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 or lower⁹ than with hand or ultrasonic instruments. There is no evidence that it removes established tartar on its own.
• Periodontal surgery. This is considered for pockets that stay deep after a deep cleaning.
• 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, depending on how widespread the disease is, your health and your preference.

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 stains 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.

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.

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.

Contact your dentist if any of the following happens after a deep cleaning:

• 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, go to a hospital emergency department.

Emergencies. The following need urgent medical help¹⁸. Do not wait for a dental appointment; go to a hospital emergency department or call 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

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

Ask for the plan in writing, showing what is included and which procedures will be assessed separately.