Professional teeth cleaning explained

You may have been told you need a scale and polish, or a deep clean, and the two can sound like one thing. They are different, and not everyone needs either on a fixed schedule.

What is a scale and polish?

The NHS describes a scale and polish as a clean by the hygienist that carefully removes the plaque and tartar that build up on your teeth. Tartar, also called calculus, is hardened plaque. A 2018 Cochrane review says it is so hard that toothbrushing alone cannot remove it.

The review describes the two parts. Scaling removes plaque, tartar, debris and staining, using hand instruments or ultrasonic scalers. Polishing then removes stain that is left, usually with a paste on a rubber cup or brush. The Scottish dental guidance adds that air polishing removes soft plaque but not tartar, so hand or powered instruments are still needed where tartar is present. The same guidance says hygienists and dental therapists can see you directly, within their scope of practice, or treat you under a plan agreed with a dentist.

What is deep cleaning?

Deep cleaning is the everyday name for cleaning below the gum. The NHS lists deep cleaning under your gums among the treatments you may need if gum disease is serious. Dental teams call it subgingival instrumentation, or subgingival professional mechanical plaque removal. It cleans plaque, tartar and endotoxin, a bacterial toxin, from the root surfaces of the teeth.

What you may hear	What it removes	Where
Scale and polish	Plaque, tartar, stain	Tooth crown, mostly above the gum
Deep cleaning	Plaque, tartar, endotoxin	Tooth root, below the gum

Calculus just below the gum that is easy to reach can also be removed during the first stage of care, according to the Scottish guidance. It lists scale and polish, root planing and root surface debridement among the older terms for professional cleaning, so you may still hear any of them.

The British Society of Periodontology and Implant Dentistry (BSP) sets out the order of care for periodontitis in its UK guideline. First comes an explanation, help with cleaning at home and with risk factors such as smoking, and often a first professional clean. The team then re-checks your home cleaning. If it has improved enough, deep cleaning is next, and if not, the first step is repeated. Your gums are checked again about 3 months later. Areas that have not settled may need more cleaning or a referral to a specialist. Once your gums are stable, you move to supportive care, with visits every 3 to 12 months set for you. Our guide to gum disease covers the whole pathway.

Clinical results for periodontitis are the same whether deep cleaning is done in one or two long appointments within 24 hours or across several shorter ones, the Scottish guidance says.

Do you need a professional clean?

The government’s prevention toolkit for dental teams says no clinical benefits of routine scale and polish have been demonstrated for adults with good gum health. It also says professional care plays an important role for people with advanced gum disease.

The toolkit cites a Cochrane review of planned cleans every 6 or 12 months in adults without severe gum disease who attended regularly. It found two trials, with 1,711 people in UK general dental practices, followed for 24 and 36 months.

• Gum inflammation, pocket depth and quality of life differed little or not at all between six-monthly, 12-monthly and no scheduled cleans. The review rates this high-certainty evidence.
• Planned cleans slightly reduced tartar. The review says it is unclear whether that matters to patients or dentists.
• People who had the cleans said their teeth felt cleaner, though the review rates that evidence low-certainty.

The review searched for trials up to January 2018. Both trials it found studied adults without severe gum disease who attended a UK dentist regularly, so they say little about people with severe gum disease.

Professional care can still help. The toolkit says tartar, or a filling edge that sticks out and traps plaque, may need removing if your gums show signs of disease. It may not be needed if there are no signs of gum inflammation (gingivitis). The NHS says that in early gum disease your dentist may advise a clean by a hygienist. A Scottish patient leaflet adds that removing hardened plaque can help you clean better at home.

How often depends on your own gums. The BSP says a Basic Periodontal Examination (BPE) score, a measure of your gum health, should be part of a routine check, and that it is worth asking your dentist what yours means.

What does it feel like, and what happens afterwards?

Comfort varies. The Scottish guidance says some patients feel pain during and after cleaning below the gum, and that local anaesthetic can make treatment more comfortable. The BSP says you can ask for an injection to numb your gums and teeth if you prefer. If you are nervous, tell the team before you start. Our page for nervous patients explains how we help.

After treatment for gum disease, the BSP says:

• your gums are likely to bleed more at first, which is normal and improves, so keep cleaning
• as gums get healthier they may shrink, so spaces can appear between teeth and teeth can look longer
• teeth may feel more sensitive to hot, cold or sweet things, usually settling within a few weeks, though some people need a sensitivity toothpaste or other treatment

After cleaning below the gum for gum disease, around half of patients may notice more sensitivity, especially if their teeth were sensitive before, says the Scottish guidance. The Cochrane review notes that scaling has been linked to tooth surface damage and sensitivity, but its two trials did not measure side effects.

What helps a clean work?

Cleaning at home is part of the treatment, and the NHS says to clean between your teeth every day with floss or interdental brushes. The BSP says regular, effective plaque removal by you offers the largest treatment benefit, and its patient leaflet says gum disease treatment will only work if you clean your teeth properly, twice a day, to a high standard. Our guides to plaque and bleeding gums cover the daily routine.

A Scottish patient leaflet says gums may bleed when you start cleaning them properly, that this comes from inflammation and not damage, and that it should settle after a few weeks. It also says stopping smoking, if you smoke, makes gum disease treatment more successful. Tell your dental team about any health conditions and the medicines you take, because the BSP says some conditions change how gum disease is managed.

When to see a dentist

For an emergency or out of hours, the NHS says to call your dentist first, since their answerphone may tell you what to do. If you have no dentist or cannot get an emergency appointment, it says to call 111.

Periodontitis is not always painful and you might not know you have it, says the Scottish leaflet. The NHS says to see a dentist if you have not had a check-up for 2 years, or 1 year if you are under 18. It advises regular check-ups with a dentist and a hygienist, especially if you are pregnant or have type 2 diabetes.

Gum disease can lead to a dental abscess, the NHS says. Our guide to tooth infection and abscess covers the signs and what to do.

What we would do

If it has been a while, a new patient exam comes first. We examine your teeth, gums and soft tissues, take small X-rays where needed and explain what we find.

At a dental hygiene appointment, your hygienist checks your gum health and looks for plaque build-up and early signs of gum disease. They then clean and scale your teeth and finish with a polish, and advise you on brushing and flossing. Most appointments take 20 to 30 minutes, and how often you come back is set after your dentist or hygienist has checked your gums.

Our price list shows single, double and triple hygiene and periodontal sessions. EMS Airflow, which uses a fine powder and warm water to remove surface staining, is an add-on to a hygiene visit. Where a gum pocket has not settled with cleaning alone, a perio chip can be placed after a periodontal clean, alongside it and not instead of it.

If you are unsure which of these you need, book an appointment and your dentist or hygienist can check your gums and tell you.

Want us to take a look?

Book an appointment at whichever of our five practices suits you. We will check what is going on and talk you through your options.

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