Deep Cleaning and Root Planing

When it may be needed

• People found to have periodontitis at an examination. Which areas are cleaned is decided by looking at the pocket measurements and the bleeding.
• Pockets that bleed again or become deeper during supportive care after treatment for periodontitis

When it is not needed, or something else is considered first

• Healthy gums. A deep cleaning is not needed. Tartar above the gum line can be cleaned at check-ups; your dentist decides how often.
• Gingivitis only. Gingivitis can be reversed with better oral hygiene². Cleaning above the gum line and improving your oral hygiene is often enough.
• Receding gums without signs of disease. The receded area can be monitored³; cleaning does not reverse recession.

Situations that need care

• Smoking. Smoking weakens⁴ the response to treatment; stopping can prevent further deterioration.
• Diabetes, heart disease, blood thinners, pregnancy. Tell your dentist before treatment. Do not stop or change⁵ your blood thinner for dental treatment unless your doctor or dentist tells you to.

• Doing nothing. In periodontitis, the tartar below the gum stays where it is; tartar does not dissolve⁶ at home with a toothbrush, toothpaste or mouthwash.
• Improving oral hygiene. This is the basis of every step, but on its own it does not remove tartar below the gum.
• Routine scale and polish. This mainly cleans plaque and tartar above the gum line. There are studies of adults without severe gum disease who attend regular check-ups. These studies compared a routine scale and polish every 6 or 12 months with no scheduled scale and polish. Over 2 to 3 years, the routine cleaning made little or no difference⁷ to gingivitis. It reduced tartar slightly; the clinical importance of this is unclear. This result is based on 2 studies of 1,711 adults in the United Kingdom, and the certainty of the evidence is high.
• Deep cleaning (below the gum). In periodontitis, this cleans the inside of the pockets and the root surfaces.
• Air-polishing. In small studies during the care period after treatment, compared with hand and ultrasonic instruments, it showed no statistically significant difference⁸ in pocket depth. This does not mean the two methods are equivalent; most of the studies carry a high risk of bias. In studies using glycine or erythritol powders, the discomfort patients reported was similar to or lower than⁹ with hand or ultrasonic instruments. We have found no evidence that it removes established tartar on its own.
• Periodontal surgery. This is considered for pockets that stay deep after a deep cleaning. Whether it is needed is discussed at the re-assessment. See periodontal surgery.
• Mouthwash and antibiotics. Chlorhexidine mouthwash reduces plaque, but it is used only for a short time and it does not remove tartar below the gum. Additional antibiotics or laser are not among the topics we give sources for on this page; if they are suggested, ask your dentist why.

The steps below are for cleaning below the gum as part of treatment for periodontitis. The whole mouth can be cleaned in one session or section by section. How many appointments you need and which route is chosen are planned together after the examination. This depends on how widespread the disease is, your health and your preference. Which steps can be done in Antalya, and which usually continue in the UK, is covered in "Treatment in Antalya, follow-up in the UK".

Risks and side effects

• Sensitivity. In the days after the procedure, your gums may be tender and your teeth sensitive to hot and cold. We cannot say on this page how often this happens or how long it lasts. If the sensitivity continues, see your dentist¹⁰ to rule out other causes such as decay. For dentine sensitivity, toothpastes containing stannous fluoride or arginine are recommended among the first options¹¹. This recommendation is based on studies of dentine sensitivity in general; it is not specific to the period after a deep cleaning.
• Gums that look receded. As the inflammation settles and the swelling goes down, the gum margin can sit lower and root surfaces can be exposed. You may feel gaps between your teeth.
• Bleeding. In the first days there may be slight bleeding when you brush.
• Air escaping into the tissues (emphysema). Air escaping into the tissues during dental treatment is an infrequently reported complication¹². The case reports include tooth cleaning and air-polishing. Swelling that appears suddenly after treatment and crackles when touched should be checked straight away.
• Chlorhexidine mouthwash. If recommended, it is used for a short time. Used for 4 to 6 weeks, it can stain the teeth¹³; altered taste and irritation inside the mouth have also been reported.

