Deep Cleaning and Root Planing

When it may be needed

• People found to have periodontitis at an examination. Which areas are cleaned is decided by looking at the pocket measurements and the bleeding.
• Pockets that bleed again or become deeper during supportive care after treatment for periodontitis.

When it is not needed, or something else is considered first

• Healthy gums. A deep cleaning is not needed. Tartar above the gum line can be cleaned at check-ups; your dentist decides how often.
• Gingivitis only. Gingivitis can be reversed with better oral hygiene². Cleaning above the gum line and improving your oral hygiene is often enough.
• Receding gums without signs of disease. The receded area can be monitored³; cleaning does not reverse recession.

Situations that need care

• Smoking. Smoking weakens⁴ the response to treatment; stopping can prevent further deterioration.
• Diabetes, heart disease, blood thinners, pregnancy. Tell your dentist before treatment. Do not stop or change⁵ your blood thinner for dental treatment unless your doctor or dentist tells you to.
• Heart conditions and antibiotics. Antibiotics are sometimes given before dental treatment to prevent infective endocarditis, an infection of the inner lining of the heart. Two UK guidelines differ on this. The NICE guideline does not recommend them routinely⁶ before dental procedures. Scottish dental guidance says to consider them before procedures that involve the gums⁷ for patients at high risk of this infection. The decision is shared with the patient and takes account of advice from their heart team. Advice also differs between countries, so ask your dentist and your heart doctor what applies to you.

• Doing nothing. In periodontitis, the tartar below the gum stays where it is; tartar does not dissolve⁸ at home with a toothbrush, toothpaste or mouthwash.
• Improving oral hygiene. This is the basis of every step, but on its own it does not remove tartar below the gum.
• Routine scale and polish. This mainly cleans plaque and tartar above the gum line. There are studies of adults without severe gum disease who attend regular check-ups. These studies compared a routine scale and polish every 6 or 12 months with no scheduled scale and polish. Over 2 to 3 years, the routine cleaning made little or no difference⁹ to gingivitis. It reduced tartar slightly; the clinical importance of this is unclear. This result is based on 2 studies of 1,711 adults in the United Kingdom, and the certainty of the evidence is high.
• Deep cleaning (below the gum). In periodontitis, this cleans the inside of the pockets and the root surfaces.
• Air-polishing. In small studies during the care period after treatment, compared with hand and ultrasonic instruments, it showed no statistically significant difference¹⁰ in pocket depth. This does not mean the two methods are equivalent; most of the studies carry a high risk of bias. In studies using glycine or erythritol powders, the discomfort patients reported was similar to or lower than¹¹ with hand or ultrasonic instruments. There is no evidence that it removes established tartar on its own.
• Periodontal surgery. This is considered for pockets that stay deep after a deep cleaning. The European guideline recommends not operating on people who do not reach and keep up an adequate level of cleaning at home¹.
• Mouthwash, antibiotics and laser. Chlorhexidine mouthwash reduces plaque, but it is used only for a short time and it does not remove tartar below the gum. The European guideline does not recommend routinely adding antibiotics taken by mouth to a deep cleaning¹. It gives the patient's health and public health as its reasons. It says they may be considered for specific groups of patients. It also suggests not using lasers in addition to the cleaning¹. If either is suggested to you, ask your dentist why.

The steps below are for cleaning below the gum as part of treatment for periodontitis. The whole mouth can be cleaned in one session or section by section. How many appointments you need and which route is chosen are planned together after the examination. This depends on how widespread the disease is, your health and your preference.

Risks and side effects

• Sensitivity. In the days after the procedure, your gums may be tender and your teeth sensitive to hot and cold. We cannot say on this page how often this happens or how long it lasts. If the sensitivity continues, see your dentist¹² to rule out other causes such as decay. For dentine sensitivity, toothpastes containing stannous fluoride or arginine are recommended among the first options¹³. This recommendation is based on studies of dentine sensitivity in general; it is not specific to the period after a deep cleaning.
• Gums that look receded. As the inflammation settles and the swelling goes down, the gum margin can sit lower and root surfaces can be exposed. You may feel gaps between your teeth.
• Bleeding. In the first days there may be slight bleeding when you brush.
• Air escaping into the tissues (emphysema, not the lung disease). This is an infrequently reported complication¹⁴ of dental treatment. The case reports include tooth cleaning and air-polishing. Swelling that appears suddenly after treatment and crackles when touched should be checked straight away.
• Chlorhexidine mouthwash. If recommended, it is used for a short time. Used for 4 to 6 weeks, it can stain the teeth¹⁵; altered taste and irritation inside the mouth have also been reported.

Benefits

• Periodontitis can be brought under control and gum health can be restored¹⁶. Bone that has been lost, however, largely does not grow back.
• In people with periodontitis and diabetes (mostly type 2), gum treatment was compared with no treatment or usual care. At 3 to 4 months, it lowered HbA1c by 0.43 percentage points on average¹⁷. HbA1c is the long-term measure of blood sugar. This result is based on 30 studies and 2,443 participants, and the certainty of the evidence is moderate. It does not replace diabetes treatment.

At the re-assessment, your dentist measures the pockets again to see how your gums have responded.

Do not eat until the anaesthetic has worn off; you could bite your lip or cheek without noticing. In the first days your gums may be tender and bleed a little when you brush. Do not stop brushing; carry on with gentle movements.

