Deep cleaning (scaling) explained

Reviewed by Dr. Samar Fadavi, DDS

Short answer: A deep cleaning, also called scaling and root planing, removes hardened tartar and bacteria from below the gum line and smooths the root surfaces so gums can heal and reattach. It is recommended when gum pockets have deepened past what a regular cleaning can reach. The area is usually frozen, and most people return to normal routines the same day.

What a deep cleaning is, in plain words

A regular cleaning looks after the parts of the teeth you can see and the shallow space just under the gum line. That is the right visit for healthy gums. When gum disease has started to form deeper pockets around the teeth, plaque and tartar collect where a toothbrush, floss and a routine cleaning cannot reach. A deep cleaning is the treatment designed for those deeper areas.

The word scaling means removing tartar, the hard mineral deposit that forms when plaque is left on the teeth. Root planing means smoothing the root surface below the gum after the tartar is gone, so bacteria have a harder time sticking and the gum tissue can tighten back against the tooth. The two steps are almost always done together, which is why dental offices call the whole treatment scaling and root planing, or simply a deep cleaning.

This guide explains who needs a deep cleaning, what happens during the visit, how it feels, how to look after your mouth at home afterwards and what follow-up looks like. It is general information for patients in Scarborough, the Danforth and East Toronto. For how cleanings and gum care work at our clinic, see our family dentistry and check-ups page.

Regular cleaning versus deep cleaning

People are sometimes surprised when they come in expecting a routine cleaning and are told they need a deep cleaning instead. The difference comes down to where the bacteria and tartar are sitting.

• Regular cleaning (prophylaxis): for healthy gums or mild gingivitis. Plaque and tartar are removed from the visible tooth surfaces and just under the gum line, then the teeth are polished. It is usually done in one visit without freezing.
• Deep cleaning (scaling and root planing): for gums with pockets that have deepened because of periodontitis. Tartar is removed from the root surfaces deep inside those pockets, and the roots are smoothed. It is often done one section of the mouth at a time, usually with local freezing.
• Maintenance cleanings: after a deep cleaning, follow-up cleanings are often booked more often than a routine recall, so the deeper areas stay clean while the gums heal.

One way to picture it: a regular cleaning is like sweeping the floor, while a deep cleaning is like lifting the rug and cleaning underneath. If the rug has been hiding a mess for a while, sweeping alone will not fix it.

Signs you may need a deep cleaning

Only a dental exam can confirm whether you need a deep cleaning, but these signs suggest gum disease may have moved past the early stage:

• Gums that bleed when you brush or floss, especially if this has been going on for weeks or months.
• Red, puffy or tender gums.
• Bad breath or a bad taste that does not go away after brushing.
• Gums that seem to be pulling back, making teeth look longer.
• Spaces opening up between teeth, or teeth that feel slightly loose.
• Pus between the teeth and gums.
• A change in the way your teeth fit together when you bite.
• Food catching in new places between teeth.

Some people have very few symptoms. Gum disease is often quiet, especially in smokers, because smoking reduces bleeding and hides one of the main warning signs. That is why your dentist measures the gums at check-ups rather than relying on how your mouth feels.

How your dentist decides

The decision is based on measurements and x-rays, not guesswork. At an exam, the dentist or hygienist gently slides a thin, marked instrument called a periodontal probe between each tooth and the gum to measure the depth of the space. Healthy gums usually have shallow spaces. When the measurements are deeper, bleed when probed or show that the gum attachment has been lost, that points to periodontitis.

Dental x-rays show the bone that supports the teeth. Bone loss around the roots, or tartar visible on the roots, helps confirm the diagnosis. Your dentist will also look at gum recession, tooth movement and areas where plaque tends to collect. Our guide to the stages of gum disease explains how these findings are grouped, from gingivitis to advanced periodontitis.

A deep cleaning is not needed for everyone. If your pockets are shallow and the bleeding is from gingivitis only, a regular cleaning plus better brushing and flossing is usually enough. A deep cleaning may cover only one or two areas of the mouth, or all four quadrants, depending on where the pockets are.

