Scaling and Root Planing: Dental Deep Cleaning

Scaling and root planing is a thorough dental cleaning of tooth root surfaces to remove plaque and tartar (calculus) from around teeth and periodontal pockets in the gums, and to smooth the teeth roots to remove bacterial toxins.

Why Scaling and Root Planing is Performed

Scaling and root planing, along with proper daily brushing and flossing, is effective in treating gingivitis, an early stage of gum disease. Scaling and root planing also is a cost effective, minimally invasive, and non-surgical way to prevent and/or treat the more serious form of gum disease called periodontitis. Gingivitis is a milder, more easily corrected form of gum disease; periodontitis is a more serious form that progresses over a longer time. Consequences and treatment may be more involved for periodontitis.

Periodontal disease involves inflammation and infection of the gums and surrounding oral tissues. The main cause of gum disease, bacterial plaque (a sticky, colorless film that forms on teeth) hardens into a rough, porous substance that releases toxins. These toxins cause the gum fibers holding the teeth firmly in place to loosen and break down, creating periodontal pockets that can become filled with more bacteria and toxins. If left untreated, the pockets continue to deepen and the bone securing the teeth will be destroyed, eventually causing tooth loss (edentulism).

Who Performs Scaling and Root Planing?

The severity and progression of gingivitis and periodontal disease, and how well you respond to therapy, determines your treatment and who performs it.

Dental hygienists and general or family dentists perform preventive scaling and root planing, or treat cases of early stage gum disease. Additional training is necessary to treat more advanced, complex cases. In such instances, a general dentist may refer treatment to a periodontist, a specialist in the diagnosis, prevention and treatment of periodontal diseases. A periodontist receives an additional three years of post-dental school education, which includes specialized gum training and treatment methods. For example, in more severe cases, a periodontist can perform surgical treatments such as making incisions in the gums to remove hardened plaque buildup and refine the boney defects.

The Scaling and Root Planing Procedure

During the initial examination, a dental hygienist and/or general dentist will evaluate your plaque buildup and examine your gums for possible periodontal problems. Using an instrument called a periodontal probe, the depth of the spaces between your teeth and gums, called the sulcus) will be measured. At the edge of the gumline, healthy gum tissue forms a sulcus; a shallow, v-shaped groove between the tooth and gums. Normal sulcus depth is 3 mm or less. With periodontal diseases, the sulcus widens, creating a deeper pocket of more than 3 mm, resulting in harmful plaque buildup that cannot be cleaned without professional dental treatment.

Scaling and root planing is performed when pockets are greater than 3 mm. Scaling removes plaque and tartar above and below the gumline. Depending on the amount of tartar and plaque buildup, and your level of tooth sensitivity, tooth scaling may prove painful; a numbing gel or anesthetic injection typically will be administered to the area to lessen discomfort.

Once numbing or anesthesia is achieved, your dental professional will use an instrument called a small scaler, an ultrasonic cleaner, or both to thoroughly remove plaque and tartar to the bottom of each periodontal pocket. The tooth surfaces then are planed – or smoothed – which prevents plaque from accumulating along root surfaces and allows gum tissue to heal.

Depending on the severity of your condition, scaling and root planing may be performed quadrant by quadrant to ensure comfort. Typically, the upper and lower quadrants on one side of the face are done at one appointment, and the upper and lower quadrants of the other side are done at a second appointment.

At the treatment appointment, your dentist also may administer local antibiotics, antimicrobials and other medications directly into the periodontal pockets to help control infection or pain, as well as encourage faster healing.

Early stage gum disease treatment may include tooth scaling and cleaning at three-month intervals, as well as the use of medicated mouthwash and daily flossing. Later stage gum disease treatment may include deep plane scaling, periodontal surgery and laser surgery.

Dental Lasers for Scaling and Root Planing

Using dental lasers during periodontal therapy typically results in less bleeding, swelling and discomfort during surgery. However, periodontal tissue damage may occur if inappropriate laser wavelengths and/or power levels are used during the periodontal procedure. Therefore, it is very important that only dental professionals trained and experienced in the proper and safe use of lasers perform this adjunct laser procedure.

After-care and Recovery

For the first few days after scaling you may experience some bleeding that should gradually subside. At a follow-up appointment, your dentist will evaluate gum healing and verify a decrease in the size of periodontal pockets. If pockets greater than 3 mm are still present after initial treatment, additional treatment may be recommended.

Maintaining good oral hygiene practices and continued, long-term follow-up by your dental professionals are essential to prevent periodontal disease from developing into a more serious and/or chronic condition that may require surgery. This is important, especially given the growing body of clinical evidence indicating the strong connection between periodontal disease and secondary health conditions such as cardiovascular disease, low birth weight babies and premature births.

Additional Considerations

For maximum patient education and protection, it is important to note certain distinctions. “Polishing” involves smoothing a surface; “cleaning” involves removing waste and other extraneous particles from teeth. Oral prophylaxis commonly is defined as removing plaque, calculus and stains from the exposed and unexposed tooth surfaces by scaling and polishing. The prophylaxis procedure is performed on a healthy mouth to prevent periodontal disease. Polishing-only procedures are considered cosmetic and have no therapeutic value. While many patients may equate polishing with oral prophylaxis, it is a mistake to assume that tooth polishing alone constitutes preventive oral health care.

Scaling and Root Planing Costs

A regular dental prophylaxis (professional teeth cleaning) can average between $50 – $100+ depending on a number of factors, (check all fees — in general these may be low) while the cost of periodontal scaling and root planing averages between $140 and $300 (per quadrant). Active periodontal therapy, which typically consists of a locally administered antimicrobial agent delivered into the gum pockets, costs approximately $75 per tooth. Periodontal maintenance costs after undergoing active therapy average $115.

Factors affecting the cost of gum disease treatment include the technology used in the procedure; the dentist’s location; type of dental insurance; type and frequency of treatment and follow-up care; and type and number of dental professionals involved in the treatment plan. For example, your general dentist may perform the initial diagnosis and some treatment, but may refer you to a periodontist more adept at performing advanced surgical procedures.

Before undergoing any gum disease treatment, consult with your insurer to determine what procedures your plan covers.  Being covered by insurance or not, does not preclude the need for treatment.