Benefits

• Periodontitis can be brought under control and gum health can be restored¹⁴. Bone that has been lost, however, largely does not grow back.
• In people with periodontitis and diabetes (mostly type 2), gum treatment lowered HbA1c by 0.43 percentage points on average¹⁵ at 3 to 4 months. HbA1c is the long-term measure of blood sugar. This result is based on 30 studies and 2,443 participants, and the certainty of the evidence is moderate. It does not replace diabetes treatment.

The figures on this page come from published studies, not from our own records.

At the re-assessment, your dentist measures the pockets again to see how your gums have responded.

Do not eat until the anaesthetic has worn off; you could bite your lip or cheek without noticing. In the first days your gums may be tender and bleed a little when you brush. Do not stop brushing; carry on with gentle movements.

Daily care

• Brush your teeth at least twice a day with a fluoride toothpaste. After brushing, spit the toothpaste out and do not rinse¹⁶ your mouth with water.
• For most people, a toothbrush with a small head and medium bristles¹⁷ is suitable.
• Clean between your teeth every day. For people who have been treated for periodontitis, interdental brushes are recommended as the first choice¹. Floss is an option where the brush does not fit.
• If your teeth are sensitive, rub a small amount of sensitivity toothpaste onto the sensitive area with your finger and avoid¹⁰ acidic food and drinks.
• Use chlorhexidine mouthwash only if your dentist recommends it, and only for a short time.
• If you smoke, ask for support to stop.
• Keep going to the supportive care appointments your dentist sets. If you were treated in Antalya, these are usually with your own dentist or hygienist in the UK.

A deep cleaning is not a one-off solution. In someone whose periodontitis has been treated, the risk of the disease coming back remains increased¹⁴, and it needs close monitoring.

The European guideline recommends a supportive care interval of at least 3 and at most 12 months¹, depending on the person's risk. Regular professional cleaning is also recommended as part of this care. Keeping your appointments and cleaning between your teeth every day at home are the way to keep the result.

After a deep cleaning, contact your dentist if you notice:

• Pain or swelling that does not ease within a few days, or keeps getting worse
• Bleeding that does not stop
• A fever
• Sensitivity that has not eased after several weeks
• Teeth becoming more and more loose

Swelling that appears suddenly after treatment and crackles when touched should be checked without waiting¹². If you cannot reach your dentist straight away, see a dentist where you are or go to an emergency department. In England, the NHS says to call 111 or get help from 111 online¹⁸ if you do not have a dentist. The same applies if you cannot get an emergency appointment.

Emergencies. The following need urgent medical help¹⁸. Do not wait for a dental appointment or for the clinic's reply. In the UK, call 999 or go to A&E. In Turkey, the emergency number is 112.

• Swelling that makes it hard to breathe, speak or swallow
• Swelling of the eye or the neck¹⁹, a painful eye, or sudden problems with your eyesight
• A lot of swelling inside the mouth
• Finding it hard to open your mouth

Before you fly home

Make sure you have a written record of what was done in which areas, with the pocket measurements and any X-rays, and written care instructions. Know when your re-assessment is due and who will carry it out. Know whom to ask if your gums stay painful or swollen after you have left.

Once you are back in the UK

If a problem comes up that is not urgent, write to the clinic and send photographs. Pain or swelling that keeps getting worse, bleeding that does not stop, or a fever needs a UK dentist, such as your own. See one without waiting for the clinic's reply. If you have no dentist, use NHS 111 as described above. In the emergencies above, call 999 or go to A&E.

Your treatment is provided by our clinic in Antalya, Turkey, and carried out there by the clinic's dentists.

Periodontology, the branch of dentistry that deals with the gums, is one of the nine dental specialties set by law in Turkey²⁰. Turkish law ties the specialist title to a specialist certificate²⁰, issued and registered by the Ministry of Health²¹. In the UK, a dentist may call themselves a specialist only if they are on the GDC's specialist list²². On this page, "your dentist" means the dentist who examines and treats you. "Your own dentist in the UK" means the dentist you see at home.

Ask who will examine you, measure your gums and carry out the cleaning, and who decides on any surgery. Ask what their titles are, where they qualified, and whether any of them holds a Ministry-registered specialist certificate in periodontology. Ask for the answers in writing.

