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Deep Teeth Cleaning (Scaling & Root Planing): Things To Know

A deep teeth cleaning (scaling and root planing) is a dental procedure which cleans your teeth below the gum line. That means it removes plaque and tartar build up from the enamel as well as the root surfaces.


Severe gum bleeding from periodontitis
Severe gum bleeding from periodontitis

You can compare that to a regular dental cleaning which only cleans the enamel that is above the gum line. From the sound of it, you can probably already tell that this periodontal procedure is much more involved than your average dental check up.


Table of Contents:


When would I need a deep cleaning?

Scaling and root planing (SRP) is used to treat moderate to severe gum disease such as periodontitis. Typically the early stages of gum disease begins as gingivitis which is just gum inflammation.


However, when gingivitis is left untreated, that inflammation can spread to the bone and begin causing bone loss. Once the bone becomes inflamed and you lose bone, you've advanced to the next stage of gum disease called periodontitis.


A normal cleaning is inadequate for treating advanced gum disease. It won't remove all of the bacteria, plaque, and biofilm.


Conditions necessitating SRP:

  • Moderate-severe calculus. If you have a lot of tartar build up on your teeth, you could very well need a deeper cleaning of your teeth. A regular one may not reach the build up that is below the gum line.

  • Periodontitis. The calculus below the gum line induces bone inflammation and bone loss. The only way to eliminate this is by scaling and root planing the teeth.

  • Gum abscess. Your gums can develop an abscess if you get food lodged into it.

  • Unhealthy pocket depths. If the probing depths are 4mm or more, you may benefit from a deeper cleaning.


Severe calculus build up
Severe calculus build up

If your gums were healthy and free of periodontal disease, you wouldn't need a deep cleaning at all. A regular teeth cleaning would be sufficient if that was the case.


What to expect during procedure

A deep cleaning is typically done in two separate visits with each visit taking about 45 minutes each. You should expect to be numb for both appointments unless you've high pain tolerance.


before deep cleaning
before deep cleaning

What to expect for each visit:

  1. Apply topical numbing cream to the gums and vestibules.

  2. Administer local anesthesia via dental syringe (injection) to half the mouth.

  3. Gross debridement via ultrasonic scaler at a higher power setting.

  4. Scale and root plane the surfaces of each tooth. (expect a lot of scraping)

  5. Floss and polish as necessary.

  6. Return next time for the other half of the mouth.


after deep teeth cleaning
after deep teeth cleaning

Do I have to be numb?

It isn't necessary to be numb for the procedure but it can certainly make it more comfortable. There are two reasons why most people do choose to receive local anesthesia during the treatment.

  • Discomfort. Cleaning deep below the gum line and onto the root surfaces can cause discomfort. The area below the gingival margin rarely if ever gets stimulation from your toothbrushing. The novelty of it may be hard for most people to handle.

  • Not used to it. Think about who are the people who need this procedure. It is those who don't routinely go to the dentist and that means they won't be used to the vibrations from the ultrasonic scaler.

  • More force required to remove tartar. Usually those who need this procedure have very mature calculus that is very difficult to remove. The only way your dentist can remove it is by increasing the power output of the scalers. That in itself can be quite uncomfortable.


Can I do it in one visit?

It is typically not recommended to complete the procedure in one visit if you need to be numb. It can be quite uncomfortable to have the entire mouth numb for about 3-4 hours. For this reason alone, we recommend scaling only half the mouth at a time.


However, if you can tolerate all of that scraping without any anesthesia, you may request your dentist or hygienist to do it all in one visit. Although if you do, you should expect a fairly long appointment visit such as 60-90 minutes total.


Most people don't want to be at the dentist for that long so they do split the appt into two visits.


Aftercare

After your deep cleaning, there are some dos and don'ts which you should follow.


Maintain oral hygiene

Please remember to brush twice a day for at least two minutes. Try to floss and use mouthwash before going to bed as well. Although if you can brush more frequently than twice a day, that would be even better.


It is crucial to maintain your oral hygiene because you can relapse and end up needing a deeper cleaning again if too much tartar builds up.


Food restrictions

Your teeth may feel sensitive, tender, and sore immediately after the procedure. For that reason you may want to avoid foods that are at the extreme ends of the spectrum for the next day or two.

