How periodontal scaling is done, step by step

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Periodontal scaling (scaling and root planing, often called a "deep cleaning") is the treatment that removes plaque and tartar that have built up below the gumline, inside the periodontal pockets, and smooths the root surface so the tissue can heal. Unlike a routine cleaning, which works above the gums and prevents problems, scaling treats a disease that's already present.

Knowing how it's done usually eases a lot of the anxiety for people who've been told they need it — because most of the discomfort people imagine comes from not knowing what will happen.

In this article, Dr. Cléo Salustiano (CRO-SP 170844) describes the process step by step, from the initial exam to the re-evaluation, and explains what each stage takes care of.

This article comes from Dr. Cléo Salustiano's dental office in Mooca, São Paulo (care in English, Portuguese and Spanish). See the gum health page to learn how the treatment is done here and book your assessment.

Step by step

1. Periodontal exam with probing. The depth around each tooth is measured and bleeding and recession are recorded. X-rays show bone levels. It's the map that guides treatment and serves as a comparison later.
2. Plan and preparation. The areas to be treated and the number of sessions are defined. Tartar above the gumline is removed and home hygiene technique is reviewed.
3. Local anesthesia in the area. Applied to the part of the mouth being treated in that session, so the instrument can work inside the pockets comfortably.
4. Tartar removal below the gumline. Done with ultrasonic instruments and hand curettes, often combined, reaching the root surface inside the periodontal pocket.
5. Root planing. The root surface is left smooth and clean, with no irregularities where plaque could stick again, allowing the gums to readapt against the tooth.
6. Follow-up sessions, by area. Treatment is divided by sections of the mouth, which increases comfort and lets you chew normally on the side not yet treated.
7. Re-evaluation weeks later. New probing, compared with the initial mapping. What responded well moves into maintenance; what still has deep pockets may need an additional approach.
8. Periodontal maintenance. Regular return visits, at an interval set for the case, removing new buildup and re-measuring the pockets to keep the disease stable.

What happens at each stage of scaling?

It all starts with a periodontal exam. Using a millimeter probe, the dentist measures the depth of the groove around each tooth. A shallow groove with no bleeding indicates healthy gums; deeper pockets, bleeding on probing and recession indicate periodontal disease. X-rays complement the exam by showing bone levels.

This mapping sets the plan: which areas need scaling, how many sessions and in what order. It's also the record against which improvement will be measured later — without it, there's no objective way to know whether treatment worked.

Before the scaling itself, tartar above the gumline is usually removed and your hygiene technique is reviewed. It seems like a minor step, but it isn't: scaling in a mouth that keeps building up plaque quickly loses its effect.

During the scaling session, local anesthesia is applied to the area being treated. This allows comfortable work inside the pockets, where the instrument needs to reach the root surface covered by tartar.

Removal is done with hand instruments (curettes) and ultrasonic instruments, often combined. The ultrasonic scaler breaks up hardened tartar; the curettes do the fine finishing, scraping the root surface and removing what's left inside the pocket.

Then comes root planing: the root surface is left smooth and clean, with no irregularities where plaque could stick again. This finishing is what allows the gum tissue to readapt against the tooth, reducing pocket depth.

Treatment is usually divided by areas of the mouth, with one or more sessions per section. Besides comfort, this lets you keep chewing normally on the side not yet treated.

A few weeks later comes the re-evaluation: new probing, compared with the initial mapping. Areas that responded well move into periodontal maintenance; areas that still have deep pockets or bleeding may require an additional approach.

What changes afterward, and how are the results sustained?

In the first few days, it's normal for your gums to feel tender and more reactive to cold, and for the area to be a bit sore to the touch. The discomfort is usually mild to moderate and eases over time. Toothpaste for sensitive teeth and avoiding very cold drinks help.

It's common to notice your gums sitting "lower" and gaps between your teeth after treatment. That's because the swelling went down and the tartar that filled those spaces is gone. It's not loss caused by the scaling — it's the real situation becoming visible, with the inflammation under control.

Home hygiene becomes part of the treatment, not an add-on. Gentle brushing along the gumline, daily flossing or an interdental brush as advised: that's what prevents buildup from returning inside the pockets that were just cleaned.

Risk factors are part of the plan. Cutting back or quitting smoking greatly improves healing and response; managing diabetes, together with your physician, has a direct effect on the gums. Ignoring these factors is what most often makes good scaling deliver less than it could.

Periodontal maintenance is what sustains the result. It consists of regular return visits, at an interval set for your case, where new buildup is removed and the pockets are measured again. Since periodontal disease progresses without pain, it's the probing measurements — not symptoms — that tell whether everything is stable.

And it's important to have the right expectations: scaling controls the disease and lets the gums heal and readapt, reducing pockets. Bone that has already been lost doesn't fully come back. That's why the goal is to stabilize and preserve what's there — and why treating early makes such a difference.

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