Scaling or air polishing — which procedure is done for which problem

It comes down to whether the deposit feels hard when you touch it with your tongue

• A soft film comes away when a jet of powder and water hits it. A hard, rough deposit has to be knocked off with an instrument, because powder does not shift it.
• The question "scaling or air polishing" rarely has an either/or answer: usually both are needed, and in many practices the powder goes first and the ultrasonic scaler after it.
• Air polishing also takes off stains from coffee and from cigarettes: pigment from the surface, not the colour of the tooth itself.
• This article settles only which procedure removes what. The course of the whole appointment, and calculus itself, are covered by separate articles.
• With your tongue you can check only what is above the gum. Calculus below the gum is detected only by the dentist, with a thin measuring instrument, and it is the dentist who decides the scope of the appointment.

Calculus, soft deposit and stain are three different things

Several layers build up on a tooth and only one of them is hard, because only one has had time to mineralise.

Biofilm is a living, organised layer of bacteria adhering to the tooth surface. It is soft, it grows back within a dozen or so hours after you brush your teeth, and it comes away both with a toothbrush and floss and with a fine powder propelled with water - that is, with air polishing of the teeth.

Dental calculus forms when biofilm has lain in place long enough and mineralises with calcium salts. It then adheres to the enamel or to the root surfaces and stops being something that can be blown away. The kind visible above the gum margin is supragingival calculus and it takes its salts from saliva, while the subgingival calculus hidden deeper takes them from the fluid beneath the gum margin.

Calculus is removed by dental scaling: an ultrasonic tip breaks up the mineralised deposit with vibrations at a frequency the ear cannot hear, and the blade of a periodontal curette, that is a hand instrument, takes off the rest under the control of touch.

Calculus is rough and porous, so it holds further layers of biofilm on itself that a toothbrush will no longer remove; it is therefore taken off even in a patient who does not feel that calculus is troubling them.

Staining is the third thing and it is neither a soft deposit nor calculus: pigment from coffee, tea, wine or tobacco smoke penetrates the thin protein film covering the enamel, called the acquired pellicle. After air polishing most of it comes away, and after scaling alone it can remain.

The same division explains why a professional cleaning appointment consists of several successive stages instead of one. The question "scaling or air polishing" concerns two different deposits: the soft one and the mineralised one; one procedure is not a variant of the other.

Scaling or air polishing: a checklist of what you can see and what the appointment will cover

The list below does not replace an examination.

• Hard, yellow-brown build-ups on the inner side of the lower front teeth. Scaling is needed; air polishing alone will not shift them.
• A greyish film that can be scraped off with a fingernail. That is biofilm: air polishing and a corrected brushing technique are enough.
• Dark lines in the fissures and along the margins of fillings. Most often staining, not calculus. A dark filling margin is sometimes a leaking margin, however, and air polishing will not remove that. Air polishing with a low-abrasive powder: sodium bicarbonate at the margins of fillings makes the surface rougher.
• Blood on the toothbrush when you brush. A signal that deposits are sitting at the gum. The scope then widens to include thorough cleaning of the gum margin, and with a deeper deposit also root surface debridement, that is cleaning of the root below the gum margin.
• Exposed roots and receded gums. The scope then covers the root surfaces as well, not the crowns alone, and the appointment is sometimes longer and more often requires local anaesthesia.

When is air polishing alone enough, and when is it not?

Air polishing alone is enough in three situations: with an exclusively soft bacterial film that comes off with a fingernail; when the only problem is staining from coffee or from cigarettes; and in a patient who has completed periodontal treatment, attends supportive appointments regularly and whose periodontal pockets have remained shallow. A periodontal pocket is the gap between the gum and the tooth surface; the dentist measures how deep it is, and with a healthy gum it does not exceed three millimetres. In every other situation air polishing is one stage of the appointment, not the whole appointment.

How fast calculus builds up depends not only on how carefully you brush your teeth, but also on the composition and the volume of the saliva you produce: in one patient an appointment every six months still means air polishing alone, in another there is something to scale after only a few weeks. A longer gap between hygiene appointments moves that boundary too - after several years one session usually will not settle the matter even with shallow pockets.

Where does most of it settle, and what can you check yourself?