What happens during a deep cleaning, step by step

1. Review and plan. Your dentist explains which areas need treatment and how many visits are planned. Many offices treat one or two quadrants per visit, though some treat the whole mouth in one longer appointment. Ask any questions before you start.
2. Freezing. Local anesthetic is usually used so the area is numb. Topical gel is placed first to make the injection more comfortable. If you are nervous, let the team know; our care for nervous patients page explains the options.
3. Scaling. An ultrasonic scaler, which uses gentle vibration and a stream of water, breaks up larger tartar deposits. Hand instruments called scalers and curettes then remove the remaining deposits from the root surfaces inside each pocket.
4. Root planing. The root surfaces are smoothed so they are less rough. Smooth roots make it harder for plaque to stick and easier for the gum to tighten back around the tooth.
5. Rinsing and checking. The pockets are rinsed. In some cases your dentist may place a medicated material inside a deep pocket or recommend a mouth rinse.
6. Home care instructions. Before you leave, you will be shown how to clean the treated areas while they heal and when to come back.

A visit for one or two quadrants often takes about an hour, although this depends on how much tartar is present and how deep the pockets are.

Does a deep cleaning hurt?

With freezing, most people feel pressure, vibration and scraping sounds rather than sharp pain. The ultrasonic scaler can feel tingly, and you may notice cold water spray. Raise your hand if you feel discomfort at any point; more freezing can be added.

After the freezing wears off, the gums are often tender for a day or two. Teeth may be sensitive to cold for a week or so, because root surfaces that were covered by tartar are now exposed to air and fluids. This sensitivity usually settles as the gums heal. A desensitizing toothpaste can help. Our guide to sensitive teeth explains more ways to manage it.

Aftercare: the first days

• Wait for the freezing to wear off before eating, so you do not bite your cheek, lip or tongue.
• Eat soft foods for the first day if your gums are tender: eggs, yogurt, soup that is warm rather than hot, pasta, rice, cooked vegetables.
• Brush gently with a soft brush the same evening. It may feel strange to brush tender gums, but keeping plaque off the treated area is what lets it heal.
• Rinse with warm salt water a few times a day for the first couple of days if your dentist recommends it: about half a teaspoon of salt in a cup of warm water.
• Use pain relief as directed if needed. Over-the-counter pain relievers usually manage the tenderness. Follow the package instructions and check with your pharmacist if you take other medicines.
• Avoid smoking for as long as you can. Smoking slows healing and is one of the main reasons gum disease returns.
• Skip very hot, spicy, crunchy or sharp foods like chips and nuts for a day or two.

If your dentist prescribed a mouth rinse or other medicine, use it exactly as directed. Some prescription rinses can stain teeth if used for a long time, so follow the time frame you are given.

Healing over the following weeks

In the weeks after a deep cleaning, the gums usually become less red, less puffy and bleed less. As the swelling goes down, the gum may tighten and sit slightly lower on the tooth. This can make the teeth look a little longer or leave small spaces between them, especially near the front teeth. That change reflects the swelling leaving the tissue; it does not mean the treatment caused damage.

Sensitivity to cold often improves within a few weeks. If it continues, your dentist can apply a fluoride varnish or a desensitizing agent.

Your dentist will usually book a re-evaluation visit several weeks after treatment. At this visit the pockets are measured again. Many pockets become shallower once the inflammation settles. If some areas are still deep, your dentist will talk with you about the next steps, which may include more localized treatment or a referral to a periodontist, a dentist who focuses on gum treatment.

What to avoid after a deep cleaning

• Skipping brushing and flossing because the gums feel tender. Gentle cleaning helps healing; skipping it lets plaque return.
• Brushing hard with a firm brush. Use a soft brush and small circles.
• Smoking or vaping. Both reduce blood flow to the gums.
• Missing the re-evaluation and maintenance visits. A deep cleaning starts the healing; regular follow-up keeps it going.
• Using whitening products right away while teeth are sensitive. Wait until your dentist says the gums have settled.

Keeping gums healthy after treatment

A deep cleaning removes the bacteria and tartar that have built up, but gum disease can come back if plaque returns. What happens at home over the following months matters a great deal.

