Scaling and Root Planing in Kitchener

Deep Cleaning for Periodontitis and Deep Gum Pockets

Scaling and root planing—often called a deep cleaning—is a nonsurgical periodontal treatment used when plaque and calculus have accumulated below the gumline around teeth affected by periodontitis.

It is different from a routine dental cleaning.

At MI Dental in Kitchener, scaling and root planing is recommended only after assessing the periodontal condition. We consider probing measurements, clinical attachment loss, bleeding, gum recession, bone levels on appropriate dental X-rays, subgingival calculus and other findings before determining whether periodontal treatment is required.

For many patients with periodontitis, subgingival instrumentation is a fundamental part of active periodontal treatment.

Scaling and Root Planing at a Glance

Question	General answer
Is this the same as a regular cleaning?	No. It treats affected root surfaces beneath the gumline in patients diagnosed with periodontitis
Is it a “deep cleaning”?	That is the common patient term; scaling and root planing or subgingival instrumentation is more precise
Does bleeding mean I need it?	No. Bleeding alone does not establish a need for periodontal treatment
Will I be frozen?	Local anaesthetic may be used when needed for comfort
How many appointments are needed?	It depends on how many areas are affected and the complexity of treatment
Does it cure periodontitis?	It can substantially improve periodontal health, but long-term maintenance remains important
Will my gums grow back?	Inflammation and pocket depth may decrease, but lost bone and attachment do not routinely regenerate
Will I need surgery?	Not necessarily. Many sites respond well to nonsurgical care
How often will I need maintenance?	The interval is individualized according to disease history, response and risk factors

What Is Scaling and Root Planing?

The treatment has traditionally been described as two components.

Scaling

Scaling removes plaque, calculus and other deposits from tooth and root surfaces, including areas below the gumline that cannot be cleaned effectively at home.

Both ultrasonic and hand instruments may be used.

Root Planing

Root planing traditionally refers to treating calculus-covered or contaminated root surfaces.

Modern periodontal guidelines increasingly use the broader term subgingival instrumentation. The objective is not to aggressively shave the root until it is perfectly smooth. It is to disrupt and remove subgingival plaque and deposits so inflammation can resolve and the area can be maintained more effectively. The EFP identifies subgingival instrumentation as the core second treatment step for Stage I–III periodontitis.

Regular Cleaning vs Deep Cleaning

The difference is more important than simply how far beneath the gums the instruments go.

Routine preventive cleaning

A routine cleaning is primarily intended to maintain periodontal health in someone who does not have established periodontitis requiring active subgingival treatment.

It removes plaque, staining and accessible calculus.

Scaling and root planing

Scaling and root planing is treatment for diagnosed periodontal disease.

It may involve:

• Instrumentation of affected roots below the gumline
• Treatment of periodontal pockets
• Local anaesthetic
• Treatment by selected teeth, areas or quadrants
• Subsequent periodontal re-evaluation

The fundamental difference is therefore the diagnosis and purpose of treatment, not simply whether the cleaning feels deeper.

The ADA recognizes scaling and root planing as a nonsurgical treatment for periodontitis.

Who Needs Scaling and Root Planing?

It may be recommended when periodontal examination shows findings such as:

• Periodontal attachment loss
• Periodontal pockets
• Subgingival plaque or calculus
• Bleeding and inflammation
• Radiographic bone loss
• Root surfaces that cannot be adequately managed through routine preventive care

But scaling and root planing should not automatically be recommended simply because someone has bleeding gums, visible tartar, gum recession, bad breath, has missed several cleanings or happens to be a new patient.

For example, gingivitis may produce considerable bleeding without the attachment and bone loss that defines periodontitis.

The complete periodontal picture matters.

Our Gum Disease Treatment page explains how periodontal disease is assessed, while our Periodontal Disease guide explains staging, grading and progression in greater detail.

How We Determine Whether Deep Cleaning Is Appropriate

A periodontal assessment may include:

Periodontal measurements

A periodontal probe is used around the teeth to assess:

• Probing depths
• Bleeding
• Recession
• Clinical attachment levels
• Furcation involvement
• Tooth mobility

Pocket depth alone does not determine the diagnosis.

