Scaling and Root
Planing -- a
patient guide from Columbia University
College of Dental Medicine.
It's Used For
Scaling and root planing
is the most common and conservative form of
treatment for periodontal (gum) disease.
Scaling is the removal of calculus (commonly
called tartar) and plaque that attach to the
tooth surfaces. The process especially targets
the area below the gum line, along the root.
Plaque is more likely to stick to rough
surfaces. For this reason, the root surface is
smoothed down in a process called root planing.
Root planing removes any remaining calculus and
smoothes irregular areas of the root
Plaque is a sticky
substance, full of bacteria, that forms on
teeth. When plaque hardens over time, it is
periodontal disease. Plaque and calculus
provide an irregular surface that allows these
bacteria to attach easily. Scaling and root
planing are done to remove them. For early
stages of the disease, this treatment may be
all that is needed to get the condition under
control. This is especially effective with
gingivitis. With more advanced gum disease,
scaling and root planing may be the first step
For some patients,
scaling and root planing can cause discomfort.
A local anesthetic may be used to numb the
portion of your mouth that is being worked
Scaling and root planing
are done with a combination of ultrasonic
scalers and hand instruments. Ultrasonic
instruments are electric or air-powered. They
have two components:
- A relatively dull metal
tip that vibrates at a very high frequency
and "knocks" plaque and calculus off the
- A water irrigation
system that cools the tip and helps to
flush out debris from around the teeth
Hand instruments are
not powered. They have cutting edges that your
dentist or hygienist uses to chip away plaque
These instruments come
in various shapes and sizes. Different
instruments are used for different teeth, and
even for different surfaces of the same
instruments are used first to remove large
deposits of plaque and calculus from the crowns
and roots of the teeth. Hand instruments called
scalers and curettes are then used to remove
any remaining material and make sure that the
tooth surface is clean and smooth. When working
under the gum line, your dentist or hygienist
cannot see the plaque or calculus. He or she
will rely on the sense of touch to feel for
roughness on the root surface.
Sometimes, scaling and
root planing can be completed in one visit.
This usually is possible if you have
gingivitis, the earliest stage of gum disease.
However, if you have periodontitis, multiple
visits are usually needed. The periodontist
typically will do a quarter of your mouth (a
quadrant) at each visit.
For two to three days
after the treatment, you may have some soreness
and be sensitive to hot and cold temperatures.
Over-the-counter pain relievers can
You may be asked to
use an antiseptic mouth rinse after scaling and
root planing. This is especially likely when
soreness of the gums prevents effective oral
hygiene measures. However, you should continue
brushing and flossing as usual. You can expect
some minor bleeding in the first days after
scaling and root planing. This usually stops
within a week.
decreases gum inflammation. It also eliminates
periodontal pockets, which can trap plaque.
Therefore, if treatment is successful, the
swelling will be gone and your gums will shrink
The extent of
shrinkage depends on the initial depth of the
pocket and the severity of periodontitis. The
more severe the disease, the more your gums
will recede after successful therapy. As a
result, some part of the root is exposed. This
makes the tooth look longer. It also will be
more sensitive to heat and cold. To prevent
root cavities, your dentist may prescribe a
fluoride-containing gel. It's also important to
If your medical doctor
has told you that you need to take antibiotics
before certain dental procedures, tell your
dentist or hygienist about this before you
undergo scaling and root planing.
If you develop a fever or
have excessive bleeding, pain or swelling after
scaling and root planing, contact your dental