Descaling, tooth cleaning, dental scraping…these are all a number of terms for what I would call a dental scale and polish.
As guidance is changing, there is now a move away from calling this procedure a “scale and polish”. The technical term is now “professional mechanical plaque removal” (PMPR). You might hear your dental professional use this name too.
Scaling and polishing is an important procedure in addition to your usual home cleaning routine, and may be recommended to aid the thorough cleaning you are doing at home.
The purpose is to help clean your gums and teeth, and there are different levels of cleaning available.
Depending on the extent of your calculus, staining or gum disease, your scaling and polishing may be completed by a dental hygienist, a dental therapist, a dentist, or a periodontist.
To find out the difference between these, read on, or click a link in the table below to jump to a particular section of this article.
What is a scale and polish?
The main aim of a scale and polish is a professional cleaning of the teeth and gums.
A traditional scale and polish is a dental procedure made up of two different procedures:
- This is the removal of plaque and calculus from the teeth and gums.
- This can be completed using an ultrasonic scaler, hand scaling instruments, or other specialist scaling instruments such as a Piezon Scaler.
- The main purpose of scaling is to disrupt the bacterial biofilm that develops on teeth and underneath the gums.
- This usually refers to the process of stain removal.
- It is not normally considered to the therapeutic, i.e. an active treatment of disease.
- Polishing does have a large amount of cosmetic value in the removal of unwanted marks on the teeth and around dental work such as fillings and crowns.
- Polishing can be done using a small rubber polishing cup (attached to a special handpiece) and polishing paste, or even using a specialist device like AirFlow.
To summarise: the purpose is to disrupt and remove plaque and calculus from the tooth surface and under the gums. Hence the name professional mechanical plaque removal.
In 2018 Lamont et al undertook a review for the Cochrane Library entitled Routine scale and polish for periodontal health in adults and defined a “routine scale and polish” as:
“scaling or polishing, or both, of the crown and root surfaces of teeth to remove local irritational factors (plaque, calculus, debris and staining), which does not involve periodontal surgery or any form of adjunctive periodontal therapy such as the use of chemotherapeutic agents or root planing.”
Generally speaking there are two different levels of a scale and polish.
There is a “routine scale and polish” which is a relatively superficial and non-invasive cleaning. The main aim is the removal of calculus and surface stains from above the gum level, or even just underneath the gum level. This is usually sufficient for cosmetic purposes or mild gum disease (gingivitis).
There is also a deeper level of cleaning, which a dentist may refer to as root planing, root surface debridement, or subgingival cleaning.
This sort of scaling will remove calculus and bacteria from deeper below your gum levels. The main purpose of this is to improve the health of your gums if you have more advanced gum disease (periodontitis).
Routine cleaning is sufficient in the prevention and treatment of mild gum disease, whereas more advanced gum disease, or periodontitis, will require deeper cleaning.
In-house dentist Dr Gemma Wheeler explains:
“The easiest way to understand the two different types of scale and polish is that a ‘routine scale and polish’ is purely to improve the appearance of the teeth. Deeper cleaning, root surface debridement, really focuses on the health of your gums.”
What is gum disease?
Early gum disease, or gingivitis as it is technically known, is irritation within the gum. This may even progress to more advanced gum disease, known as periodontitis.
There is a whole article dedicated to gum disease here, where we go into a lot of detail about the causes of gum disease and how to treat it (spoiler, there is a lot you can do at home!).
But, in order to explain the benefits of a scale and polish it’s important to know what causes gum disease.
If you want the quick facts of the article without the explanation, the following bullet points are for you.
- Gingivitis is inflammation of the gums caused by bacteria found in plaque.
- If treated early enough it is a fully treatable and reversible condition.
- Everyone is at risk of gingivitis, but some are at a higher risk.
- Symptoms include red, swollen, and bleeding gums.
- Treatment is usually professional cleaning, followed by a good oral hygiene routine.
- Best investment you can make is in yourself by perfecting your brushing techniques.
- If left untreated it can develop into periodontitis which can cause irreversible damage, including tooth loss.
If you can spare a few minutes though, it is well worth reading the entire article to get a full understanding of gum disease.
Gum disease is caused by bacteria on the teeth, which are not cleaned away well enough, and therefore get underneath the gums.
These bacteria, if they are not cleaned regularly, form what is known as a biofilm. This is a collection of bacteria, their waste, and food. On your teeth this can form a soft, sticky substance known as plaque.
This biofilm, or plaque, irritates the gums.
Initially the damage to the gums will just be within the top layer, and will be a layer of swollen and bleeding gums (inflammation).
This early gum disease is called gingivitis.
The research by Lamont et al tells us that a routine scale and polish will not in itself reverse this gum disease. It will, however, remove calculus to make it easier for you to clean at home (read on for more information about calculus).
This initial gingivitis can be reversed with good oral care at home.
But what happens if you don’t change your ways soon enough?