It does not settle evenly. Supragingival calculus grows opposite the openings of the submandibular, sublingual and parotid salivary glands, that is where saliva flows into the mouth: on the inner side of the lower front teeth and on the cheek-side surfaces of the upper molars.

1. Run your tongue over the inner side of the lower central incisors. Smooth means there is no calculus you can feel there; rough and hard means a mineralised deposit.
2. Check the gum margin at those teeth in the mirror. A yellow-brown band just above the gum is most often a mineralised deposit.
3. Count how many months have passed since your last hygiene appointment.

One thing you will not check yourself, with either your tongue or a mirror: subgingival calculus lies below the gum margin and it is sometimes black and hard. The dentist assesses whether it is present primarily by tactile examination with a probe or an explorer; a radiograph may reveal some of the larger deposits, but a normal image does not rule calculus out.

Air polishing hurts less, but it does not replace scaling

Air polishing gives an effect that is visible immediately: the tooth is smooth, the stains disappear. The effect concerns the surface, however, and periodontal disease begins below the gum margin, in a place the patient neither looks at nor controls with a toothbrush.

When gum inflammation has to be brought down, air polishing comes out neither better nor worse than hand instruments and ultrasonics; that is what emerged from a systematic review of studies on biofilm control. Its authors note at the same time that follow-up was short and that some of the included studies were funded by equipment manufacturers. A meta-analysis of studies on glycine powder came out differently: gums bled after air polishing less often than after hand instruments, by eight percentage points. The included publications give only the difference, however, without a starting point, so it is not known whether that is a lot. In periodontal pocket depth there was no advantage at all.

These studies measured something narrower than it seems, however. What they mainly compared was what maintains the result in patients who have completed periodontal treatment; not what is done in someone whose calculus has just built up.

The clearest advantage concerns what the patient feels. Pain rated on a scale from zero to one hundred came to thirteen points after subgingival air polishing and twenty-nine after a sonic scaler, that is one working at an audible frequency; this was compared within the same people, on two sides of the mouth. The clinical results after six months did not differ between the groups.

The pain of scaling does not have to be endured, however: the most sensitive sites are worked on under local anaesthesia or after an anaesthetic gel.

Deep pockets were examined in a separate randomised trial, that is one with random allocation to groups. When subgingival air polishing was additionally added to ultrasonics, the result after three months did not change: slightly under half of the pockets closed in both groups, and these were pockets of five to nine millimetres in patients with advanced periodontitis.

The authors' conclusion runs as follows: in deep, bleeding pockets ultrasonic root surface debridement remains the method of choice, while air polishing can remove biofilm subgingivally as well, but it does not remove mineralised calculus and does not replace mechanical debridement of the root. This does not mean that air polishing is useless in periodontal disease; it means only that it does not replace debridement of the root.

From the perspective of the clinical team at Modern Dental & Orthodontics (Klinika MDO), most misunderstandings arise around dental calculus lying beneath the gum margin: the patient judges the appointment by whether the teeth are smooth, and the dentist by whether the gum has stopped bleeding.

What does the gum feel in the first days after the procedure?

Bleeding during scaling and for the first twenty-four hours after it is typical wherever the gum was inflamed beforehand. This is not a complication. That does not mean, however, that bleeding may be ignored, because not every kind of bleeding means the same thing.

Oozing of blood on brushing weakens from day to day, and the gum returns to a normal state usually within one to two weeks; if after two weeks blood still appears on brushing, the inflammation is continuing and requires renewed periodontal assessment. Bleeding that does not stop, or that increases, is a different matter, and you do not wait two weeks with it.

Healing also has a side that patients usually do not expect: after extensive supragingival and subgingival deposits have been removed, the gum shrinks back and the gaps between the teeth become more noticeable. This is not the result of damage to the tissues but of the receding of the inflammatory swelling that had previously filled those spaces, and for several weeks the teeth are then sometimes perceived as longer than before the hygiene appointment. That is why, with before and after photographs of a hygiene appointment, the after photograph is best taken only a week or two after the procedure, because before that the picture of the gum is still being altered by swelling.

Two factors lie on the practice's side, not on the side of home hygiene. The gum tolerates the jet more gently when the nozzle is held perpendicular to the surface than when it strikes at an angle; this was measured in an experimental model on animal tissue, that is outside a living organism. The second factor is the powder, although for the gum itself no difference has been measured; it shows on hard surfaces.

