What Is Scaling & Root Planing?

Dr Advocate Avatar IconUpdated: September 1, 2022
By: Dr. Advocate

One of the most common diseases, affecting 48% of adults, is heart disease. But did you know there’s another disease nearly as prevalent and could indicate heart health? Periodontal disease, also called periodontitis or gum disease, is a severe infection that affects the gums and bone supporting the teeth. It’s caused by bacteria that have accumulated deep below your gum line.

According to a recent Centers for Disease Control and Prevention (CDC) report, 47% of adults 30 years and older have periodontal disease. The prevalence increases with age, as 70% of adults 65 years and older have periodontal disease. Researchers are still working to identify a link, but gum disease could be a risk factor for heart disease. The good news is that the dentist or dental hygienist can treat gum disease early and effectively - it starts with scaling and root planing.


What is scaling and root planing?

Scaling and root planing (SRP), also known as deep cleaning, removes bacteria above and below the gum line when inflammation and bone loss are present, known as periodontitis. As we discussed in the prophylaxis section, bacteria thrive in difficult areas to clean.

Below the gumline is home to the most aggressive bacteria in your mouth. They embed deep into the gum tissue and adhere to the root surface if they’re not removed. Initially, they assemble into a sticky solution known as plaque, and over time they form “rock-like” crystals known as calculus or tartar. Bacteria become extremely difficult to remove, similar to a barnacle on the back of a seashell.

The only way to remove bacteria deep below the gum line is with scaling and root planing treatment.


Periodontal probings

The periodontal probe is an essential instrument to assess and evaluate the gum attachment level within the sulcus, where the teeth and gum tissue meet. Your clinician or dental hygienist will record measurements within the gingival sulcus at six different sites.


Periodontal Testing and Probings gum recession process illustration | My Dental Advocate
  • Measurements of 1-3mm indicate the gum tissue is securely attached to the tooth. Therefore, the pockets are shallow and easier to clean when brushing, flossing, or using a Waterpik. If this is you, keep it up!
  • Measurements of 4 mm indicate the attachment below the gum line may be failing. The attachment fibers fail when bacteria congregate below the gum line and irritate the gum tissue.
  • Measurements of 5-7 mm indicate the attachment has been compromised and bacteria have advanced near the bone. This inflammatory process causes the bone to retreat from the bacterial source leading to bone loss. In addition, as the bacteria progress deeper below the gum line, it becomes more difficult for your hygienist to clean non-surgically.
  • Measurements of 8+ mm indicate advanced gum disease is present. Unfortunately, the hygenist cannot thoroughly remove the bacteria when it’s this deep below the gum line. You will most likely need to see a Periodontist (gum specialist) for surgical intervention to remove and arrest the bacteria properly. If the bacteria is not controlled, it can lead to infection and loss of teeth.

Your hygienist will most likely be measuring your gums; however, don’t be alarmed if your dentist chooses to record the measurements. Healthy gums don’t bleed, so if you taste blood after the probing is complete, you may have areas of inflammation, also known as gingivitis. Fortunately, this is reversible, so work with your clinician to improve home care before gum disease progresses.


How is periodontal disease diagnosed?

After gum measurements are recorded, your clinician will evaluate your x-rays, analyzing the bone level around your teeth. If bone loss is noted, the dentist will diagnose periodontal disease. The measurements confirm if the disease process is currently active or stable. An “active stage” means bacteria thrive subgingivally, causing severe inflammation, infection, and bone loss. Scaling and root planing will be diagnosed and is the first step to restoring your gums.

However, if bone loss is present, and your gum measurements are between 1 and 4 mm, your periodontal disease is most likely stable. However, don’t let your guard down, as you’re still at risk for active periodontitis in the future.


What happens during treatment?

Periodontal Disease Treatment | Ultrasonic teeth cleaning machine removing plaqueAs discussed earlier, scaling and root planing involves cleaning the bacteria deep below the gum line. Unfortunately, this process is uncomfortable for most individuals. There are multiple ways to achieve pain relief. Cetacaine is a needle-free topical solution applied within the gingival sulcus to prevent pain at the source. If more pain relief is needed, a local anesthetic can be administered.

After the gums are adequately numbed, your hygienist will use various hand instruments and an ultrasonic scaler to remove the tenacious calculus deep below the gum line. Don’t be alarmed if your gums bleed during this process; this is common. Your hygienist will complete half the mouth during the first visit and the other half at a future visit. Then, if time allows and you’re tolerating the procedure well, full mouth scaling can be completed. Lastly, the teeth are polished and flossed, and fluoride is applied if desired.


Common adjunctive procedures

Periodontal disease can be challenging to manage, and sometimes we have to throw the kitchen sink at it. We’re mechanically removing the bacteria during the scaling and root planing process; however, there are ways to fight the bacteria chemically. Let’s look at standard adjunctive procedures that the dentist or dental hygienist can use.


