For Scaling and Root Planing/Deep Cleaning

Patient Consent Information

I understand that periodontal procedures (treatment involving the gum tissues and other tissues supporting the teeth) include risks and possible unsuccessful results from such treatment. Even when the utmost care and diligence is exercised in the treatment of periodontal disease and associated conditions through scaling and root planning, risks and results associated with treatment include but are not limited to the following:

1. Response to treatment: Because of the variables within each patient’s physiological makeup, it is impossible to determine whether or not the healing process, in which tissue response is a vital element, will achieve the results desired by the doctor and the patient. Should the desired results not be attained, extractions may be required.

2. Postoperative patient responsibility for care: With the types of treatment required in correcting periodontal problems, it is mandatory that the patient exercise extreme diligence in performing the home care required after treatment, as instructed by the treating dentist. Without the necessary follow-up care, the probability of unsatisfactory results is greatly increased.

3. Pain, soreness and sensitivity: There may be temporary or permanent postoperative discomfort, related to hot and cold stimuli, contact with teeth, and sweet and sour foods, and the gums may also be sore immediately following treatment.

4. Bleeding during or after treatment: Laceration or tearing of the gums may occur, which might require suturing. The gums may bleed as well during or after treatment.

5. Recession of the gums after treatment: After healing occurs, there may be gum recession that exposes the margin or edge of crowns or fillings, increase sensitivity of teeth and creates aesthetic or cosmetic changes in the front teeth resulting in longer tooth appearance and wider inter-proximal spaces. These wider inter-proximal spaces are more likely to trap food.

6. Broken curettes, scalers or other instruments: If an instrument breaks off during scaling or root planning, it may be necessary to retrieve the broken instrument surgically.

7. Post-treatment infection: Post-treatment infection also may result from calculus being lodged in the tissue, which may also require surgical intervention.

8. Increased mobility (looseness) of the teeth during the healing period: some patients experience increased mobility of teeth during the healing period. This is usually a temporary condition.

9. Noise and water spray: ultrasonic instrumentation is noisy, and the water used may cause cold sensitivity during treatment on nonanesthetized teeth not being treated.

10. Post treatment complications: Cracking or stretching of the lips or corners of the mouth during treatment is possible. There is the possibility that additional surgical treatment may be necessary after root planning.

11. Sequela of local drug delivery: If tetracycline fiber is used, there may be premature loss of the fivers necessitating a return visit to the dental office for replacement. There may be soreness or pain in the treated areas. The patient will be aware of the adhesive sealer, which often has a granular surface. The sealer has an opaque or milky appearance and may be visible. There will be a need for a postoperative visit to remove the fibers seven to 10 days after placement. There may be an adverse reaction to the antibiotic in the fiver whether a pre-existing, known allergy exists or not.

INFORMED CONSENT: I have been given the opportunity to ask questions regarding the nature and purpose of periodontal treatment and have received answers to my satisfaction. I voluntarily assume any and all known possible risks, including the risk of substantial harm, if any, which may be associated with any phase of this treatment in hopes of obtaining the desired results, which may or may not be achieved. No promises or guarantees have been made to me concerning my recovery and results of the treatment. The fee(s) for this service have been explained to me and are acceptable.

Post-Operative Instructions



Slight swelling of the operated area is not unusual. Chapped lips or bruising of the lips/cheek area may occur.

  • A reusable ice bag or a frozen vegetable bag, wrapped in a soft towel, may be applied to the area of scaling to help minimize the swelling. Alternating 20 minutes on and 20 minutes off will usually be adequate during the first 24-48 hours.
  • Keeping your head elevated above your heart will also help. Most swelling can occur in the morning and up to 3 days after surgery. Avoid sleeping/laying on the side that surgery was performed.
  • Any major swelling should be reported to the doctor at once.

You may experience some tooth sensitivity after Scaling and Root Planing, especially to cold. Sensitivity usually decreases within several weeks after the procedure and can be minimized by keeping the area as free of plaque as possible. If the sensitivity is extreme, contact the doctor for recommendations or medications to relieve the discomfort.

Minor bleeding, such as a pinkish tinge to your saliva, may occur during the first 48 hours following the procedure. Avoid extremely hot foods for the rest of the day and do NOT rinse out your mouth, as these will often prolong the bleeding. If bleeding increases or occurs past the initial 48 hours, please call our office as soon as possible to notify the doctor and receive further instructions.

Eating / Diet:
You may eat as tolerated after the numbness has worn off. Avoid sticky, hard (such as ice cubes, nuts, popcorn, chips), brittle, spicy, highly seasoned, or acidic foods in your diet. Foods such as soups, pasta, scrambled eggs, mashed potatoes, macaroni & cheese etc. are best. Be sure to maintain adequate nutrition and drink plenty of fluids.

Smoking is not advised during the 7-14 days following surgery, as smoking will delay your healing.


Please brush twice a day and floss daily. Rinse your mouth with chlorhexidine twice daily after brushing and flossing your teeth. Measure your dose using the cup provided with the medication. Swish the medicine in your mouth for at least 30 seconds, then spit it out. DO NOT RINSE JUST SPIT OUT AS MUCH AS YOU CAN.

If you already do not have your 3 months cleaning appointment, please call us immediately to make that appointment. These 3 months periodontal maintenance (cleaning) appointments is essential to your periodontal health and will prevent you from needing another Scaling and root planning.