A deep cleaning is one step in a course of gum treatment. The re-assessment comes only once the gums have healed, and supportive care continues after that, at intervals set by your risk. Some of this can be done during a stay in Antalya. The re-assessment and the supportive care usually continue after you are home, with your own dentist or hygienist in the UK. Agree how this will work before treatment starts.

What can be done in Antalya

Whether you need a deep cleaning cannot be decided from photographs. The General Dental Council says you should be assessed by a qualified dentist before being given a treatment plan and cost estimate²³. For a deep cleaning, that assessment is the examination in Antalya.

• Examination and measurement. The pockets are measured and the bleeding points recorded, with X-rays if needed. The plan follows from those measurements.
• Preparation. Advice on cleaning your teeth at home, and cleaning above the gum line.
• Cleaning below the gum line. The whole mouth can be cleaned in one session or section by section over several appointments.

What usually continues in the UK

• The re-assessment. It comes only once the gums have healed, so it usually falls after you have gone home. Plan it with your own dentist in the UK, or plan a return visit to Antalya.
• Further cleaning or surgery. If pockets stay deep at the re-assessment, the cleaning can be repeated or surgery is discussed. So do not expect the cleaning, the re-assessment and any surgery to fit into one trip.
• Supportive care. Regular check-ups and professional cleaning continue at intervals set by your risk (see "How long does the effect last?"). After periodontitis, supportive care is part of the treatment, not an optional extra.

What to agree in writing before you start

Before you book, you receive a written preliminary plan with the appointments and how many days they need. It is based on what you send, such as recent X-rays or gum measurements from your own dentist, and it is not a diagnosis. The examination confirms or changes it, and with it the days and the cost. The number of days in Antalya depends on how many areas need cleaning below the gum. It also depends on other treatment that is to follow, such as implants or crowns; gum disease is usually treated before that work starts.

Ask for the plan to answer these questions:

1. Which steps will be done in Antalya, and which are expected to continue in the UK?
2. When is the re-assessment due, and who will carry it out: your own dentist in the UK, or the clinic on a return visit?
3. If the re-assessment shows that pockets are still deep, who decides on more cleaning or surgery, and where would it be done?
4. Which records will you take home for your own dentist?
5. Which supportive care interval is recommended for you, and who will provide that care?

You can also ask a dentist in the UK for an independent opinion before you decide. Ask whether you need a deep cleaning, and what having it in the UK would involve. After the examination in Antalya, you can still decide not to go ahead. You can say no, or ask to stop, at any stage.

Flying. We have found no guidance that sets a waiting time before flying after a deep cleaning specifically. A 2023 review of flying after dental treatment suggests waiting about a week after most dental interventions²⁴. The authors note that the research is limited and comes mainly from military aviation. Ask your dentist when you can fly, and treat the review as a starting point for that advice, not as a rule.

Your own dentist or hygienist

The General Dental Council suggests talking to your own dentist²³ before you go. They need to know the plan, because the re-assessment and the supportive care that follow are usually theirs. Ask them before you travel whether they will take it on, and what that care will cost. If you do not have a regular dentist, find one before you travel. The NHS lists exchanging medical records and arranging aftercare back home²⁵ among the things to consider before treatment abroad. National guidance in England (NICE) says the interval between check-ups should be set for each person according to their risk²⁶ and discussed with them.

Your records

Ask the clinic for a written record of the treatment to take back to your own dentist. It should show the pocket measurements before the cleaning, and after it if you are re-assessed during your stay. It should also say which areas were cleaned, and which supportive care interval is recommended for you. Ask for copies of any X-rays too. In Turkey, the health tourism regulation entitles international patients to an itemised bill. On request, they also get free copies of the records of the materials used, the tests and the imaging²⁷.

What the NHS does and does not do

In England and Wales, an NHS dental practice may accept you for a course of treatment, not just an urgent appointment. If it does, it provides clinically necessary treatment, with your consent²⁸. This means the treatment that every NHS dental contract must offer. Having been treated abroad does not change that. But the NHS rules on further treatment within 2 months, and on free repair or replacement, do not apply²⁸ to work that another provider did. The NHS also states that it is not liable for negligence or failure of treatment²⁵ when you have treatment abroad. On the NHS England routes that fund planned treatment abroad, you cannot get reimbursement for dental treatment²⁹.