Long term, the bacteria in the biofilm or plaque will spread beneath the gums. They can sit at the bottom of the pocket between the gum and the tooth. The waste they produce will cause damage to the bone holding the tooth in place, this is now a more severe gum disease known as periodontitis.
What is calculus?
I have already explained the plaque that develops on teeth and underneath the gums is made up of bacteria and their waste products.
If this is left untouched for 72 hours, for example by not brushing, the plaque can harden up. This process is called calcification.
That means it hardens into a pale yellow hard substance, stuck on the tooth. This is calculus, or sometimes called tartar.
Because calculus forms when your teeth aren’t cleaned properly, calculus is a good indicator as to where you are missing when cleaning your teeth. This will help a dental professional give you advice specific to you.
In house dentist Dr Gemma Wheeler explains:
“If you are consistently missing the same areas when cleaning, you will get a build up of calculus. These areas are not having bacteria removed from them and so are at increased risk of dental decay and gum disease.”
This calculus is impossible for you to remove at home, it is well and truly stuck to the tooth.
So do you really need it removed?
In itself the calculus is not a problem, but there are a few associated problems if you do not have it removed.
- Without a hygiene appointment, you will not learn how to clean properly and the bacteria will affect the teeth and gums in those areas. Eventually this can cause tooth decay and gum disease.
- Calculus is more sticky than your tooth. This means the bacteria that cause gum disease are more likely to stick to this than to your normal tooth. This can increase your risk of gum disease.
- Calculus can also make it more difficult to clean your teeth and remove the bacteria causing gum disease. Leaving calculus may mean that you do not clean well enough to get rid of early gum disease (gingivitis).
- Calculus can pick up stains easily, for example from tea, coffee, smoking or red wine. You may not like the appearance of these stains.
How do we get stains building up on our teeth?
Staining on teeth is a common occurrence.
It is possible to stain your teeth with dark food and drinks.
As we have already said, if you have a build up of calculus, this can stain more easily than your teeth.
Our article about yellow teeth talks a lot about staining and what causes them.
How does scaling help gum disease?
So we know that gum disease is caused by bacteria in the gums. For many people, effective daily cleaning at home will get rid of and also prevent the buildup of bacteria.
But some people are more prone to gum disease and calculus, and these people will benefit more from scaling. Those people include:
- People who are more prone to the build up of calculus because of the mineral content in their saliva.
- People who are more susceptible to the effects the bacteria have on the gum and the bone that holds the teeth in place. There is a well known genetic link with periodontal disease.
- People simply do not have effective enough cleaning, although there may be reasons for this. This might include people with disabilities that affect how they hold their toothbrush, for example arthritis in their hands.
- Some people who have teeth that are poorly aligned, or perhaps a wisdom tooth breaking through, may find these areas difficult to clean.
In all of these cases you may get areas that are prone to a build up of calculus which can only be removed with professional cleaning.
Scaling will remove the calculus which can harbour bacteria, and can also clean out bacteria from difficult to reach places between the gum.
There are two main methods for scaling:
- Ultrasonic scaling – uses a special machine. Very high vibrations are used with a constant stream of water to physically remove bacteria and calculus, and flush out the gums.
- Hand scaling – uses specialised hand instruments to physically remove the bacteria and calculus. There is no flow of water.
Scaling vs Root surface debridement
Routine scaling focuses mostly on the area above the gum line. This scaling and polishing will remove calculus and stains on the surface of your teeth. This is the treatment if you have only mild gum disease, although studies debate how effective it truly is when it comes to curing early gum disease by itself. In other words, cleaning better at home is actually more important.
Deeper cleaning, often called root surface debridement, will focus the cleaning below the gum level, in the gap between the gums and bone and tooth. This is the treatment if you have more advanced gum disease, periodontitis. This scaling will remove calculus and help flush out bacteria too.
The aim of root surface debridement is to reduce swelling in the gums, and the get the gums to follow the bone that has been lost around the teeth as a result of periodontal disease. If the gums do not shrink back, there will be a space, a pocket, for the bacteria to hide in and continue to damage the bone.
In both cases, scaling can be completed with an ultrasonic scaler or hand instruments.
What is polishing?
Polishing is mostly a cosmetic procedure that focuses on the removal of stains from tooth surfaces and around dental work.
Some polishing can be important in removing rough patches from your teeth which can hide small amounts of bacteria. In some cases, fillings may need to be adjusted by your dentist to prevent future build up in such areas.
Polishing can be done in a number of ways. The simplest is the use of a rubber cup with what is called prophylaxis paste.
Newer technology, known as air polishing, is becoming ever popular as a technique to remove stains from teeth. This uses a mix of water and powder directed at the teeth to remove bacteria and stains.
What happens when you have a scale and polish?
A scale and polish procedure is typically two separate parts to an appointment.
Depending on the current health of your teeth or gums, you may only have the scaling part done. This is because scaling is a therapeutic procedure. In other words, it is a treatment for the disease. In this case, scaling is the treatment for gingivitis and periodontitis.