  1. Diode laser effectively kills bacteria when used in conjunction with scaling and root planing. The laser fiber is gently placed below the gum line around the affected tooth. The light energy produces heat, which raises the tissue temperature killing the bacteria at its source. Like how your body responds when you are sick, a fever occurs to fight off the pathogen.
  2. 2% Chlorhexidine Gluconate is an antiseptic and antimicrobial disinfectant commonly used in the dental office. This solution can be administered using an ultrasonic scaler or monoject syringe. It’s a safe and effective disinfectant that chemically attacks bacteria.
  3. Arestin is an antibiotic medication that can be applied at a depth of affected pockets. It’s effective at killing bacteria over many days. After it's used, they recommend avoiding flossing at the site for ten days which allows the medication to work over an extended period to decrease the pocket depth. Arestin works well in 6+ mm pockets because effective scaling at this depth can be challenging.

Postoperative instructions

Your clinician may inform you to avoid eating hot or spicy foods for the remainder of the day. Also, your teeth and gums may be sore and tender, so protect them from being damaged inadvertently. Brushing and flossing after is well tolerated and encouraged to maintain gingival health.

Periodontal disease is always present, so it’s essential to have routine periodontal maintenance to prevent re-infection. Periodontal maintenance will be recommended every 3 to 4 months, depending on your home care, medical history, and gum disease severity. If the dentist or dental hygienist cannot control the gum disease, further surgical intervention will be needed with a Periodontist.

Related: Best MDA Recommended Products


Final thoughts


Periodontal disease is prevalent in our population today; however, it's commonly underdiagnosed, which is unfortunate because, in addition to possible links with heart disease, the bacteria that cause gum disease are also associated with the development of Alzheimer’s disease and dementia. Have you recently been diagnosed with gum disease? Are you comfortable with your treatment plan? My Dental Advocate’s team of board-certified dentists can provide a second opinion on your planned treatment. We look forward to bringing you peace of mind by verifying your treatment plan, suggesting an alternative, or answering your questions.


Dr Advocate Avatar IconAbout the Author

Dr. Advocate is an actual board-certified dentist with clinical practice experience and a mission to provide accurate dental patient education. He believes everyone should access easy-to-read dental resources presented in layman’s terms with relevant, up-to-date dental research and insight to improve their oral health.




Scaling and root planing illustration of human teeth treatment | My Dental Advoctae

What Is Scaling & Root Planing?

Dr Advocate Avatar IconUpdated: September 1, 2022
By: Dr. Advocate

One of the most common diseases, affecting 48% of adults, is heart disease. But did you know there’s another disease nearly as prevalent and could indicate heart health? Periodontal disease, also called periodontitis or gum disease, is a severe infection that affects the gums and bone supporting the teeth. It’s caused by bacteria that have accumulated deep below your gum line.

According to a recent Centers for Disease Control and Prevention (CDC) report, 47% of adults 30 years and older have periodontal disease. The prevalence increases with age, as 70% of adults 65 years and older have periodontal disease. Researchers are still working to identify a link, but gum disease could be a risk factor for heart disease. The good news is that the dentist or dental hygienist can treat gum disease early and effectively - it starts with scaling and root planing.


What is scaling and root planing?

Scaling and root planing (SRP), also known as deep cleaning, removes bacteria above and below the gum line when inflammation and bone loss are present, known as periodontitis. As we discussed in the prophylaxis section, bacteria thrive in difficult areas to clean.

Below the gumline is home to the most aggressive bacteria in your mouth. They embed deep into the gum tissue and adhere to the root surface if they’re not removed. Initially, they assemble into a sticky solution known as plaque, and over time they form “rock-like” crystals known as calculus or tartar. Bacteria become extremely difficult to remove, similar to a barnacle on the back of a seashell. The only way to remove bacteria deep below the gum line is with scaling and root planing treatment.


Periodontal probings

The periodontal probe is an essential instrument to assess and evaluate the gum attachment level within the sulcus, where the teeth and gum tissue meet. Your clinician or dental hygienist will record measurements within the gingival sulcus at six different sites.


Periodontal Testing and Probings gum recession process illustration | My Dental Advocate
  • Measurements of 1-3mm indicate the gum tissue is securely attached to the tooth. Therefore, the pockets are shallow and easier to clean when brushing, flossing, or using a Waterpik. If this is you, keep it up!
  • Measurements of 4 mm indicate the attachment below the gum line may be failing. The attachment fibers fail when bacteria congregate below the gum line and irritate the gum tissue.
  • Measurements of 5-7 mm indicate the attachment has been compromised and bacteria have advanced near the bone. This inflammatory process causes the bone to retreat from the bacterial source leading to bone loss. In addition, as the bacteria progress deeper below the gum line, it becomes more difficult for your hygienist to clean non-surgically.
  • Measurements of 8+ mm indicate advanced gum disease is present. Unfortunately, the hygenist cannot thoroughly remove the bacteria when it’s this deep below the gum line. You will most likely need to see a Periodontist (gum specialist) for surgical intervention to remove and arrest the bacteria properly. If the bacteria is not controlled, it can lead to infection and loss of teeth.

Your hygienist will most likely be measuring your gums; however, don’t be alarmed if your dentist chooses to record the measurements. Healthy gums don’t bleed, so if you taste blood after the probing is complete, you may have areas of inflammation, also known as gingivitis. Fortunately, this is reversible, so work with your clinician to improve home care before gum disease progresses.


