Gum Symptoms

What is gum curettage, how is it done, and what happens afterwards?

Root surface cleaning: the procedure, pain and healing

In Turkey, 'curettage' usually means cleaning the pockets below the gum; in today's literature this is called scaling and root planing. We explain who needs the procedure, how a session goes, what sensitivity to expect afterwards and how the result is measured.

Short answer

Gum curettage is the procedure in which tartar and bacterial plaque in pockets reaching below the gum are cleaned off the root surface; its current name is root surface cleaning. It is done in periodontitis, meaning gum disease in which pockets have formed and bone loss has begun. The area is numbed, and the procedure can be spread over several sessions or done in a single day. Tooth sensitivity for a few weeks afterwards is normal. In studies, on average three quarters of pockets close; the measurement taken once the tissue has healed shows whether further treatment is needed.

Current name: Scaling and root planing
For whom: Periodontitis patients with pockets
Numbing: Usually with local anaesthetic
Common side effect: Sensitivity to cold lasting a few weeks

What curettage means, and what is done

As gum disease progresses, the gum comes away from the root surface and a pocket forms between them. Inside this pocket, tartar and bacteria that the brush cannot reach build up. In root surface cleaning, this build-up is cleaned out with hand instruments or ultrasonic tips down to the bottom of the pocket, and the root surface is smoothed. MSD Manuals describes this as the first phase of treatment in every type of periodontitis.

The word 'curettage' has two meanings. In Turkey, in everyday language and at many clinics, it is used as the general name for cleaning inside the pocket. In the narrow medical sense, however, 'gingival curettage' means scraping away the inflamed soft tissue on the inner wall of the pocket. In a small study carried out in 1983, this additional scraping of soft tissue brought no extra improvement over root surface cleaning. Today's guidelines build treatment on cleaning the root surface.

The difference from a scale and polish is depth. A scale and polish removes build-up above and just below the gum margin and usually does not need numbing. Root surface cleaning goes down to the bottom of the pocket; that is why the area is usually numbed and the procedure takes longer.

It is a treatment whose effect has been measured. In the studies the European Federation of Periodontology (EFP) guideline is based on, after 6 to 8 months pocket depth decreased by 1.7 millimetres on average, on average 74 per cent of pockets closed, and bleeding on probing fell by 63 per cent. A review by the American Dental Association (ADA) found an average gain of about 0.5 millimetres in gum attachment and recommended the procedure as the first non-surgical treatment for periodontitis.

The EFP guideline ties the success of treatment to a clear criterion: if the pocket depth is 4 millimetres or less and there is no bleeding when measured with a probe, the pocket is considered closed. That is why how well curettage has worked is understood not on the day of the procedure but at the re-measurement taken once the tissue has healed.

The modifiable factor that affects the result most is smoking. In a meta-analysis combining 17 studies, after non-surgical treatment, pocket reduction in people who smoke was on average 0.33 millimetres less, and attachment gain 0.20 millimetres less, than in non-smokers. The deeper the pocket at the start, the more marked the difference became. That is why the EFP guideline gives support for stopping smoking during treatment as a strong recommendation.

There are a few questions you should ask your dentist before curettage: Which teeth have pockets, and how many millimetres deep? How many sessions will the procedure take? Will numbing be used? When is the re-measurement? What is the plan for pockets that do not close? The answers to these questions show that the treatment has been planned not as a 'clean' but as a measured treatment.

Curettage aims to stop bone loss; it does not bring back bone that has been lost. How long the result lasts also depends on care at home and regular check-ups. Plaque sticks to the cleaned root surface again every day.

Who curettage suits, and when the plan changes

The decision is made with pocket measurements and X-rays. The list below gives a rough direction.

When it fits

Periodontitis patients with pockets deeper than 4 millimetresIf the gum has come away from the root and there is bleeding and tartar in the pocket, root surface cleaning is the first treatment. MSD Manuals counts pockets deeper than 4 millimetres as a sign of periodontitis.
Areas that keep bleeding despite a scale and polishIf there is an area that still bleeds after superficial cleaning, there may be build-up at the bottom of the pocket that has not been reached.
Pockets that stay at 4 to 5 millimetres after treatmentThe EFP guideline recommends repeating the cleaning in pockets that stay moderately deep at re-measurement.
Patients in the maintenance periodPockets that have deepened again or bleed at a check-up are cleaned again at the maintenance session.