Private scaling and polishing will often consist of both scaling and polishing.
NHS scaling and polishing will often be scaling only. That is because the NHS treats disease, and does not focus on cosmetic procedures such a stain removal.
What happens during the procedure?
During the appointment, the dentist, dental therapist or dental hygienist should do a number of things:
- Explain why you need a scale and polish.
- Give local anaesthetic injections, if you require them.
- Scale the gums and teeth.
- Polish the teeth (but not always).
- Spend some time explaining how you can better care for your teeth and gums at home, including demonstrating brushing and interdental cleaning technique.
If you have more advanced gum disease they may also do a more detailed examination of your gums, to record if there are any pockets (gaps between the gum and the bone), if there is any bleeding from the gums, and if the teeth are loose at all.
In addition to the scaling and/or polishing, your dentist, dental hygienist, or dental therapist will also give you information about how to clean your teeth and gums better at home.
This is arguably the most important part of the procedure because with good home care you can avoid the calculus build up and eliminate the bacteria causing gum disease.
What happens after a scale and polish?
After the scale and polish you can carry about your normal day to day activities.
What is most important is that you make some changes to how you clean at home to ensure that your gums heal fully from the gum disease and to prevent further gum disease.
You may be booked in for a review, and depending on your dental professional’s preference this could be a couple of weeks later, 3-4 months later, or at your next checkup as recommended by your dentist. How soon it is will depend on how serious your gum disease is.
Scale and Polish Before & After
You can see some before and after photos of a patient treated by one of our in house dentists below:
Does a scale and polish hurt?
Some people complain that their teeth hurt after scale and polish – this may be because their gums are sore during the treatment or because they get sensitivity to cold afterwards.
In any case it is not normal for a scale and polish to hurt, so read on to find out more about what to expect.
Scaling can be completed using a powered scaling device, such as an ultrasonic scaler. For simple gingivitis and removal of a small amount of calculus, this should not hurt.
Some people find the sensation of an ultrasonic scaler uncomfortable, but not painful.
Scaling gums that have a lot of gum disease, and where a lot of cleaning is required underneath the gums, can be painful. If this is the case, your dental professional can offer local anaesthetic before the procedure.
Pain is caused when gums are already inflamed. If you are regularly cleaning sufficiently this will not happen.
Think of it this way, if you get a cut on your finger and it gets infected, it becomes swollen and red, and bleeds if you touch it. It obviously hurts when you try to touch the finger. But get rid of the infection, and you will have no problem.
The problem is the same with your gums. You fail to clean them and the bacteria gets underneath the gums causing them to become infected and swollen. Then when you clean them, it obviously hurts!
If you look after your gums regularly at home you will not get the build up of infection and cleaning will be a lot less uncomfortable.
If you have had scaling for severe gum disease (periodontitis) the gums can be tender afterwards, but this is usually better the next day.
There is a small chance of developing small local infections if you had severe gum disease, which may appear as small gum boils. With good cleaning at home these should go down within a few days.
Mouthwashes can help during this healing process.
In house dentist Dr Gemma Wheeler recommends:
“After treatment for gum disease I advise my patients to avoid chlorhexidine containing mouthwashes, such a Corsodyl. This is because of the links with staining, taste disturbances, and interactions with toothpaste. Instead, I recommend the use of Ultradex or Colgate Peroxyl for a few days. Hot salty mouthwashes – a cup of warm water out of kettle with a spoonful of salt, rinsed for a minute and then spat out, is also great relief for discomfort after cleaning, and it can be used as much as you like.”
Teeth which had a lot of calculus removed may become sensitive after a professional clean. This is because the tooth surfaces were previously coated and could not feel the hot or cold. Using a sensitive toothpaste should help reduce this.
Any discomfort or toothache that lasts for more than a few days should be checked out by a dentist.
How to avoid pain during cleaning
You can take some simple steps to try and reduce any discomfort you usually experience during cleaning.
Firstly, looking after your gums at home, so that there is no inflammation will help. Reducing the level of infection in the gums by brushing effectively twice a day, and daily interdental cleaning, will reduce the discomfort you feel during the cleaning.
If you are struggling to do this at home in the lead up to your appointment, it may help to take painkillers about an hour before your appointment. If you are able to take them, anti-inflammatories such as ibuprofen are effective, as is paracetamol. It is best to avoid aspirin as this increases the chance of bleeding as it thins the blood.
You may normally get sensitivity to cold water. If this is the case, scaling with an ultrasonic can be sensitive for you. You can reduce this sensitivity by using a special sensitivity toothpaste for a couple of weeks in the lead up to your scaling. Examples include Sensodyne, Colgate Sensitive Pro Relief. These are especially effective if you simply rub them onto the teeth last thing at night without rinsing afterwards.
How long does a scale and polish take?
