Scaling is the removal of calculus (tartar) and plaque from the tooth, especially below the gum line along the root surface. Ultrasonic scalers, which use high frequency vibration to blast away hard calculus, are sometimes used first to remove the larger chunks. Then, special hand-held instruments called scalers and curettes are used to do fine scaling. Because plaque is more likely to stick to rough surfaces, the root surface is also smoothed down in a process called root planing. This gets rid of any remaining calculus or "contaminated" cementum on the root and buffs out any scratches that might have been caused during scaling. If you have gingivitis or periodontitis that is localized to one part of your mouth, scaling and root planing can be done in one visit. However, if you have a more generalized form of periodontitis spread throughout your mouth, your periodontist typically will do a quarter of the mouth (a quadrant) at one time. This means that four visits will be necessary to complete the scaling and root planing.

Patients may be asked to rinse with warm salt water periodically, about five times during the day, for the first day, to flush out any debris loosened by the treatment. Normal brushing and flossing should be continued. There may be some minor bleeding, but this is normal and will stop in a day or two. Some patients may be prescribed low-dose doxycycline hyclate, a form of tetracycline. Although this medication is an antibiotic, it is not used for its antibiotic properties. Its value lies in its ability to inhibit some of the enzymes that our bodies produce in response to periodontal bacterial infections. For example, it inhibits collagenases, which can chew up the proteins that make up bones and soft tissues. Although this medication cannot cure or prevent periodontitis, it may be prescribed in conjunction with scaling and root planing as a supplement treatment for some patients.