Scaling and root planing — often called deep cleaning — is the removal of plaque and hardened tartar from the root surfaces below the gum line, and the smoothing of those surfaces so the gum can reattach. It is done under local anaesthetic, and it is the main treatment for periodontitis.
It is a different procedure from the routine scale and polish most people have at a check-up, and the distinction is worth understanding.
How it differs from a routine clean
A routine clean removes deposits above the gum line and just below the margin, and polishes the visible surfaces. It takes one appointment, needs no anaesthetic, and is a preventive measure.
Scaling and root planing works on root surfaces inside the pockets — four millimetres deep and more, where you cannot reach and where a routine clean does not go. It requires anaesthetic because those surfaces are sensitive, it takes several appointments, and it is a treatment for disease rather than prevention.
If you have pockets and have only ever had routine cleans, the disease has not been treated.
Why it works
The bacteria driving periodontitis live in the pocket, in plaque that hardens onto the root surface as tartar. Tartar is firmly attached and cannot be brushed off; it also has a rough surface that holds more plaque against the gum permanently.
Removing it breaks the cycle. With the deposits gone, the inflammation subsides, the tissue tightens against the tooth, and pocket depths reduce — which makes the area cleanable again with an ordinary brush and interdental brush.
What the appointments involve
The mouth is usually treated in sections — commonly one quadrant per visit, or half the mouth at a time — over two to four appointments, so the anaesthetic is manageable and each area gets sufficient time.
Each session: local anaesthetic, then thorough instrumentation of the root surfaces with ultrasonic scalers and fine hand instruments, working along each root surface to its full depth. Expect 45 to 90 minutes per session.
You should not feel pain. You will feel vibration, pressure and water. Say if you feel anything sharp — more anaesthetic can be given.
Afterwards
For a few days to a couple of weeks:
- Tender gums, particularly for the first two or three days.
- Sensitivity to cold, sometimes marked. This is the most common complaint and it settles. A desensitising toothpaste helps — rub a little directly onto the sensitive areas and do not rinse it off.
- Some bleeding when brushing initially.
- Teeth feeling slightly loose for a short period as swollen tissue settles.
- Gaps appearing between teeth. Expect this and understand it: the swelling that was filling those spaces has gone down, revealing bone loss that had already occurred. It is a sign the treatment has worked, not that it caused damage. It is worth being told beforehand.
Keep brushing gently from the start, including the treated areas, and follow any specific instructions about rinses or interdental cleaning.
Contact the clinic if pain is severe or increasing after the first few days, if there is swelling, or if bleeding does not settle.
How success is measured
Not by how the gums look or feel, but by remeasuring. Six to twelve weeks after treatment, pocket depths are recorded again and bleeding on probing is reassessed.
A good response means pockets have reduced — commonly by one to three millimetres — and bleeding has largely stopped. Where deeper pockets persist and continue to bleed, further treatment is considered: repeated instrumentation at those sites, adjunctive measures, or access surgery to clean the root surfaces directly.
Ask for your before-and-after numbers. They are the clearest evidence of whether it worked.
What happens next matters more than the treatment
Scaling and root planing removes the deposits. It does not change your susceptibility, and plaque starts reforming within hours. Without maintenance, pockets recolonise and the disease returns.
Maintenance means professional cleaning at intervals shorter than standard — commonly every three to four months — with periodic remeasurement, plus daily cleaning between the teeth at home. Patients who complete treatment and then return to six-monthly visits frequently relapse. See periodontal maintenance visits.
And if you smoke, this is the point at which it matters most. Smokers respond less well to this treatment than non-smokers, consistently — see who is at higher risk of gum disease.
Frequently asked questions
Does it hurt?
Not during, with anaesthetic. Afterwards, tenderness and cold sensitivity for a few days.
Why does it take several appointments?
Anaesthetising the whole mouth at once is unpleasant, and each area needs sufficient time to be done thoroughly. Thoroughness is what determines the result.
Can I just have a normal clean instead?
If you have pockets, a routine clean does not reach the deposits causing the problem.
Will my gums grow back?
Pockets reduce as inflammation resolves and the tissue tightens, but recession that has occurred does not reverse.
Do I need antibiotics?
Not routinely. They are used as an adjunct in specific cases.
Should I have it if my gums do not bleed?
It is indicated by pocket depths and bone loss, not by bleeding alone — and smokers frequently do not bleed despite active disease.
Ask what your pocket depths are
Whether you need this treatment is a measurement. See our gum and periodontal care page and periodontitis: when bone is involved.
To arrange a consultation at our clinic on Abbas El-Akkad in Nasr City, call +20 101 969 7597 or message us on WhatsApp.