How long a scale and polish takes depends on a number of things:
- Whether it is NHS or Private
- A private appointment with a hygienist will usually be charged by time, and this is often 15-20 minute appointments, which will also include any discussions you have. This is usually sufficient for a superficial scaling, but possibly not the polishing.
- An NHS appointment will provide all the care you need for one price. The appointment will usually only be offered for more advanced gum disease (read on to find out why) and will usually be between 15 and 30 minutes per appointment. Again, this includes time for any discussions.
- How much calculus there is
- Obviously, if there is more calculus it will take longer to remove. Calculus that has been there for a long time can also be more stubborn to remove.
- How much staining there is
- Some stains are more stubborn to remove, such as those caused by smoking or Corsodyl (or chlorhexidine containing) mouthwash.
- How severe your gum disease is
- Mild gum disease (gingivitis) with a small amount of calculus will not take long for a scale and polish, and is easily completed in a 15 minute appointment.
- Advanced gum disease (periodontitis) will take longer for treatment. It may not even be completed all in one appointment, especially if you need local anaesthetic for the cleaning. You may need two or even three 30 minute appointments, maybe even longer.
If you struggle with scaling and polishing, you could ask for multiple short appointments to make it more comfortable for you.
Who can do a scale and polish?
As I have mentioned a few times, a number of people are able to complete a scale and polish for you.
A dentist can complete the scale and polish on the NHS or Privately. You would normally need a checkup first.
A dental therapist and a dental hygienist are both qualified to do a scale and polish. Often this is privately, although some dental practices do have NHS dental therapists and dental hygienists. On the NHS you must have a checkup first.
In 2013 the law changed so that you can now see a dental hygienist or a dental therapist without seeing a dentist first. This is known as “direct access”, and means that you can have a scale and polish without having a dental check up. At the time of writing, this is only possible for private treatment as NHS rules state that for NHS treatment you must see a dentist first. A direct access appointment will also often incur an extra charge compared to a normal scale and polish appointment with a dentist.
Why it’s important to have a regular scale and polish
Not everyone needs a regular scale and polish. The purpose of a scale and polish is to help your cleaning at home if you have early gum disease, and to treat advanced gum disease.
If you clean your teeth well enough at home, you should not need a scale and polish.
A recent review by the Cochrane Oral Health Group advises that a routine scale and polish doesn’t actually reduce the signs of early gum disease (gingivitis) such as bleeding, but it does result in a reduction in the amount of calculus build up.
What they are saying is that a routine scale alone does not treat gingivitis.
So what are the advantages of routine scaling?
- Feels good – patients like the feel of a professional clean.
- Removal of calculus – makes it easier for you to clean at home and prevents a hiding place for more bacteria.
- Increases motivation for home care – by providing a professional clean, some patients may be more motivated to make changes at home. The appointment time also gives time for a dental professional to give tailored advice specific to the individual so that they can cure gingivitis at home.
It is worth noting that that this only applies to a “routine scale and polish”. This evidence is not the same for deeper cleaning, also known as root planing or root surface debridement. The use of deeper gum cleaning is instrumental in treating advanced gum disease, periodontitis.
The British Society of Periodontology recommends the use of root surface debridement for periodontal disease in their Good Practitioners Guide to Periodontology. The evidence for the use of root surface debridement is overwhelming, but it is worth bearing in mind
“results are only achieved along with patient co-operation, particularly with good home care”
So in the case of advanced gum disease, regular cleaning is beneficial, but only if you make some changes at home!
There are, however, some small groups who will particularly benefit from regular cleaning in addition to their home care, in order to reduce risks to their general health. This includes:
- Pregnant mothers who are more prone to gum disease, especially gingival epulis.
- Diabetic patients – where poor glucose control is linked to gum disease and vice versa.
- Patients with heart disease – some patients who have had heart surgery are at increased risk of infections around the heart unless they take control of gum disease.
Who can’t have a scale and polish?
Dental scaling and polishing is safe for almost everyone. But there are some people who need to take care.
Some patients with pacemakers fitted can’t have cleaning with an ultrasonic scaler. It is important you tell your dentist, hygienist or therapist of any medical conditions or procedures you have.
Patients taking blood thinners are more prone to bleeding gums during scaling. Whilst this does not mean that you cannot have a scaling and polishing, it is something to be aware of so that you are not shocked if there is a lot of blood.
Scaling and polishing may not be offered on the NHS to patients who do not improve their cleaning at home. The most important factor for successful gum treatment is the cleaning you do at home. If you are unable to make changes at home you may not be able to having NHS treatment for gum disease, which includes scaling.
Dental polishing should also be used with care, as Sawei et al explain, and because of it’s abrasive nature it should be avoided in people with:
- Dental decay.
- Tooth wear.
- Dental hypersensitivity.
- Hypomineralisation of teeth.
Can a scale and polish damage teeth?
If done incorrectly, scaling can damage the gums and cause gum recession.