Dental X-rays

Appropriate radiographs help evaluate:

• Supporting bone levels
• Patterns of bone loss
• Root anatomy
• Furcation areas
• Calculus
• Existing restorations
• Other conditions affecting tooth prognosis

Risk factors

Smoking, diabetes, previous periodontal treatment, home-care effectiveness and history of tooth loss can influence periodontal risk and treatment planning.

What Happens During Scaling and Root Planing?

1. Periodontal assessment

The areas requiring treatment are identified before instrumentation begins.

2. Local anaesthetic when needed

Local anaesthetic may be used for deeper or sensitive areas so treatment can be performed comfortably.

3. Ultrasonic and hand instrumentation

Ultrasonic scalers use rapidly vibrating tips with water irrigation to remove deposits. Specialized hand instruments allow the clinician to detect and treat specific root surfaces and anatomical areas.

The two techniques complement one another.

4. Treatment of the affected areas

Treatment may involve:

• Selected teeth
• One quadrant
• Two quadrants
• Half of the mouth
• More extensive treatment

There is no universal rule that exactly two quadrants must be treated at every appointment.

The number of appointments depends on the extent of disease, amount of calculus, anaesthetic requirements, patient comfort and treatment complexity.

Does Scaling and Root Planing Hurt?

Local anaesthetic can be used when required, allowing most patients to remain comfortable during treatment.

You may notice pressure, vibration, water spray and movement of the instruments.

After treatment, temporary effects may include:

• Gum tenderness
• Mild bleeding
• Cold sensitivity
• Root sensitivity

Significant or worsening pain should be reported rather than assumed to be a normal part of healing.

What Results Can Deep Cleaning Achieve?

Successful nonsurgical periodontal treatment may result in:

• Less bleeding
• Reduced inflammation
• Shallower periodontal pockets
• Firmer gum tissues
• Improved access for daily cleaning
• Better periodontal stability

The ADA guideline supports scaling and root planing as an effective initial nonsurgical treatment for periodontitis.

However, treatment does not guarantee that every periodontal pocket will disappear or that all previously lost attachment and bone will regenerate.

Response varies between patients and even between different sites in the same mouth.

Will My Gums Reattach After Deep Cleaning?

As periodontal inflammation resolves:

• Swelling may decrease
• Bleeding may improve
• Tissues may become firmer
• Probing depths may decrease
• The gum may adapt more closely to the cleaned tooth surface

That should not be confused with complete regeneration of previously destroyed periodontal ligament and bone.

Selected periodontal defects may be suitable for regenerative surgery, but that is a different treatment.

Why Can My Teeth Look Longer After Deep Cleaning?

This occasionally surprises patients.

Inflamed gums can be swollen and enlarged. As treatment reduces inflammation, the tissues may shrink toward a healthier contour.

If periodontal attachment and bone had already been lost, this can make:

• Teeth appear longer
• Existing recession more visible
• Spaces between teeth appear larger

The treatment did not necessarily cause the tissue loss. It can reveal the true gum position after the swelling resolves.

Why Are My Teeth Sensitive Afterward?

Periodontitis can expose root surfaces.

Once deposits have been removed and inflammation decreases, these surfaces may temporarily become more sensitive to:

• Cold
• Air
• Touch
• Brushing

Sensitivity often improves with time.

Desensitizing toothpaste, fluoride or other professional treatments may be recommended when necessary.

Persistent sensitivity affecting one particular tooth should be assessed because recession is not the only possible cause.

Can My Teeth Feel Looser After Treatment?

Periodontitis can make teeth mobile by destroying the bone and attachment supporting them.

Heavy calculus deposits can sometimes bridge neighbouring teeth and make them feel more rigid than their actual periodontal support would suggest.

After deposits are removed, existing mobility may become more noticeable.

Scaling and root planing does not create the underlying periodontal bone loss.

What Happens After Scaling and Root Planing?

This is one of the most important parts of periodontal treatment.

We do not simply finish the deep cleaning and assume that the disease is controlled.

After appropriate healing, the gums are reassessed.

