will my teeth feel different?

Gums should become more firm and less painful than before.

Many people also notice that their teeth and gums are less sensitive, and less prone to bleeding during brushing, after the procedure.

Does scaling and root planing hurt?

For most patients, teeth scaling pain is rare.

The main sensation patients report is just the physical feeling of pressure and the sound of scraping. If either of these send you through the roof just thinking about them, it is important to talk with your dentist to alleviate your fears. Dental anxiety is one of the main reasons people avoid the dentist. Without treatment, gum disease can progress with disastrous consequence.

If you have any concerns about pain,