This is different from successful root surface debridement where gum recession is the aim of treatment. This is because the aim of root surface debridement is to reduce swelling in the gums, and the get the gums to follow the bone that has been lost around the teeth as a result of periodontal disease. If the gums do not shrink back, there will be a space, a pocket, for the bacteria to hide in and continue to damage the bone.
Scaling can also dislodge fillings and caps or crowns. This will only happen if the fillings or crowns were faulty or loose anyway. A dentist or dental therapist may be able to fix this straight away, or you may have to come back another time for permanent treatment. A dental hygienist will need to book you in with a dentist or dental therapist to fix such problems.
As I previously mentioned, polishing is abrasive and can remove the outermost layer of enamel. If done correctly this does not cause serious harm. But if done incorrectly it could cause irreversible damage and sensitivity.
Scale and polish costs
As we have explained, scaling is a useful tool in the treatment of more advanced gum disease (periodontitis), and can help cure the disease when changes are also made at home. NHS UK states:
“The NHS will provide any clinically necessary treatment needed to keep your mouth, teeth and gums healthy and free of pain.”
This means scaling for the treatment of disease is included, and
“more complex treatment for gum problems may be charged within a Band 2 course of treatment.”
There are in fact two different charges for a scale and polish on the NHS. Unless you belong to one of the groups who are exempt and are entitled to free NHS treatment, you will need to pay for your checkup and treatments.
Costs for a routine scale and polish
A “routine scale and polish” would be
- England – Band 1 £23.80 (including checkup and any necessary radiographs)
- Wales – Band 1 £14.70 (including checkup and any necessary radiographs)
- Scotland – £11.40 (from, there are variations between patients and this does not normally include any other treatment)
- Northern Ireland – £10.86 (from, there are variations between patients and this does not normally include any other treatment)
But as explained above, an NHS dentist only needs to provide treatment that is clinically necessary, and there is no evidence to support that routine scale and polish alone reduces the signs of early gum disease. In practice, this means that you are unlikely to be entitled to an NHS routine scale and polish as part of your regular NHS checkup.
This is a good thing! A dentist refusing an NHS scale and polish means that you do not have any serious disease (although you may benefit from advice on how to clean better at home).
If you like the feel of the cleaning and still want it, you will need to pay privately for this, as the NHS UK site explains “If your dentist says a scale and polish is not clinically necessary but you want one anyway, you will have to pay for it privately.”
Costs for root surface debridement
If you have more advanced gum disease, periodontitis, professional mechanical plaque removal (a scale and polish) is clinically needed to treat this disease, however it is only effective in combination with good cleaning techniques at home. An NHS dentist can offer this treatment, and the charges would be:
- England – Band 2 £65.20 (including checkup, any necessary radiographs and any other required Band 2 treatment such as fillings)
- Wales – Band 2 £47.00 (including checkup, any necessary radiographs and any other required Band 2 treatment such as fillings)
- Scotland – £27.68 – £57.08 (from, there are variations between patients and this does not normally include any other treatment)
- Northern Ireland – from £10.86 (from, there are variations between patients and this does not normally include any other treatment)
To summarise, a basic scale and polish is generally a Band 1 with an NHS dentist, but your dentist could justify that it is not clinically indicated if your early gum disease will be improved by you simply improving your cleaning at home.
If you need a scale and polish on the NHS, this is almost always going to be a Band 2 treatment.
Root surface debridement as treatment for periodontitis is clinically justified on the NHS, and can be provided by an NHS dentist (or hygienist or therapist if available), generally under a Band 2 course of treatment.
There has been a long standing expectation that patients are entitled to an NHS scale and polish. The problem is that, even with advanced disease, the professional cleaning part will not be effective unless you make changes to the way you clean at home.
The British Society of Periodontology and NHS Business Service Authority have now released guidance for dental professionals to clarify the charging for NHS periodontology services.
With the new system, you will be assessed to be either an “engaging” or “non-engaging” patient. This is assessed by your dental professional and takes into account bleeding levels, plaque levels, and how much you want to change your cleaning to improve your health.
Your dental professional will help you to make the changes at home.
As the new guidance explains “There is a robust evidence base that undertaking time-consuming subgingival PMPR (root surface debridement) in patients with poor plaque control is ineffective and fails.”
You will no longer be able to have an unlimited number of NHS gum treatments if you are a “non-engaging” patient and cannot reduce plaque levels at home. You will be able to pay privately if you still wish to have a scale and polish though. If your cleaning at home improves then you will become entitled to NHS appointments once again.
The purpose of these changes is to try and alleviate the pressure on NHS dental services. Providing treatment to patients which will not be successful is not the most effective use of the limited resources available
There are a few reasons why you might pay privately for scale and polish. These include if:
- you do not have access to an NHS dentist.
- you want a scale and polish but your NHS dentist has said it is not clinically necessary.
- you have had previous NHS scale and polish appointments which have not resolved you disease, but you have been assessed as a “non-engaging” patient so no longer qualify for NHS treatments.