We may evaluate:

• Plaque control
• Bleeding
• Probing depths
• Remaining deep pockets
• Gum recession
• Tooth mobility
• Furcation areas
• Patient comfort and sensitivity

Periodontal guidelines use a stepwise model: risk-factor and plaque control, subgingival instrumentation, reassessment and additional treatment where required, followed by supportive periodontal care.

What If Deep Pockets Remain?

Some periodontal sites are more difficult to treat because of:

• Very deep initial pockets
• Complex root anatomy
• Furcation involvement
• Vertical bone defects
• Difficult access
• Advanced attachment loss
• Smoking
• Poor plaque control

Persistent disease may lead to:

• Additional nonsurgical instrumentation
• Modification of home care
• Closer periodontal maintenance
• Periodontist referral
• Periodontal surgery
• Regenerative treatment
• Extraction when a tooth has an unfavourable prognosis

Nonsurgical treatment is the foundation, but deeper defects and advanced cases sometimes require treatment beyond subgingival instrumentation.

Will I Need Periodontal Surgery?

Not necessarily.

Many periodontal sites respond well to nonsurgical care.

Surgery or periodontist referral may be considered when clinically significant problems remain, such as persistent deep pockets, vertical bone defects, complex furcations, advanced bone loss or sites that may benefit from regenerative treatment.

The decision is made after evaluating the response to initial therapy, rather than assuming every patient with periodontitis requires surgery.

What About Antibiotics or Lasers?

Neither routinely replaces proper periodontal instrumentation.

Systemic or local antimicrobial treatment may be appropriate in selected circumstances, but scaling and root planing, effective daily plaque control, risk-factor management and re-evaluation remain central to nonsurgical periodontal care. The ADA guideline evaluates adjunctive treatments specifically as additions to—not substitutes for—SRP.

MI Dental also has dental laser technology. Lasers may have selected applications, but we do not present them as a shortcut that sterilizes periodontal pockets or cures periodontitis.

Periodontal Maintenance After Deep Cleaning

Scaling and root planing is active periodontal treatment.

After the disease has responded appropriately, patients with a history of periodontitis generally move into supportive periodontal care.

Maintenance may involve:

• Periodontal monitoring
• Plaque and bleeding assessment
• Professional removal of deposits
• Subgingival instrumentation where needed
• Monitoring of pockets, recession and mobility
• Home-care reinforcement
• Risk-factor review
• Appropriate dental X-rays when indicated

Supportive periodontal care is the fourth step of the EFP treatment pathway rather than an optional extra after active treatment.

Is Periodontal Maintenance Always Every Three Months?

No.

Three- or four-month intervals are common for many patients with a history of moderate or advanced periodontal disease, but the schedule should be individualized.

It may depend on:

• Disease stage and grade
• Remaining pockets
• Previous disease progression
• Smoking
• Diabetes
• Plaque control
• Bleeding
• Furcation involvement
• Response to treatment

The important distinction is that a patient successfully treated for periodontitis should not automatically be returned to an ordinary six-month preventive schedule without considering their periodontal risk.

Home Care After Periodontal Treatment

Professional treatment works best when plaque is also controlled between visits.

Patients are generally encouraged to brush twice daily with fluoride toothpaste and clean between their teeth daily using tools appropriate for their anatomy.

Depending on the spaces, this may include:

• Dental floss
• Expanding floss
• Interdental brushes
• Water flossers
• Specialized products for bridges or implants

Patients with periodontal attachment loss often have larger interdental spaces where appropriately sized interdental brushes may be useful.

Our Choosing an Electric or Manual Toothbrush and Types of Dental Floss guides cover these subjects in detail, so we do not need to turn this page into another home-care textbook.

How Much Does Scaling and Root Planing Cost?

The fee depends on the amount and complexity of periodontal treatment required.

Factors may include:

• Number of teeth or areas affected
• Number of quadrants requiring treatment
• Amount and location of calculus
• Appointment length
• Need for local anaesthetic
• Periodontal complexity
• Follow-up and maintenance requirements

Some patients require treatment only in selected areas. Others have generalized periodontal disease.

