Scaling and Root Planing

Scaling and root planing is a cleaning that reaches below the gum line. A regular cleaning removes deposits you can see. This one removes hardened tartar and bacterial film from the root surface inside the pocket. At Pearl32 Dentistry and Wellness in Laguna Hills, it is done by quadrant or half mouth under local anesthetic, usually across one or two visits. Gums tighten as they heal. We measure again at four to six weeks.

When is a deep cleaning needed?

It is needed when pockets measure four millimeters or deeper with bleeding and there is bone loss on the x-ray. A regular cleaning reaches about three millimeters. Past that, tartar sits on the root where no brush reaches and no rinse penetrates.

We do not recommend it from the way gums look. We recommend it from a full chart: six measurements per tooth, bleeding points, recession and bone levels. You see the chart before you decide. If the numbers do not support deep cleaning, we do a regular cleaning and watch. Read about periodontal care.

How is the appointment arranged?

Most people are treated one half of the mouth at a time, or one quadrant at a time when pockets are deep. Each visit runs about sixty to ninety minutes. Local anesthetic numbs that side, so you feel pressure and vibration rather than pain.

We use an ultrasonic scaler to break up heavy deposits and fine hand instruments to smooth the root. Where a pocket is unusually deep, a local antibiotic can be placed inside it. Nitrous oxide and oral sedation are available. Our hours are Monday to Friday, 8 AM to 5 PM, in Suite 450.

What does it feel like afterward?

Expect tenderness for three to five days and cold sensitivity for two to four weeks. Roots that were covered by tartar are now exposed to the mouth, and they need time to settle. A potassium nitrate toothpaste used twice daily helps most people.

Your gums will also shrink as the swelling resolves. That is healing, not harm, but teeth can look longer and gaps can open between them. Some people notice food catching where it did not before. We show you how to clean those areas with interdental brushes, which reach wider spaces better than floss.

Why do we re-measure at four to six weeks?

Because numbers tell the truth and appearance does not. At four to six weeks the tissue has tightened and the result is stable enough to judge. We chart the same six points per tooth and compare them against your starting numbers.

Most sites improve by one to three millimeters. Sites that remain at five millimeters or deeper with bleeding need more: a repeat of that area, a local antibiotic, or a surgical opinion from the visiting periodontist who comes to our office. From there you move onto a maintenance schedule every three to four months.

What scaling and root planing will not do

It will not regrow bone that has already been lost. Pockets get shallower mainly because inflammation resolves and the gum tightens, not because bone returns. Where a defect has the right shape, a graft may rebuild part of it, and we will say whether you are a candidate.

It will not hold without maintenance every three to four months, because bacteria repopulate a pocket in about that time. It also works poorly against continued smoking. If you smoke, expect less improvement, and ask us for help with quitting. We would rather plan around the truth than promise more.

What does scaling and root planing cost?

Cost is charged by quadrant and depends on how many quadrants need treatment, and it is quoted in writing, itemized, after an examination and a full chart. Local antibiotic placement, if it is needed, is listed as its own line.

We are in network with most major PPO plans and Delta Dental HMO. Most plans cover this treatment when the pocket depths and x-rays support it, and they limit how often it can be repeated. We check your benefits before you start. Third party financing is available and the practice is not the creditor, through CareCredit, Cherry, Sunbit and Happen Bank (formerly LendingClub). See financing.

Questions people ask about scaling and Root Planing

How is this different from a regular cleaning?

A regular cleaning works above the gum line and about three millimeters below it. Scaling and root planing cleans the root surface inside pockets of four millimeters or more, which requires local anesthetic and more time. A regular cleaning takes one visit. Deep cleaning is usually split across two visits by half mouth, or four by quadrant.

Do I really need anesthetic?

For most people, yes. The instruments work against the root surface below the gum, and that area is sensitive when it is inflamed. Numbing lets us clean thoroughly rather than lightly, which decides the result. If pockets are shallow and deposits are light, some people manage with numbing gel alone. We decide that with you at the visit.

How long before my gums feel normal?

Tenderness settles in three to five days. Cold sensitivity can last two to four weeks and fades as the roots build a protective layer. Bleeding should decrease within two weeks if your daily cleaning is thorough. If bleeding continues past four weeks, tell us at the re-evaluation, because that site may need more attention.

Will my teeth get loose?

Teeth that were already loose can feel slightly looser at first, because swollen tissue was holding them. As the gum tightens over four to six weeks, most settle. Teeth loosened by significant bone loss stay loose, and we discuss splinting, bite adjustment or replacement for those. We measure mobility at each visit so any change is tracked.

What happens if I skip the three month recall?

Bacteria rebuild inside deep pockets within about three months. Skipping visits usually means pocket depths and bleeding return to where they started, and the treatment has to be repeated. Insurance often limits how often it will pay for a repeat. Keeping a three to four month schedule is less expensive and less uncomfortable than restarting.

This page is general information, not a diagnosis. What is right for you can only be decided after an examination.