How should I brush and floss after scaling and root planing?

The first week: gentle, not absent

This is the whole ballgame. Scaling and root planing gives your gums a clean, smooth root surface to reattach to. The ADA describes root planing as smoothing the tooth roots to help the gums reattach to the teeth, and the Academy of Periodontology describes it as preventing future plaque and toxins from adhering. If plaque rebuilds in those same pockets over the following week, you have paid for a procedure and undone it.

Sore gums make that hard. The instinct is to leave the tender area alone, and that instinct is wrong. Brush it, just softly. The ADA notes that cleaning between the teeth should not cause pain, and that flossing too hard can damage the tissue between the teeth, so use that as your calibration: pressure light enough not to hurt, but thorough enough to reach every surface.

Brushing technique the ADA recommends

Use a soft-bristled toothbrush that fits your mouth comfortably, with fluoride toothpaste, twice a day. The ADA specifically recommends a soft-bristled brush and gentle pressure, both of which may help reduce the risk of gum injury.

Place the brush at a 45 degree angle to the gums so the bristle tips get into the space where the gum meets the tooth. Move the brush back and forth in short strokes about the width of one tooth. Cover the outer surfaces, the inner surfaces and the chewing surfaces, and tilt the brush vertically to use up and down strokes behind the front teeth. Replace the brush every three or four months, or sooner if the bristles fray.

• Soft bristles only; hard bristles can push gums away from the teeth
• 45 degree angle into the gumline, not flat against the tooth
• Short, tooth-wide strokes, twice a day with fluoride toothpaste
• Cover outer, inner and chewing surfaces, plus behind the front teeth
• Consider a desensitizing toothpaste while roots are sensitive; the ADA notes it needs several applications to work
• Replace the brush every 3 to 4 months or when bristles fray

Flossing and cleaning wider spaces

The ADA recommends cleaning between your teeth once a day. Break off about 18 inches of floss and wind most of it around one middle finger and the rest around the same finger on the other hand. Guide the floss between the teeth with a gentle rubbing motion and never snap it into the gums. When it reaches the gumline, curve it into a C shape against one tooth and gently slide it into the space between the gum and the tooth, then repeat against the neighbouring tooth.

After a deep cleaning the spaces between teeth are often wider, because the tartar that was filling them is gone. Plain floss may not contact both surfaces properly. The ADA notes that beyond traditional floss you can use dental picks, tiny brushes or water flossers. Interdental brushes sized by your hygienist are usually the better tool for open spaces. Ask at your follow-up rather than guessing at sizes.

Bleeding when you clean is not a stop signal

Gums that are inflamed bleed when touched. NIDCR describes gum disease as starting with swollen, red and bleeding gums, and the ADA lists bleeding gums among the normal after effects of scaling and root planing. Bleeding while you brush and floss in the first weeks is expected and it goes down as the tissue heals.

MedlinePlus states that after periodontal treatment, gum bleeding and tenderness should go away within three to four weeks, with careful home brushing and flossing kept up for life. If a spot is still bleeding at four weeks, it goes on the list to show your dentist at the re-check, not into the too-hard basket.

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