Deep Cleaning (Root Planing)

Deep cleaning removes the tartar and bacterial layer that have built up in the pockets below the gum, and leaves the root surface smooth, which is why it is also called root planing. The aim is to create conditions in which the gum can settle firmly back against the cleaned root, and to make the pockets shallower.

Deep cleaning is the second step of gum disease treatment and the foundation of treating periodontitis. In most patients it is enough to stop the disease without any need for surgery. It is also known as closed curettage or non-surgical periodontal therapy: the gum is not opened, and the work is done from inside the pocket.

How is it different from a scale and polish?

	Scale and polish	Deep cleaning
Where we work	Above the gum and at the gum line	Below the gum, down to the bottom of the pocket
Who it is for	Gingivitis, routine maintenance	Pockets of 4 mm or more, bone loss
Anaesthetic	Usually not needed	Local anaesthetic
Visits	Usually 1	Usually 2–4

Giving a patient who has pockets only a scale and polish means cleaning the visible part and leaving the real problem in place. The gum looks healed from the outside while the inflammation carries on inside the pocket.

Who needs it, and who does not?

Deep cleaning is planned when the pocket depth measured at the examination is 4 mm or more, when the pocket bleeds as it is measured and when bone loss shows on the X-ray. Patients who have only gingivitis, with no pockets, do not need it; for them a surface clean and home care are enough. Deep cleaning shallow, healthy areas can actually damage the gum's attachment to the root. That is why we do not recommend it without measuring first.

How is the procedure done?

The mouth is usually divided into four areas (quadrants), and one or two are treated at each visit. In some patients the whole mouth is completed within a day or two; studies show that the results of the two approaches are similar. We choose between them based on the number of pockets and your schedule.

1. Numbing. Local anaesthetic is given to the area being treated. You do not usually feel pain during the procedure; what you feel is pressure and vibration.
2. Cleaning below the gum. Fine ultrasonic tips and hand instruments with curved ends (curettes) are taken down to the bottom of the pocket. The tartar and bacterial layer on the root are removed.
3. Smoothing the root surface. The rough root surface is smoothed; bacteria find it harder to stick to a smooth surface, and the gum settles against it more easily.
4. Rinsing and checking. The pockets are rinsed and checked with a probe for any tartar left behind.

One area usually takes 45–60 minutes. Antibiotics are not given routinely; they are considered as support only in severe, rapidly progressing cases, at the dentist's discretion based on the measurements and your history. We may recommend an antiseptic mouthwash for a short period.

The days after deep cleaning

• Numbness lasts a few hours; until it wears off, avoid hot drinks and food that needs chewing.
• For the first day or two the gums may be tender and bleed slightly. An ordinary painkiller is usually enough.
• Root sensitivity to cold and heat is common and mostly eases within a few weeks.
• Keep brushing. Gentle but thorough cleaning with a soft brush is part of healing.
• Smoking slows healing markedly; taking a break from it during this period has a direct effect on the result.

What affects the result most?

Success is not measured only by what is done in the chair. Studies generally show pockets of moderate depth becoming a millimetre or two shallower; in deep pockets the reduction is greater, but it does not always bring the pocket down to a healthy level. The result depends most on the following:

• Home care. Using interdental brushes of the right size between your teeth is the most effective way to limit plaque building up again around the pockets. We work out together at the appointment which size fits which gap.
• Smoking. In smokers, pockets become less shallow, and inflammation can continue even when bleeding reduces.
• Diabetes. When blood sugar is well controlled, the gums respond better to treatment.
• Tooth anatomy. The areas where molar roots divide, and vertical bone defects, are harder to reach with the closed method.

Why are my gums receding and my teeth looking longer?

In the weeks after deep cleaning, the inflamed, swollen gum shrinks and tightens. This is the healing itself, but the gum margin may move a millimetre or two towards the root. The teeth may look a little longer and the gaps between them more noticeable. We tell you this in advance, because a patient who does not know may mistake healing for a new problem: as the pocket gets shallower, the gum margin dropping slightly is part of the same process.

What does the re-measurement after 6–8 weeks decide?

Once the gum has finished healing, usually within 6–8 weeks, we measure all the pockets again. Comparing them with the first measurements shows the result:

• If the pockets are below 4 mm and there is no bleeding: active treatment is complete, and you move on to supportive care every 3–6 months.
• If bleeding pockets of 4–5 mm remain: deep cleaning can be repeated in those areas.
• If pockets of 6 mm or more persist: it becomes difficult to reach the bottom of the pocket safely with the closed method, and in that case we discuss periodontal flap surgery.

If you are coming from outside İzmir, we can plan the gaps between visits around that; however, the re-measurement has to be done in person and cannot be assessed from photos. The cost depends on the number of areas to be treated and whether any of them need repeating; you receive a written, itemised quote after the examination.