How is periodontal
disease diagnosed?

After gum measurements are recorded, your clinician will evaluate your x-rays, analyzing the bone level around your teeth. If bone loss is noted, the dentist will diagnose periodontal disease. The measurements confirm if the disease process is currently active or stable. An “active stage” means bacteria thrive subgingivally, causing severe inflammation, infection, and bone loss. Scaling and root planing will be diagnosed and is the first step to restoring your gums.

However, if bone loss is present, and your gum measurements are between 1 and 4 mm, your periodontal disease is most likely stable. However, don’t let your guard down, as you’re still at risk for active periodontitis in the future.


What happens during treatment?

Periodontal Disease Treatment | Ultrasonic teeth cleaning machine removing plaque

As we’ve discussed earlier, scaling and root planing involves cleaning the bacteria deep below the gum line. Unfortunately, this process is uncomfortable for most individuals. The good news is there are multiple ways to achieve pain relief. Cetacaine is a commonly used needle-free topical numbing solution that’s applied within the gingival sulcus to prevent pain at the source. If more relief is necessary, local anesthetic can be administered.

After the gums are adequately numbed, your hygienist will use various hand instruments and an ultrasonic scaler to remove the tenacious calculus deep below the gum line. Don’t be alarmed if your gums bleed during this process, this is common. Your hygienist will complete half the mouth during the first visit and the other half at a future visit. If time allows and you’re tolerating the procedure well, full mouth scaling can be completed. Lastly, the teeth are polished, flossed and fluoride is applied, if desired.


Common adjunctive procedures

Periodontal disease can be challenging to manage, and sometimes we have to throw the kitchen sink at it. We’re mechanically removing the bacteria during the scaling and root planing process; however, there are ways to fight the bacteria chemically. Let’s look at standard adjunctive procedures that the dentist or dental hygienist can use.


  1. Diode laser effectively kills bacteria when used in conjunction with scaling and root planing. The laser fiber is gently placed below the gum line around the affected tooth. The light energy produces heat, which raises the tissue temperature killing the bacteria at its source. Like how your body responds when you are sick, a fever occurs to fight off the pathogen.
  2. 2% Chlorhexidine Gluconate is an antiseptic and antimicrobial disinfectant commonly used in the dental office. This solution can be administered using an ultrasonic scaler or monoject syringe. It’s a safe and effective disinfectant that chemically attacks bacteria.
  3. Arestin is an antibiotic medication that can be applied at a depth of affected pockets. It’s effective at killing bacteria over many days. After it's used, they recommend avoiding flossing at the site for ten days which allows the medication to work over an extended period to decrease the pocket depth. Arestin works well in 6+ mm pockets because effective scaling at this depth can be challenging.

Postoperative instructions

Your clinician may inform you to avoid eating hot or spicy foods for the remainder of the day. Also, your teeth and gums may be sore and tender, so protect them from being damaged inadvertently. Brushing and flossing after is well tolerated and encouraged to maintain gingival health.

Periodontal disease is always present, so it’s essential to have routine periodontal maintenance to prevent re-infection. Periodontal maintenance will be recommended every 3 to 4 months, depending on your home care, medical history, and gum disease severity. If the dentist or dental hygienist cannot control the gum disease, further surgical intervention will be needed with a Periodontist.

Related: Best MDA Recommended Products


Frequently asked questions (FAQ)


loader-image

If the bacteria is not removed, it will continue to cause destruction of your gums, supporting bone, and loss of teeth. In addition, some individuals are at an increased risk of periodontal disease because of their family and genetic history. Also, others may be prone to early-onset periodontal disease due to a more significant amount of aggressive bacteria. So be proactive before it’s too late.

Halitosis can be embarrassing! The tongue harbors many of the bacteria that cause bad breath. Be sure to brush your tongue each night to remove bacteria. If you take medication that causes dry mouth, this will also lead to more bacteria growth and greater chances of bad breath. Learn more about the best mouthwashes that eliminate halitosis-causing bacteria.

Yes, the bacteria that cause gum disease can be transmitted to other individuals in your home. The most common way is through kissing or sharing drinks. Commit to improving your oral health so you can break the cycle and empower your family to do the same.


Final thoughts


Periodontal disease is prevalent in our population today; however, it's commonly underdiagnosed, which is unfortunate because, in addition to possible links with heart disease, the bacteria that cause gum disease are also associated with the development of Alzheimer’s disease and dementia. Have you recently been diagnosed with gum disease? Are you comfortable with your treatment plan? My Dental Advocate’s team of board-certified dentists can provide a second opinion on your planned treatment. We look forward to bringing you peace of mind by verifying your treatment plan, suggesting an alternative, or answering your questions.


Dr Advocate Avatar Icon
About the Author

Dr. Advocate is an actual board-certified dentist with clinical practice experience and a mission to provide accurate dental patient education. He believes everyone should access easy-to-read dental resources presented in layman’s terms with relevant, up-to-date dental research and insight to improve their oral health.



Related Topics


Prophylaxis

Periodontal Maintenance


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