• Brush twice a day for two minutes with a fluoride toothpaste. Angle the brush toward the gum line. A powered toothbrush can make this easier for many people.
• Clean between your teeth every day. Floss, interdental brushes or a water flosser all work; the right choice depends on the spaces between your teeth. Interdental brushes are often easier when gums have pulled back. Our guide on why flossing matters shows how.
• Keep maintenance visits. After periodontitis, many people need cleanings every three or four months rather than every six. Your dentist will suggest the interval that suits your gums.
• Manage health conditions. Diabetes that is not well controlled makes gum disease harder to control. Tell your dentist about changes in your health and medicines.
• Quit smoking if you smoke. It is one of the most helpful changes you can make for your gums. Your doctor or pharmacist can help with quit-smoking options.

Who is more likely to need a deep cleaning

Anyone can develop gum disease, but some factors raise the risk:

• Smoking or other tobacco use.
• Diabetes, especially when blood sugar is not well controlled.
• A family history of gum disease.
• Pregnancy, because hormone changes make gums more reactive. See our guide on pregnancy and your teeth and gums.
• Dry mouth from medicines, common in older adults.
• Crowded or overlapping teeth that are hard to clean.
• Long gaps between dental visits.
• Stress and poor sleep, which can affect the body’s response to infection.

Gum health and the rest of your body

Gum disease is an infection and inflammation of the tissues that hold the teeth. Health organizations have noted links between gum disease and other conditions, including diabetes and heart disease. Diabetes and gum disease affect each other: high blood sugar makes gum infection harder to control, and gum inflammation can make blood sugar harder to manage. Treating gum disease is part of looking after your overall health. Our guide on oral health and overall health explains these links in more detail.

If you have a heart condition, an artificial joint or another medical condition, tell your dentist before a deep cleaning. In some specific situations your doctor or dentist may recommend antibiotics before treatment.

Coverage and planning

Scaling is a common dental service and is often included in dental insurance plans, usually measured in time units. Plans vary in how much scaling they include in a year. The Canadian Dental Care Plan includes scaling among its preventive services, with frequency limits. Before treatment, our team can send a predetermination to your insurer and give you a written estimate, so you know what your plan includes. We direct bill most insurers and see Canadian Dental Care Plan patients; our CDCP dentist page explains how coverage works here.

When to see a dentist

Book a visit if your gums bleed when you brush or floss, if you notice receding gums, loose teeth, a persistent bad taste or pus near a tooth. Call sooner if a gum area becomes swollen and painful, because this can be a gum abscess. Our emergency dentist page explains same-day visits. For routine cleanings, gum assessments and follow-up care, see our family dentistry and check-ups page.

Questions about deep cleaning

Is a deep cleaning the same as a regular cleaning, just longer?

No. A regular cleaning works on the tooth surfaces and just below the gum. A deep cleaning works on the root surfaces inside deeper gum pockets, usually with freezing.

Can a deep cleaning damage my teeth?

No. It removes tartar and smooths the roots. Teeth may feel more sensitive or look slightly longer as swollen gums shrink, which reflects healing.

Why do my teeth feel loose after a deep cleaning?

Tartar can act like a splint. When it is removed and gums are still swollen, a tooth may feel slightly looser for a short time. This often improves as the gums tighten. Tell your dentist if it gets worse.

How many visits will I need?

It depends on how many areas need treatment. Some people need one visit; others need two to four, plus a re-evaluation visit.

Will gum disease come back after a deep cleaning?

It can, if plaque builds up again. Daily brushing and cleaning between teeth, not smoking and regular maintenance visits help keep it under control.

Can I go back to work after a deep cleaning?

Most people do. Your lips and cheeks may stay numb for a few hours, so plan meals around that.

Do I need antibiotics with a deep cleaning?

Most people do not. Your dentist may suggest a medicated rinse or a local treatment in deep pockets, or antibiotics for certain medical conditions or severe infection.

Can children need a deep cleaning?

It is uncommon. Children more often have gingivitis, which responds to regular cleanings and better home care.