Here the data do not agree. On specimens of human roots, trehalose and sodium bicarbonate turned out to be the gentler ones, while glycine and erythritol left the surface rougher; tissue loss was negligible in all groups. In a review of laboratory studies on restorations it is the other way round: after sodium bicarbonate, restorations become distinctly rougher, and erythritol and glycine come out gentlest. The two publications measured different things and on different material, so they do not invalidate each other. For the patient one thing follows from them: before air polishing you have to say what prosthetic restorations you have in your mouth.

The procedures themselves also have their limitations and contraindications. The powder jet is not directed at freshly ulcerated mucosa. Asthma, lung disease and a sodium-restricted diet are worth mentioning before the appointment, because they change the choice of powder and the way the work is done.

Come in sooner, do not wait until your next appointment, if bleeding does not stop after two days or increases, if pain grows instead of easing, if swelling of the cheek or a fever appears. This is not the expected course of healing.

When is one appointment not enough?

It depends on how deep the deposits reach. One session settles the matter when the deposits lie above the gum and the pockets do not exceed three millimetres. Four millimetres is an intermediate band: what decides then is whether the site bleeds on probing.

With deeper periodontal pockets and subgingival calculus, periodontal treatment begins. Non-surgical subgingival debridement is usually carried out first, and after a period of healing the response of the tissues is assessed. Flap surgery is considered only at sites with deep residual pockets that have not responded to the earlier stages; the number of appointments depends on the extent of the disease and on the treatment plan. Air polishing and supragingival scaling are usually carried out by a dental hygienist, while the root surfaces are debrided and curettage performed by the dentist.

Scaling or air polishing stops being the right question at this point - the right one runs differently: how much root surface has to be debrided, and in how many sessions.

Frequently asked questions

Does scaling damage the enamel?

No. The scaler tip works on the deposit, not on the enamel surface, so a correctly performed procedure is not an abrading of the tooth. The surface is sometimes temporarily rougher after it. The appointment therefore ends with polishing. Exposed roots call for caution, because cementum and dentine are softer than enamel.

Does air polishing whiten teeth?

No. Air polishing of the teeth removes pigment deposited on the surface. The tooth thereby comes closer to its own colour and looks lighter. In a study on tobacco stains, none of the cleaning methods compared restored the original shade of the specimens. The tissue of the tooth itself is lightened only by whitening, that is a procedure based on peroxide.

Why are the teeth sensitive after the procedure, and for how long?

Sensitivity is strongest in the first two days and usually eases within a week. It comes from the exposure of tooth necks that calculus had previously covered, and from the momentary opening of the tubules in the dentine, and it does not mean damage to the tooth. A toothpaste containing compounds that reduce sensitivity helps, as does avoiding very cold drinks for a few days.

Can the gums bleed after scaling, and for how many days?

Yes, if they were inflamed before the procedure. Oozing of blood on brushing then usually lasts from one to three days and gradually weakens; if it still appears after two weeks, renewed assessment is needed. Brushing should not be given up, because it is brushing that brings the inflammation down. Bleeding that does not stop after two days, or that intensifies, calls for contact with the practice.

With subgingival calculus, is ordinary hygiene treatment enough?

Usually not. A deposit lying below the gum margin requires root surface debridement, not merely cleaning of the crown. The scope is established by measuring pocket depth with a probe. With pockets above four millimetres the question "scaling or air polishing" moves into the background. The management then passes into periodontal treatment.

A clean tooth does not mean a healthy gum

Smoothness of the surface is the measure the patient has to hand, so it is sometimes confused with the result of treatment - whereas the state of the gum is measured quite differently: by bleeding on probing and by pocket depth. Scaling and air polishing do not replace one another: air polishing removes biofilm and surface staining, while scaling removes mineralised calculus; depending on the indications and the instruments used, both procedures can cover supragingival and subgingival areas.

An appointment that, with deposits under the gum, delivers air polishing only ends in a nice photograph and a disease that goes on. In practical terms this means: it is worth asking whether pocket depth was measured and whether any sites bled on probing.

Read more:

• Dental hygiene and whitening at Modern Dental & Orthodontics (Klinika MDO)
• Dental hygiene: scaling, air polishing and fluoridation
• Dental calculus — how to recognise it and remove it effectively
• Closed vs open curettage — a comparison of methods for treating advanced periodontitis
• Mouthwash for gingivitis — what does the evidence say really works?