- You want aesthetic or cosmetic treatment such as the removal of stains.
The cost of a scale and polish private will vary depending on your location and who completes the treatment.
Private treatment will normally be charged per appointment length, and in some cases you may need a double appointment or even longer for your treatment.
Pay as you go prices vary but expect to pay between £30 and £50 per 15 minute appointment time with a hygienist. These costs are more if you choose to have the treatment with a dentist, or if you choose to have direct treatment with a hygienist without having an appointment with a dentist beforehand.
On some private payment plans a routine scale and polish may well be included in your monthly rate.
Are there alternatives to a scale and polish?
Scaling is important to improve your gum health, and is one of the few options available for treatment that is known to work for the treatment of periodontitis.
That said, successful gingivitis and periodontitis treatment must include good home care.
Other treatments may be used alongside scaling to treat more advanced gum disease, such as antibiotics placed underneath the gum.
When it comes to stain removal however, there are a number of other options available.
Instead of traditional polishing with a rubber cup and paste you could consider air polishing treatment.
AirFlow is a specific treatment that uses very fine particles to help remove plaque, calculus and stains, and I go into more detail about what to expect in an article dedicated to air polishing.
Is it safe to do your own scale and polish at home?
By the very definition of a scale and polish, with it being a professional clean of the gums and teeth, there is no real DIY scale and polish alternative.
Some shops do sell at-home scale and polish kits, which can include something that looks similar to a hand scaling instrument used at a dental practice.
I have tested such products (see the review here), and I strongly recommend against using them. Professionals at Colgate also agree on the dangers of home cleaning!
Firstly, when used incorrectly, the sharp instruments can do serious damage to your gums. You may even cause accidental damage to the soft tissues of your tongue, lips or cheeks.
Secondly, such instruments bought in a shop and used at home are not sterile. You could, unknowingly, bring harmful bacteria into your mouth and underneath your gums which could cause an infection.
Finally, without proper technique you may cause damage to dental work in your mouth such as fillings and caps. This could be very costly to repair when seeing a dentist.
I cannot stress this enough, please see a professional for removal of calculus and stains.
Does a scale and polish whiten your teeth?
A scale and polish can remove the stains that have built up on your teeth.
A scale and polish will not change the overall colour of your teeth.
If you want to lighten the overall colour of your teeth, the only option is professional tooth whitening.
To find out about tooth whitening, see our whitening hub page.
What is dental scaling?
Dental scaling is a professional cleaning of the teeth and/or gums to remove the plaque and calculus that cause dental decay and gum disease.
What is the difference between scaling and root surface debridement/planing?
Routine scaling is a superficial cleaning of the teeth to remove plaque, calculus and stains, whereas root surface debridement (or root planing) focuses the care underneath the gum level. Routine scaling treats minor gingivitis and staining, root surface debridement treats periodontitis.
What is dental polishing?
Dental polishing is the use of special paste and rubber cup, or the use of a powder-water mix, to remove surface plaque and stains from your teeth.
What is airflow?
AirFlow is a brand of air polishing. These use special handpieces to direct a mix of water and powder at the teeth to remove plaque and staining.
Why do dentists recommend a scale and polish?
Scaling will remove the bacteria contained in plaque that causes gum disease and dental decay. This will prevent and treat periodontitis (advanced gum disease).
Polishing will remove surface stains to improve the appearance of your teeth.
Will scaling hurt?
A routine scale and polish should not hurt at all. Root surface debridement can be uncomfortable and so can be completed under local anesthetic.
Who can I see to have dental scaling done?
Dental scaling can only be completed by a qualified dental professional. In the UK it can be done by a dentist, a dental therapist, or a dental hygienist.
How often should I have a scale and polish?
How often a scale and polish is done will depend on the severity of your disease and how well you can clean your teeth at home.
Will and scale and polish whiten my teeth?
No. A scale and polish will remove stains from the tooth surface but will not lighten the overall colour of your teeth.
Why can’t I have a scale and polish on the NHS?
If you do not have advanced gum disease, periodontitis, you will not qualify for a routine scale and polish of the teeth. This is because the NHS will only provide treatment that is clinically necessary. For mild gum disease, gingivitis, the evidence indicates that a routine scale and polish does not get rid of the disease, but better home care does.
25 thoughts on “Dental scaling and polishing explained by a dentist”
I had been registered with aNHS dentist for over 3 decades,and as I had advanced gum disease, I was given descaling and polishing on regular basis (every 3 months) at a cost of£10.60 ,now that my dentist has been taken over by another company called “my dentist ” I am told that this facility no more given on the NHS and that I need to go private at a cost of £45 per half hour visit and that’s cost me £90 as they insisted I needed 2 visits whereas when it was on the NHS it only took one visit of20 minutes to complete the job why is that
We can’t comment on your specific circumstance without more information and assessment. It is best to discuss this with the practice you are with to understand why the change.