Daily care

• Brush your teeth at least twice a day with a fluoride toothpaste. After brushing, spit the toothpaste out and do not rinse¹⁸ your mouth with water.
• For most people, a toothbrush with a small head and medium bristles¹⁹ is suitable.
• Clean between your teeth every day. For people who have been treated for periodontitis, interdental brushes are recommended as the first choice¹. Floss is an option where the brush does not fit.
• If your teeth are sensitive, rub a small amount of sensitivity toothpaste onto the sensitive area with your finger and avoid¹² acidic food and drinks.
• Use chlorhexidine mouthwash only if your dentist recommends it, and only for a short time.
• If you smoke, ask for support to stop.

A deep cleaning is not a one-off solution. In someone whose periodontitis has been treated, the risk of the disease coming back remains increased¹⁶, and it needs close monitoring.

The European guideline recommends a supportive care interval of at least 3 and at most 12 months¹, depending on the person's risk. Regular professional cleaning is also recommended as part of this care. Keeping your appointments and cleaning between your teeth every day at home are the way to keep the result.

This interval is for people who have been treated for periodontitis. For healthy gums, your dentist sets the check-up interval separately. The UK's NICE guideline on dental recall says it should be set for each person according to their risk²⁰ and discussed with them.

After a deep cleaning, contact a dentist if you notice:

• Pain or swelling that does not ease within a few days, or keeps getting worse
• Bleeding that does not stop
• A fever
• Sensitivity that has not eased after several weeks
• Teeth becoming more and more loose

While you are still in Antalya, contact the dentist who treated you.

Swelling that appears suddenly after treatment and crackles when touched should be checked without waiting¹⁴. If you cannot reach the dentist who treated you straight away, see a dentist where you are or go to an emergency department.

Emergencies. The following need urgent medical help²¹. Do not wait for a dental appointment or for the clinic's reply. Go to the nearest emergency department or call the emergency number where you are (112 if you are in Turkey).

• Swelling that makes it hard to breathe, speak or swallow
• Swelling of the eye or the neck²², a painful eye, or sudden problems with your eyesight
• A lot of swelling inside the mouth
• Finding it hard to open your mouth

Before you fly home

Make sure you have a written record of what was done in which areas, with the pocket measurements and any X-rays, and written care instructions. Know whom to ask if your gums stay painful or swollen after you have left.

Once you are home

If a problem comes up that is not urgent, write to the clinic and send photographs. Pain or swelling that keeps getting worse, bleeding that does not stop, or a fever needs an urgent appointment with a dentist where you are. Do not wait for the clinic's reply. In the emergencies above, go to the nearest emergency department or call the emergency number where you are.

Whether you need a deep cleaning cannot be decided from photographs. The pockets are measured at the examination, and the plan follows from those measurements. The whole mouth can be cleaned in one session or section by section over several appointments. The re-assessment comes only once the gums have healed. The number of days in Antalya depends on how many areas need cleaning below the gum. It also depends on other treatment that is to follow, such as implants or crowns; gum disease is usually treated before that work starts. Before you book, you receive a written preliminary plan with the appointments and how many days they need. It is based on what you send us, such as X-rays or gum measurements from your own dentist, and it is not a diagnosis. The examination confirms or changes it, and with it the days and the cost. You can say no, or ask to stop, at any stage. Having the treatment with a dentist where you live remains an option.

Re-assessment and supportive care. These usually happen after you have gone home. Plan them with a dentist where you live, or plan a return visit, before treatment starts. Supportive care after periodontitis is part of the treatment, not an optional extra.

Flying. We have found no guidance that sets a waiting time before flying after a deep cleaning specifically. A 2023 narrative review of flying after dental treatment suggests waiting about a week after most dental interventions²³. This assumes there is no pain, swelling or bleeding where you were treated. The authors note that the research is limited and comes mainly from military aviation. Ask your dentist when you can fly, and treat the review as a starting point for that advice, not as a rule.

Your dentist at home. Talk to your own dentist before you go. They need to know the plan, because the supportive care that follows is usually theirs. Ask them before you travel whether they will take it on. What a health service or an insurer covers after treatment abroad differs from country to country. Before you travel, ask the health service or your insurer in the country where you live what it would cover for your supportive care. Ask the clinic for a written record of the treatment to take back to them. It should show the pocket measurements before the cleaning, and after it if you are re-assessed during your stay. It should also say which areas were cleaned, and which supportive care interval is recommended for you. In Turkey, the health tourism regulation entitles international patients to an itemised bill. On request, they also get free copies of the records of the materials used, the tests and the imaging²⁴.

Questions to ask before you commit. Ask us these questions, and ask for the answers in writing:

1. Who will carry out my treatment, and what are their qualifications?
2. Are you regulated by a professional body and registered with it?
3. What happens if I am not happy with the result?
4. What aftercare do you provide, and who can I contact after the treatment?
5. If there are complications, who pays for further treatment, extra flights and the hotel?
6. Do you have a complaints system, and can I see a copy?

Our full list of questions to ask before treatment abroad, with our answer to each, is on our page about dental treatment abroad.

This page does not give prices. Your treatment plan is prepared for you after the examination. The main factors that shape the plan are:

• In how many areas and on how many teeth cleaning below the gum is needed
• How many appointments it takes and whether anaesthetic is needed
• X-rays, if needed
• Re-assessment, surgery if needed, and supportive care appointments, and whether they take place in Antalya or with a dentist where you live

Ask for the plan in writing, showing what is included and which procedures will be assessed separately. Ask too who pays for further treatment and extra travel if there is a complication.