Content and liability disclaimer

This article is informational and educational in nature and does not constitute medical advice, a diagnosis or a therapeutic recommendation — it does not replace a consultation with a specialist. If you are experiencing symptoms, have doubts or are facing a decision about treatment, consult a dentist. The methods described and the data cited are general in nature. The results of scientific studies relate to populations, not to an individual patient. The course and outcome of therapy depend on the individual clinical situation and may vary between patients. No information contained in this article constitutes a guarantee of result. The content has been prepared with due care, based on publicly available medical knowledge and the scientific publications indicated in the Sources section. We do not advise taking or refraining from any health-related action solely on the basis of the content of this article, without prior consultation with a doctor.

Sources

Source 1

Links https://doi.org/10.1007/s00784-020-03762-y │ https://pubmed.ncbi.nlm.nih.gov/33464417/

Description Nascimento GG, Leite FRM, Pennisi PRC, López R, Paranhos LR. „Use of air polishing for supra- and subgingival biofilm removal for treatment of residual periodontal pockets and supportive periodontal care: a systematic review.” Clinical Oral Investigations. 2021;25(3):779-795.

Source 2

Links https://doi.org/10.1007/s00784-020-03648-z │ https://pubmed.ncbi.nlm.nih.gov/33404760/

Description Mensi M, Scotti E, Sordillo A, Calza S, Guarnelli ME, Fabbri C, Farina R, Trombelli L. „Efficacy of the additional use of subgingival air polishing with erythritol powder in the treatment of periodontitis patients: a randomized controlled clinical trial.” Clinical Oral Investigations. 2021;25(2):729-736.

Source 3

Links https://doi.org/10.5051/jpis.1902340117 │ https://pubmed.ncbi.nlm.nih.gov/34114379/

Description Zhu M, Zhao M, Hu B, Wang Y, Li Y, Song J. „Efficacy of glycine powder air-polishing in supportive periodontal therapy: a systematic review and meta-analysis.” Journal of Periodontal & Implant Science. 2021;51(3):147-162.

Source 4

Links https://doi.org/10.1186/s12903-022-02109-1 │ https://pubmed.ncbi.nlm.nih.gov/35282825/

Description Kruse AB, Wölki BJ, Woelber JP, Frisch E, Vach K, Ratka-Krüger P. „Subgingival air polishing with trehalose powder during supportive periodontal therapy: use of a conical shaped tip during a randomized clinical trial.” BMC Oral Health. 2022;22(1):70.

Source 5

Links https://doi.org/10.1007/s00784-026-07007-2 │ https://pubmed.ncbi.nlm.nih.gov/42467139/

Description Wetzel C, Hieble R, Bumm CV, Christoff V, Kessler A, Pitchika V, Altpeter P, Reymus M, Schwendicke F, Folwaczny M, Werner N. „Comparative analysis of low-abrasive powders on root surface roughness and substance loss: an ex vivo study.” Clinical Oral Investigations. 2026;30(8):341.

Source 6

Links https://doi.org/10.1007/s00784-023-05236-3 │ https://pubmed.ncbi.nlm.nih.gov/37644232/

Description Weusmann J, Deschner J, Keppler C, Imber JC, Cores Ziskoven P, Schumann S. „The working angle in low-abrasive air polishing has an influence on gingival damage – an ex vivo porcine model.” Clinical Oral Investigations. 2023;27(10):6199-6207.

Source 7

Links https://doi.org/10.1016/j.identj.2024.11.008 │ https://pubmed.ncbi.nlm.nih.gov/39709239/

Description Sigwart L, Wiesmüller V, Kapferer-Seebacher I. „Colour Changes and Surface Roughness After Air-Polishing for Tobacco Stain Removal.” International Dental Journal. 2025;75(2):1409-1419.

Source 8

Links https://doi.org/10.1111/jerd.13428 │ https://pubmed.ncbi.nlm.nih.gov/39908196/

Description Esati J, Amran T, Weiger R, Alsulaimani L, Blatz MB, Eggmann F. „Adverse Effects of Ultrasonic Instrumentation and Air Polishing on Dental Restorations: A Systematic Review of Laboratory Studies.” Journal of Esthetic and Restorative Dentistry. 2025;37(6):1372-1383.