When it doesn't

People who have only gingivitisIf there is no bone loss and no true pocket, curettage is not needed; a scale and polish and care at home are enough. Unnecessary deep cleaning can harm healthy attachment.
Pockets that stay at 6 millimetres or more despite root cleaningFor stage III patients, the EFP guideline recommends surgery for these pockets instead of repeating the cleaning.
People on blood thinners and people with bleeding disordersThe procedure can be done, but the planning changes. Do not stop your medicine yourself; your dentist decides together with your doctor.
People with uncontrolled diabetes or suppressed immunityHealing may be slower and the risk of infection may increase. Having blood sugar under control improves the result; the EFP counts diabetes control as part of treatment.

How a session goes

The sequence below is a general framework; your dentist's method may differ in the details.

1
Measurements and X-rays
Pocket depth and bleeding are recorded around each tooth, and the bone level is seen on X-rays. This record is the basis for measuring the result after the procedure. Ask for a copy.
2
What you need to tell your dentist
The medicines you take (especially blood thinners), diabetes and your latest readings, heart valve disease or a valve replacement, pregnancy, smoking, and any problem you have had with numbing before. These can change the treatment plan.
3
Numbing
The area is numbed with local anaesthetic. In a randomised study, patients who were numbed reported less discomfort and less anxiety during the procedure; discomfort is greater in deep pockets and in areas where inflammation is heavy.
4
Cleaning
Tartar and plaque inside the pocket are cleaned off the root surface with an ultrasonic tip and hand instruments. The EFP states that hand instruments and ultrasonic instruments can be used on their own or together.
5
How the sessions are arranged
The procedure can be split quarter of the mouth by quarter over several sessions, or the whole mouth can be completed within 24 hours. According to the EFP guideline, there is no difference in results between the two methods; because doing the whole mouth in a short time can cause a temporary inflammatory response in the body, your general health is taken into account.
6
Instructions for care at home
After the procedure, brushing and cleaning between the teeth are shown to you again. This step is as important as the procedure itself.

What comes alongside curettage, and instead of it

These options are not rivals to curettage; most of the time they come before or after it.

Scale and polish

Superficial cleaning, which is enough if there is only gingivitis. If there is no pocket, curettage is not needed.

Local antibiotics inside the pocket

According to the EFP, some slow-release products may be considered in addition to root cleaning; a small extra gain has been reported in the short term, and no marked difference has been shown in the long term.

Antibiotics by mouth

Not recommended routinely. The EFP states that they may be considered in particular groups of patients, for example widespread stage III disease in young adults.

Laser

The EFP guideline recommends not using a laser in addition to root cleaning (a weak recommendation). The ADA guideline gave a weak recommendation to photodynamic therapy with a diode laser, and, because the evidence for other lasers was uncertain, came out against them as expert opinion. A laser is not a procedure that replaces root cleaning.

Supportive maintenance

Whether pockets closed by curettage stay closed depends on regular maintenance. The EFP guideline recommends that maintenance appointments be planned at intervals of between 3 and at most 12 months according to the person's risk profile, and that attending these appointments be strongly supported. At the maintenance session the pockets are measured again, plaque and tartar are cleaned off, and areas that have deepened again are treated again.

Surgery

In pockets that stay at 6 millimetres or more after curettage, the gum is lifted back so the root surface can be seen directly. In suitable bone defects, regenerative surgery can be done. For details, see our periodontitis treatment guide.

Side effects and possible problems

The side effects of root surface cleaning are usually mild and temporary. Knowing them lets you tell what is expected from what is not.

Tooth sensitivity

The most common side effect. In a systematic review, root sensitivity was seen in 9 to 23 per cent of patients before treatment and in 54 to 55 per cent afterwards. Its intensity increases over 1 to 3 weeks and then decreases. The review is based on only two studies, but it shows that sensitivity should be expected in about half of patients.

Receding gums and teeth that look longer

When the inflammation clears, the swelling goes down and the gum margin draws back. The teeth may look longer and the gaps wider. This is a change that healing makes visible.

Pain and slight bleeding

Once the numbness wears off, there may be an ache for a few days and slight bleeding when you brush. Severe pain that keeps getting worse is not expected.