For work to be conducted under the NHS fee structure it has to be considered ‘clinically necessary’. I suspect, this is where the difference and reason for change has come in.
I am not sure on your location within the UK, but at £10.60 that is less than the standard costs in the different countries of the UK for such a service. We have a bit more info here on the typical costs with the NHS.
I have been referred to a hygienist by my dentist ?, i have really sensitive teeth and receding gums at my lower gums?, im worried about the pain scale of this procedure as u have heard alot of horror stories, is this a sore procedure to endure ??, and would i need an injection to get this done and if so how many roughly would it be ?
The answer is it depends.
Injections are not always necessary. It is on a case by case basis. If you are particularly sensitive and find it painful it may well be beneficial and advised.
The number will depend on how many of your teeth are being cleaned at one time. If the cleaning is split over multiple days/sessions then this will have an impact.
It would be advisable to speak to the hygienist in advance and make them aware of your concerns. Most hygienists want the best for you. If that means taking longer and going slower (if they have the time) they will. Most will tell you to raise your hand if you want them to stop etc.
Hello. I have recently visited my dentist and was told I have infection and gum disease, and my gums are receding. The dentist told me to book with the hygienist for a deep clean and I understood this to be charged extra. I have not booked it as I thought it should be included in the band price 2 I have already paid to have fillings, an extraction and a scale. I was at this practice for a filling earlier this year and last year for an extraction but was not told about gum disease or deep cleaning ( this was a different dentist) Now I am confused. As I have already paid for the treatment I am to receive next month should I have to pay privately for a deep clean that was at the dentists suggestion. Thank you.
I can’t comment on if and when you should have been told about the need for a scale and polish. Perhaps last year it wasn’t so bad and it has gotten worse and the new dentists feel it would be beneficial. But as it stands it has been recommended. You don’t have to have it done, but failing to do so might cause more problems for you longer term.
It isn’t generally included as part of Band 2 treatment.
There are times when it is offered, but you generally have to have more advanced gum disease for this to apply. So as odd as it might sound you are in a better position having to pay for it.
So to answer the question, yes it is right you are having to pay for it.
Thank you for replying so quickly. I didn’t know if it was under band 2 as stated on the nhs website, or if I had to pay band 2 again having already paid it once. It seems it will be a private treatment then. Thank you again . Jo
Dear Dr. Wheeler
Thank you for your article – very complete and informative.
My question is: I am an NHS patient. If my dentist says I should see a hygienist for a scale and polish, does this mean it’s ‘clinically necessary’ and therefore payable via the NHS scale?
Thank you for your feedback. I can’t comment on your individual circumstances, but I do recommend calling your practice to ask why they have recommended the treatment they have proposed.
Dear Dr Wheeler
I am lucky to be registered with an N.H.S . Dentist.
A couple of years ago on visiting my dentist they would always finish my appointment with cleaning my teeth (getting rid of plaque build up and stains). However I have noticed that my dentist no longer cleans my teeth and does not ask me if I want it done. I can see the build up of tartar on the back of my bottom front teeth and slight brown stains between my teeth should I ask for a separate appointment to have this cleaned if so would it be under the N.H.S. or private? I am not sure what to do I would like them cleaned but would they say it was cosmetic?
Hi Mrs Grindle. Gemma’s currently overseas volunteering at the moment, so I will reply on my behalf.
I can’t say for sure, but it seems that you were fortunate to get some form of cleaning previously when most wouldn’t have.
You can ask for a cleaning, but you will likely be asked to pay for it. Only if it is ‘clinically necessary’ will they offer this under standard NHS services.
If the buildup of tartar gets worse it will likely be considered clinically necessary at some point, but of course, it is best to avoid it getting to this stage if possible.
At your checkups if the dentist notices tartar buildup they should be advising you of this and providing tips on how to minimise this ongoing.
Dear Mr Love
Thank you for your reply to my questions. I will seriously consider paying for a professional clean do you know how much the charge would be? Would this take place at my registered dentist or would I have to arrange for this service at a private dental clinic.
Most dental practices have a hygienist available. Although you can elect to go to a different practice/hygienist if you prefer. The cost will vary from one practice to another.
As a very rough guide you will pay £60-100.
Thank you for the information Jon.
Thank you for the article it was very informative. I have been to my dentist on 2nd June for the first time after several years.she took a few x-rays and was surprised to see that there is a significant bone loss, I had sore gums by that time.
A little bit about me- I am 33 years old, non smoker, non alcoholic.
Since the time my dentist said that there is a high possibility of loosing my teeth, I started looking after my teeth way better. Started brushing twice a day, flossing after every meal and using corsodyl mouth wash regularly.
The thought of loosing my teeth at the age of 33 is putting me into depression. This is start of July now, and I had to cancel my hygienist appointment for unforeseen circumstances and I am really worried.