The NHS guidance quoted on this page is for England, and for England and Wales where stated. Scotland and Northern Ireland have their own NHS rules, and we hold no source for them on this page. If you live there, check the local arrangements.

Travel insurance

The NHS says that most travel insurance policies will not cover you for planned treatment abroad, so you may need specialist cover²⁵. Tell your insurer about your plans. Before you book, ask whether anything linked to the treatment is covered, such as a complication or an extra trip.

The General Dental Council lists questions to ask before treatment abroad²³. Below are most of them, with what this page can answer today and what to ask for in writing.

1. Who will carry out my treatment, and what are their qualifications? The treatment is provided by our clinic in Antalya, Turkey. Ask for the name of the dentist who will examine you and carry out the cleaning. Ask where they qualified and what their title is (see who carries out the treatment, above).
2. Are you regulated by a professional body and registered with it? In Turkey, a health facility needs an authorisation certificate²⁷ from the Ministry of Health to treat international patients. Authorised facilities appear in a register the Ministry publishes³⁰, so you can check it yourself. The authorisation belongs to the facility, not to the dentist, and it says nothing about the result of your treatment. Ask for the treating dentist's own registration details as well. See health tourism authorisation.
3. Will the dental team speak English, or will you provide a translator? Ask who will explain the plan, the consent form and the aftercare instructions to you, in which language, and whether you get them in writing.
4. How many times have you carried out this treatment, and what are your rates of success and complications? The figures on this page come from published studies, not from the clinic's own results. Ask the clinic whether it keeps its own figures, and how they were collected.
5. Is the work guaranteed, and for how long? A deep cleaning can bring the disease under control, but the disease can come back (see "How long does the effect last?"). This page makes no guarantee. Ask what the clinic's written terms cover, for example further cleaning if the re-assessment shows that pockets are still deep.
6. What happens if I am not happy with the result? For a deep cleaning, the result is judged at the re-assessment, when the pockets are measured again. Ask for the clinic's answer in writing.
7. What aftercare do you provide, and who can I contact after the treatment? Your written plan should say who carries out the re-assessment and the supportive care. It should also say whom to contact, how, and in which language.
8. If there are complications, who pays for further treatment, extra flights and the hotel? Ask for the answer in writing before you commit.
9. What happens if the examination shows that I do not need a deep cleaning, or that it is not the right treatment for me? Ask in advance what you pay for the examination, and what happens to anything you have already paid.
10. Do you have a complaints system, and can I see a copy? Ask for it before treatment. The GDC says it cannot resolve complaints or help with refunds³¹; its investigations concern the dentists on its own register. Turkish regulation makes the facility responsible for complications and medical malpractice arising after the health service it provided²⁷.
11. Do you have insurance to cover this treatment? In Turkey a facility treating international patients must take out complication insurance for surgical and interventional procedures carried out in an operating theatre²⁷. That does not by itself tell you whether your treatment is covered, so ask which procedures in your plan, if any, fall under it. Ask too, in writing, whether the clinic or the treating dentist holds insurance for complications or errors, what it covers and whom it protects.

The NHS names warning signs to think about before booking any treatment abroad. They are a hard sell, a lack of information, pressure to make a quick decision, no discussion of possible complications, and no mention of aftercare²⁹. Apply them to this clinic too.

This page does not give prices. Your treatment plan is prepared for you after the examination. The main factors that shape the plan are:

• In how many areas and on how many teeth cleaning below the gum is needed
• How many appointments it takes and whether anaesthetic is needed
• X-rays, if needed
• Re-assessment, surgery if needed, and supportive care appointments, and whether they take place in Antalya or with your own dentist in the UK

Ask for the plan in writing, showing what is included and which procedures will be assessed separately. Ask too who pays for further treatment and extra travel if there is a complication.

If you are comparing with a plan from a UK practice, compare what each one includes, item by item.