A temporary feeling of looseness

As the swelling goes down, some teeth may feel looser in the first few days. If this continues or gets worse, tell your dentist.

Infection and abscess

Though rare, build-up left in a pocket can lead to an abscess. Swelling and a discharge of pus are signs that need assessing straight away.

Healing after curettage

The sequence below is a general framework; timings vary from person to person.

The day of the procedure
Until the numbness wears off, avoid hot drinks and the risk of biting your cheek. Once it wears off there may be a slight ache; you can take the painkiller your dentist recommends.
The first few days
Keep brushing with a soft brush; do not skip the area because of bleeding and sensitivity. If your dentist has recommended a mouthwash for a short time, use it for the recommended period.
Weeks 1–3
Root sensitivity may increase during this period and then decrease. Ask your dentist about toothpastes for sensitive teeth.
Throughout the first weeks
The swelling goes down, the bleeding decreases and the gums firm up. The teeth may look longer.
Re-measurement
Once the tissue has healed, the pockets are measured again. Ask how many pockets have closed; a repeat or surgery for pockets that have not closed is decided with this measurement.

Don't wait if

Swelling, a discharge of pus or a fever. There may be an abscess, and you need to be assessed the same day. If there is swelling spreading quickly in the face and neck, or difficulty swallowing or breathing, call 112.
The bleeding will not stop. Bleeding that continues despite pressing with gauze means you need to call your dentist, especially if you take a blood thinner.
The pain is getting worse as the days go by. Sensitivity is expected; increasing pain is not. Go for a check-up.
Sensitivity is not decreasing after weeks. There may be decay or another problem on the exposed root surface.

What determines the scope of curettage

The scope of root surface cleaning varies from mouth to mouth. The determining factors:

The number of teeth and areas affected: Pockets limited to a few teeth and disease spread across all four areas are not the same in scope.
Pocket depth and the amount of tartar: Deep pockets and heavy tartar may need longer sessions and more sessions.
Supporting treatments: If local medicine inside the pocket or other supporting methods are used, the scope changes.
What comes afterwards: If surgery is needed at re-measurement and the maintenance interval is shortened, the long-term plan widens.

Frequently asked questions

Does curettage hurt?

Because it is done with the area numbed, what you usually feel during the procedure is not pain but pressure and vibration. In one study, patients who were numbed reported less discomfort. In the following days there may be an ache and sensitivity.

Are curettage and a scale and polish the same thing?

No. A scale and polish removes build-up above and just below the gum margin. Curettage, meaning root surface cleaning, goes down to the bottom of the pocket and usually needs numbing.

Why are my teeth sensitive after curettage?

When tartar and inflamed tissue are removed, the root surface is exposed. In one review, sensitivity was seen in about half of patients; its intensity increases over 1 to 3 weeks and then decreases. Ask your dentist to recommend a toothpaste for sensitive teeth.

Will my teeth become loose after curettage?

Curettage does not cause permanent looseness in a tooth. When the swelling goes down, the movement of teeth that already have bone loss may be felt more clearly. Over time, as the gums firm up, this feeling usually decreases.

How many sessions does it take?

It depends on the number of areas affected. It can be split quarter of the mouth by quarter over several sessions, or completed within 24 hours; according to the EFP guideline, the results of the two methods are similar.

What should I eat after curettage?

Do not eat until the numbness has worn off. For the next day or two, very hot, hard and spicy foods may increase sensitivity; lukewarm and soft foods are more comfortable.

Is laser curettage better?

The EFP guideline recommends not using a laser in addition to root cleaning. A laser does not replace the mechanical cleaning of tartar from the root surface.

Can I smoke after curettage?

Smoking has a negative effect on healing and on the result; in one meta-analysis, pocket reduction was smaller in people who smoke. The treatment period is a good opportunity to stop; ask your dentist or your GP (family doctor) for support to stop.

How long after curettage should I go for a check-up?

Your dentist sets the time for re-measurement; it is done once the tissue has healed. Do not skip this appointment: whether the treatment has worked, and whether surgery is needed, is understood from this measurement.

Will the teeth that have had curettage be saved?

Most pockets close, but in teeth with advanced bone loss the result may be limited. Which teeth can be kept is decided with re-measurement. If there are teeth that cannot be saved and many teeth are missing, implant planning can be discussed separately.

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