I have now booked hygienist on 19th of July, my question is to what extent can I save my teeth from loosing, what are the necessary precautions that I need to take care of. Please advise. I was trying to book appointment with periodontist but they are no way near. And I am worried if it could cause more damage to the teeth. Please advise. Thank you
Thank you for the feedback. I am sorry to hear that you are worried about your diagnosis.
With gum disease, yes it is caused by poor plaque control. In other words, if the bacteria are not removed, then gum disease will worsen.
There are, however, other factors that also increase your risk. Some of these factors, such as genetics, are actually outside of your control. There is a lot of information about the causes of gum disease on this page.
It sounds like you are trying to clean as well as you can. I would recommend the use of interdental brushes instead of floss, as there is some evidence that these remove more plaque and lead to a better improvement in gum disease. For more information about different types of interdental cleaning, read this link.
The delay in seeing the hygienist ( a couple of weeks) is relatively small compared to the amount of time you haven’t seen a dental professional. I can only reassure you that a delay of a few weeks will do very little harm in the long term.
With long term gum disease, chronic periodontitis, it will go through weeks, months and years of being very active and then settle down a little. Therefore it can be difficult to say at what point you will start losing teeth. Tooth loss from gum disease is actually very common. It is thought that 70% of tooth loss is caused by gum disease. So whilst it is upsetting, you are not alone.
Because I have not examined you clinically and have not seen the x-rays I can’t comment on when this will be or how likely it will be. If your dentist says you are definitely going to lose teeth because of your gum disease, you should be able to sit down and discuss with them what the plan will be over the next few years when this starts to happen. Having a plan will help to relieve any anxiety you are feeling about what will happen if you do lose a tooth.
You can only change what you can control – how well you are cleaning at home, and how well you alter your habits depending on the advice from the hygienist. If at any point you are unsure about your diagnosis, the advice given, or what will happen in the future, do ask your hygienist and/or you dentist for further information. You can also ask for a second opinion too.
The European Federation of Periodontology has a lot of useful information too, which you might like to read before your appointment with the hygienist.
Best of luck with your appointment.
I am an NHS patient and my dentist surgery has a peridontist on site who I was referred to by the hygienist. The peridontist is carrying out debridement tomorrow, but at a private rate of £400+. There was no mention of getting the treatment on the NHS. Should I have been charged at the NHS rate or am I within my rights to ask for a refund and pay at the NHS rate?
This is something you will need to discuss with your dental practice. Without knowing all the facts, it would seem as this is an elected procedure (where you have the choice) than one that is deemed clinically necessary. Therefore it would not be covered by the NHS.
I have just called my dentist to book an appointment with the hygienist to have a general scale and polish. Been told they do not have a hygienist it would be done by a dentist. I’m a NHS patient, I asked for the cost and was told it was £75.00 – I was horrified, before Covid19 it was £40 t0 £45 – reading through your information – I understand from your details that “cost of routine scale and polish” would be: English – Band 1 £23.80 (including checkup and any necessary radiographs). Being a pensioner without benefit, this seems a price snatched out of the air – what shall I do!!!!!
An NHS dentist only needs to provide treatment that is clinically necessary, and there is no evidence to support that routine scale and polish alone reduces the signs of early gum disease. In practice, this means that you are unlikely to be entitled to an NHS routine scale and polish as part of your regular NHS checkup. And thus as part of the costs your quote.
This is a good thing! A dentist refusing an NHS scale and polish means that you do not have any serious disease (although you may benefit from advice on how to clean better at home).
If you like the feel of the cleaning and still want it, you will need to pay privately for this, as the NHS UK site explains “If your dentist says a scale and polish is not clinically necessary but you want one anyway, you will have to pay for it privately.”
Evening Jon, thank you for your prompt reply. I’ve had gum disease in my early 20’s which was treated at Guys Hospital in London. My gums have reduced considerably. Thank you for clarifying my request.
Thank you so much for this article, it’s really well written and informative- I’ve even just forwarded this to my mum! The dentist didn’t offer me scaling for my gingivitis despite it causing gum recession and sore gums and now I understand why he didn’t offer me the treatment. It means that it isn’t as serious as I thought it is. Do you still think I should probably book a basic dental cleaning privately just in case?
Hi Sarah. Glad you found it helpful.
It doesn’t necessarily hurt to get a cleaning done privately if you can afford it. It may not be essential, but you have more to gain than lose.
Thank you so much Jon, I really appreciate your answer! I think I’ll go for it because I have some tartar buildup (especially near the gums that have raised edges) and I think maybe it is what is stopping my gums from fully healing? I changed my dental care routine (as my dentist instructed) around a month and a half ago because of my gingivitis but I have only seen minor improvements since… maybe I’ll pay for a regular manual cleaning so hopefully my gums don’t feel as irritated and fully heal…. I’m still super afraid of the gum recession though. Once again, thank you ever so much for your reply, it was very helpful. Enjoy the rest of your day!
Thank you for a very clear and informative advice.
Have just been for a deep clean by a dentist and your information has helped me a great deal to understand