After assessment, MI Dental explains which areas require treatment, why it is recommended, the anticipated number of appointments, applicable fees and the proposed follow-up.

Dental-plan reimbursement depends on the individual insurance contract and does not determine the clinical diagnosis.

Why Choose MI Dental for Scaling and Root Planing?

Diagnosis before treatment

We do not recommend a deep cleaning simply because gums bleed or a patient has missed several cleaning appointments.

Individualized periodontal assessment

Pocket depths are considered alongside attachment levels, recession, bone levels, inflammation and other clinical findings.

Treatment tailored to the mouth

The number of areas and appointments is based on the actual periodontal condition rather than a fixed formula.

Comfort when needed

Local anaesthetic can be used for deeper or sensitive treatment areas.

Appropriate instrumentation

Ultrasonic and hand instruments are selected according to deposits, anatomy and clinical needs.

Re-evaluation

We assess how the tissues responded before deciding what happens next.

Long-term maintenance

Patients with treated periodontitis receive an individualized supportive-care recommendation.

Specialist referral when appropriate

Advanced or persistent periodontal problems are referred when specialist care is likely to provide a more predictable outcome.

Frequently Asked Questions About Scaling and Root Planing

What is scaling and root planing?

Scaling and root planing is nonsurgical periodontal treatment used to remove plaque and calculus from affected tooth and root surfaces beneath the gumline.

It is commonly called a deep cleaning.

Is scaling and root planing the same as a deep cleaning?

Yes. “Deep cleaning” is the common patient term.

Scaling and root planing or subgingival periodontal instrumentation is the more precise clinical terminology.

How is a deep cleaning different from a regular cleaning?

A routine cleaning primarily maintains periodontal health.

Scaling and root planing treats affected root surfaces beneath the gumline when periodontitis has been diagnosed.

Do bleeding gums mean I need a deep cleaning?

No.

Bleeding can indicate inflammation, but the need for periodontal treatment depends on attachment levels, probing measurements, bone levels, calculus and other findings.

Is scaling and root planing painful?

Local anaesthetic may be used to keep the areas comfortable.

Temporary tenderness or sensitivity may occur afterward.

How many appointments will I need?

There is no standard number.

Treatment may involve selected teeth, one or more quadrants or more extensive areas depending on the extent and complexity of the disease.

Can deep cleaning cure periodontitis?

Scaling and root planing can substantially improve periodontal inflammation and pocket conditions, but it does not erase the patient’s history of periodontitis or regenerate all previously lost bone and attachment.

Why do my teeth look longer after deep cleaning?

As swollen gums become healthier and less inflamed, their true position may become more visible. Existing recession or attachment loss can therefore appear more noticeable.

Why are my teeth sensitive afterward?

Previously covered root surfaces may become more exposed after deposits are removed and inflammation decreases.

Temporary sensitivity often improves with time.

Will I need periodontal surgery?

Not necessarily.

Many periodontal sites respond well to nonsurgical treatment. Persistent deep pockets or complex defects may require additional therapy or specialist referral.

Do I need antibiotics?

Usually not.

Antibiotics and other antimicrobial treatments are reserved for selected situations and do not replace proper periodontal instrumentation.

Will I need cleanings every three months forever?

Not necessarily.

Periodontal-maintenance intervals are individualized according to disease history, stability, plaque control and risk factors.

Can gum disease return after scaling and root planing?

Yes.

Periodontitis can recur or progress, which is why daily plaque control, risk-factor management and supportive periodontal maintenance remain important.

Can I return to work after deep cleaning?

Most patients can return to their normal activities, although temporary numbness, tenderness or sensitivity may occur.

Request a Periodontal Assessment in Kitchener

Scaling and root planing should not be prescribed simply because someone has bleeding gums or has been told they need a “deep cleaning.”

The first step is determining whether periodontitis is present, which areas are affected and what level of treatment is appropriate.

At MI Dental, we use periodontal measurements, clinical examination, appropriate dental imaging and individual risk factors to make that determination.

Call MI Dental at (519) 894-9444 or contact our office to arrange a periodontal assessment in Kitchener.