by Rana Baroudi
Dr. Baroudi is a Board Certified Periodontist. She has successfully passed the American Board of Periodontology oral and written examinations covering all phases of periodontal disease, its treatment and dental implants. She is also an Associate Clinical Professor of Periodontology at UCSF where she enjoys teaching and lecturing on a bi-monthly basis.
Learn MoreWhen you’re diagnosed with gum disease, it can be overwhelming to hear about the various treatment options available. Some therapies focus on deep cleaning below the gumline, while others involve surgical techniques to address more advanced stages of periodontal disease. Two of the most commonly recommended procedures are scaling and root planing and pocket reduction surgery. While both play a critical role in controlling infection and preserving oral health, they differ significantly in their approach, the stage of disease they target, and what patients can expect during treatment.
Understanding the distinction between these therapies is important for making confident decisions about your care and achieving the best possible results for your smile.
Gum disease, or periodontitis, begins when bacteria accumulate along and below the gumline. As the infection advances, the body’s response to these bacteria can cause the gums to separate from the teeth, forming periodontal pockets. These pockets create hidden spaces that trap even more bacteria and debris. As pockets deepen, it becomes nearly impossible to clean them with brushing and flossing alone. Over time, this can result in the destruction of the supporting bone and gum tissue and, eventually, tooth loss if left untreated.
The depth of these periodontal pockets is a key factor in deciding which treatment is most appropriate. Smaller pockets often respond well to deep cleaning procedures, while deeper or persistent pockets may require surgical intervention.
Scaling and root planing is a non-surgical periodontal treatment that goes beyond a standard dental cleaning. It is sometimes called a “deep cleaning” and is often recommended as the first step in controlling early to moderate gum disease.
During scaling and root planing, special instruments are used to remove plaque and hardened tartar (calculus) from above and below the gumline. The “scaling” portion targets deposits on the tooth surface and beneath the gums, while “root planing” involves smoothing the root surfaces of the teeth. Smoother roots discourage future buildup of bacteria and toxins, and can help gum tissue reattach more effectively.
This procedure is usually recommended for patients who have pockets measuring up to 5 millimeters in depth. In many cases, scaling and root planing can halt the progression of gum disease, reduce inflammation and bleeding, and restore gum health—especially when paired with diligent home care and regular dental visits.
Pocket reduction surgery is a surgical procedure performed when gum disease has advanced and periodontal pockets have become too deep to treat with non-surgical therapy alone.
The periodontist gently lifts the gum tissue away from the teeth to gain direct access to the tooth roots and the underlying bone. This allows thorough removal of plaque, tartar, and infected tissue from deep within the pockets. In some cases, the bone may also be reshaped to eliminate irregularities that can harbor bacteria. After cleaning and reshaping, the gum tissue is repositioned snugly around the teeth and secured with sutures.
By reducing the depth of the periodontal pockets, pocket reduction surgery makes it easier for you and your dental care team to keep the area clean, lowering the risk of future infection and bone loss.
This procedure is typically recommended when pocket depths exceed 5 millimeters and continue to persist despite thorough non-surgical therapy such as scaling and root planing. Deep, persistent pockets are difficult to clean and are associated with ongoing tissue and bone destruction. Pocket reduction surgery is an effective solution for stopping disease progression and saving teeth that might otherwise be lost.
Approach and Treatment Process
Scaling and root planing is typically performed under local anesthesia, sometimes in multiple visits if several areas require attention. It does not involve incisions or stitches, and patients usually return to their regular routine quickly.
Pocket reduction surgery, on the other hand, is a minor surgical procedure that requires incisions in the gum tissue, and sometimes sutures, to allow deeper cleaning. Some patients may receive sedation for comfort. There is a short healing period during which the gums recover and reattach more closely to the teeth.
Indications and Outcomes
Patients with mild to moderate periodontal pockets typically benefit most from scaling and root planing, while pocket reduction surgery is reserved for more advanced cases with deep or persistent pockets. Both aim to preserve natural teeth, but the choice depends on the severity of disease and response to initial treatments.
Long-Term Maintenance
Regardless of the procedure, successful management of gum disease relies on ongoing maintenance. This includes professional cleanings, good oral hygiene at home, and regular check-ups with your periodontist. If new pockets develop or gum disease returns, additional treatment may be necessary.
Scaling and root planing can control and, in early stages, even reverse the effects of gum disease. However, since periodontitis is a chronic condition, ongoing maintenance and regular professional care are crucial for keeping it in remission.
Pocket reduction surgery is performed with appropriate anesthesia or sedation, so discomfort during the procedure is minimal. After surgery, mild swelling or soreness is common but usually resolves within a few days. Most patients report that the benefits far outweigh any temporary discomfort.
Your periodontist will evaluate the depth of your pockets, the extent of bone loss, and your response to initial therapy before making a recommendation. Often, scaling and root planing is the first step, and pocket reduction surgery is considered if pockets remain deep or disease persists.
Consistent oral hygiene practices, such as thorough brushing, flossing, and regular dental visits, are key. Following your periodontist’s recommendations for maintenance appointments and at-home care helps protect your gums and teeth long after treatment.
Both scaling and root planing and pocket reduction surgery are important tools in modern periodontal therapy. Each has a unique role in treating gum disease and preserving your natural smile. By working with an experienced periodontist and staying proactive about your oral health, you can enjoy stronger gums, healthier teeth, and greater confidence for years to come.
