Scaling and root planing, also known as conventional periodontal therapy, non-surgical periodontal therapy or deep cleaning, is a procedure involving removal of dental plaque and calculus (scaling or debridement) and then smoothing, or planing, of the (exposed) surfaces of the roots, removing cementum or dentine that is impregnated with calculus, toxins, or microorganisms,[1] the agents that cause inflammation.

Although everyone has a tendency to develop plaque and materia alba, through regular brushing and flossing these organized colonies of bacteria are disturbed and eliminated from the oral cavity.

However, if, after 24 hours in the oral environment, biofilm remains undisturbed by brushing or flossing, it begins to absorb the mineral content of saliva.

Through this absorption of calcium and phosphorus from the saliva, oral biofilm is transformed from the soft, easily removable form into a hard substance known as calculus.

As the gingivitis stage continues, the capillaries within the sulcus begin to dilate, resulting in more bleeding when brushing, flossing, or at dental appointments.

Because tooth brush and floss cannot reach the bottom of a gum pocket 4–5 mm deep, bacteria stagnate in these sites and have the opportunity to proliferate into periodontal disease-causing colonies.

This plaque eventually transforms into calculus, and the process continues, resulting in deposits under the gum, and an increase in pocket depth.

The cell walls of gram negative bacteria contain endotoxins, which allow these organisms to destroy gingival tissue and bone more quickly.

The first evidence of periodontal disease damage becomes apparent in radiographs as the crestal bone of the jaw begins to become blunted, slanted, or scooped out in appearance.

In periodontitis, however, the chemical mediators, or by-products, of chronic inflammation stimulate the osteoclasts, causing them to work more rapidly than the cells that build bone.

These processes will persist, causing greater damage, until the infectious bacterial agents (plaque) and local irritating factors (calculus) are removed.

Brushing and flossing are effective only at removing the soft materia alba and biofilm in supragingival areas, and in pockets up to 3 mm deep.

Therefore, in order to remove the causative factors that lead to periodontal disease, pocket depth scaling and root planing procedures are often recommended.

The inflammation dissipates as the infection declines, allowing the swelling to decrease which results in the gums once again forming an effective seal between the root of the tooth and the outside environment.

The term "deep cleaning" originates from the fact that pockets in patients with periodontal disease are literally deeper than those found in individuals with healthy periodontia.

The objective for periodontal scaling and root planing is to remove dental plaque and calculus (tartar), which house bacteria that release toxins which cause inflammation to the gum tissue and surrounding bone.

Since the bacteria living in periodontically involved pockets are mainly obligate anaerobes, meaning unable to survive in the presence of oxygen, these bubbles help to destroy them.

Alternatively, power scalers may be used following hand scaling in order to dispel deposits that have been removed from the tooth or root structure, but remain within the periodontal pocket.

Ultrasonic scalers also include a liquid output or lavage, which aids in cooling the tool during use, as well as rinsing all the unwanted materials from the teeth and gum line.

A recent European study suggests a link between the long-term use of the mouthrinse and high blood pressure, which may lead to a higher incidence of cardiovascular events.

Site specific antibiotics may also be placed in the periodontal pocket following scaling and root planing in order to provide additional healing of infected tissues.

Arestin, a site specific brand of the antibiotic minocycline, is claimed to enable regaining of at least 1 mm of gingival reattachment height.

Intervention may also include discontinuation of medication that contributes to the patient's vulnerability or referral to a physician to address an existing but previously untreated condition if it plays a role in the periodontal disease process.

Other advantages of full mouth ultrasonic debridement include speed/reduced treatment time, and reduced need for anaesthesia, with equivalent results to scaling and planing.

[12] Studies by the Leuven group, using somewhat different protocols, found that the one-stage treatment (i.e. in 24 hours) gave better results than the quadrant-by-quadrant approach (taking six weeks).

[14][7] In contrast to traditional scaling and root planing, the aim of some FMUD procedures is to disturb the bacterial biofilm within the periodontal pocket, without removing cementum.

[1] After examining two studies with 1711 participants, they concluded that routine scale and polish treatment for adults without severe periodontitis makes little to no difference for gingivitis, probing depths or oral health quality of life when compared to no scheduled care.

First and foremost, periodontal scaling and root planing is a procedure that must be done thoroughly and with attention to detail in order to ensure complete removal of all calculus and plaque from involved sites.

If the patient fails to change the factors that allowed the disease to set in – for example, not flossing or brushing only once a day – the infection will likely recur.

Gains in gingival attachment may occur slowly over time, and ongoing periodontal maintenance visits are usually recommended every three to four months to sustain health.