  • Nothing too spicy or too acidic.

  • Avoid extremely hot or cold foods/beverages.

  • Perhaps try eating foods that aren't too hot.


Complications

A deep cleaning of your teeth is not fool proof because it can come with complications.

  • Bleeding. Rare but it can happen. We had one patient who had persistent bleeding for the next two days after their procedure.

  • Sensitivity. Your teeth may feel more sensitive after all of the calculus has been removed. The tartar actually shields your teeth from cold air and hot beverages. After it has been removed, your teeth may not be used to external stimuli.

  • Relapse. If you don't maintain your oral hygiene and you don't keep up with your regular dental visits, you can relapse and need the procedure again.


Treating teeth sensitivity

Typically after a deep dental cleaning and the mouth has fully healed, what you'll end up noticing is gum recession. All of that plaque and tartar build up has destroyed your gums and caused them to recede.


Gum recession showing exposed root surfaces
Gum recession showing exposed root surfaces

With recession comes exposed root surfaces which can be sensitive to cold and other stimuli. In order to reduce the sensitivity, you can desensitize the teeth with a sensitivity toothpaste such as sensodyne. It works by desensitizing the nerve or by occluding dentinal tubules.


Alternative treatment options

The only alternative treatment option to a deep dental cleaning would be gum surgery (osseous surgery), which is an even more involved procedure. It is essentially a deep cleaning but with the gums peeled back so your dentist can visualize all of that calculus. You can expect to leave with stitches in your mouth.


When we say there is no real alternative, that means there isn't a pro and con to getting this treatment. If you need it, there is no other option.


Cleaning vs Deep cleaning vs Gum surgery

You can think of all three periodontal procedures as on the same spectrum. As your periodontal disease increases in severity, you must move onto the next treatment. Each procedure encompasses the previous one but with MORE.

  • A regular cleaning removes plaque and tartar above the gum line.

  • A deep cleaning is a regular cleaning but it also involves removing plaque and tartar from beneath the gum line.

  • Gum surgery is a deep cleaning except the gums get opened up so that ALL of the plaque and tartar can be visibly seen and cleaned off.


Most often, gum surgery is required because the deep cleaning was unable to remove all of the calculus and biofilm. It becomes necessary to open up the gums in order to see all of it so that they can be removed.


Can't I do just a regular cleaning?

No, a dental cleaning is inadequate or insufficient treatment when you have tartar below the gum line. It won't remove any of that build up which means your periodontal condition would've had zero improvements without a deeper clean.


The only alternative option would be to go in the opposite direction and treat more aggressively with osseous surgery (pocket depth reduction surgery).


Cost

The average cost of a deep cleaning is $1168.32 and that includes all four quadrants of the mouth. That is according to the ADA survey of dental fees.


Of course, it can cost more or less depending on the cost of living in your neighborhood. So, don't be surprised if your exact cost is different


The cost with dental insurance

On average, most dental insurances will cover periodontal services at about 80% coverage. Therefore you can probably expect to pay roughly $233.66 for your scaling and root planing procedure.


Once again, we wish to reiterate that it may cost more or less depending on the cost of living and also based on what insurance you have. Some plans have higher coverage while some have less such as 50% coverage.


If you wish to know the exact cost, simply ask your dentist.

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About the author: Dr David Chen, DDS

Hello, I'm Dr Chen and I'm an actively practicing dentist in Long Island City, NY. I graduated from Columbia University College of Dental Medicine in 2016 but prior to going to dental school I was already working in the dental field. It's been more than a decade since I first got to know dentistry and let me tell you, time flies by quickly. Since then I've developed a fondness for writing, which is how this all got started!

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Medical Disclaimer:

This blog is purely meant for information purposes and should not be used as medical advice. Each situation in your mouth is unique and complex. It is not possible to give advice nor diagnose any oral conditions based on text nor virtual consultations. The best thing to do is to go in person to see your dentist for an examination and consultation so that you can receive the best care possible.

The purpose of all of this oral health information is to encourage you to see your dentist and to inform you of what you may expect during your visit. Due to the unfortunate nature of dentistry, there isn't really any true home remedies that will get rid of dental problems. Roughly 99.99% of them require in-person intervention by a healthcare professional.

Hint: That is the reason why you can't eliminate seeing dentists in your life!

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