Your teeth cleaning, step by step.

Plaque is the soft, sticky film of bacteria that builds up on teeth every day. Brushing and cleaning between the teeth remove most of it, and where some is missed, minerals from saliva harden it into tartar, which dentists call calculus ^[1]. Tartar always carries a layer of live plaque on its surface ^[2] and keeps it in place along the gum line. Once tartar has set, a toothbrush cannot remove it; it comes off at a cleaning.

In people who brush daily and see the dentist regularly, tartar above the gum forms mainly on the teeth next to the openings of the salivary glands ^[1]. Those openings sit under the tongue, behind the lower front teeth, and in the cheeks beside the upper back teeth, which is why a rough edge is often felt first on the inside of the lower front teeth. Tartar-control toothpastes help before tartar sets: they slow the hardening and keep fresh deposits soft enough to brush away ^[1]. Whatever has already set is lifted at your cleaning.

A cleaning also lifts stain. Tea, coffee, shisha and smoking leave yellow and brown marks on the surface of the teeth, often as a darker rim along the gum line and between the teeth. In a laboratory study of tobacco stain, air polishing with a low-abrasive powder removed it as well as coarser powder and pumice did, without roughening the enamel ^[6]. A cleaning lifts what sits on the surface; for a shade lighter than your teeth's own, teeth whitening is planned once the teeth are clean and the gums are healthy.

First, a short update on your health and any medicines, then a careful look at your gums: where they bleed, how deep the pockets between gum and tooth measure, and whether the gum has drawn back from the tooth. Gums that bleed at fewer than one in ten of the measured points count as healthy, and bleeding at more points than that is gingivitis ^[7][8]; gums that do not bleed, visit after visit, are a reliable sign that they are stable ^[9]. If your gums need more than a routine cleaning can give, you hear it now, before anything else is done.

Next, a plaque dye, also called a disclosing solution. It colours the plaque so you can see it too, and it guides the cleaning to every place the plaque sits: in a randomised trial, a cleaning guided by the dye left about half as much plaque near the gum as the same cleaning without it ^[10]. The colour comes away as the teeth are cleaned.

Then ultrasonic scaling for the tartar. A fine tip vibrates in a spray of water, breaking tartar away from the teeth above the gum and just below it while the water rinses it off. Where a smoother finish is needed, a slim hand instrument completes the work. Either kind of instrument is accepted: in the review behind the European guideline on gum treatment, hand and ultrasonic instruments gave the same results, and the guideline recommends either or both ^[11][8].

Then air polishing (Airflow). A fine, low-abrasive powder carried in air and water lifts stain, the remaining plaque and soft deposits, including from the spaces between the teeth. Low-abrasive powders have been studied closely: glycine changed root surfaces less than coarser powders, and the gum less than coarser powders or hand instruments ^[12][13]; glycine and erythritol were the least abrasive on fillings and crowns in laboratory tests ^[14]; and repeated erythritol air polishing left enamel no rougher in a laboratory study ^[6]. People treated with these powders report the same or less discomfort than with hand or ultrasonic instruments ^[15][16][17], and in people having regular maintenance after gum treatment, air polishing gave the same clinical results as conventional cleaning, with more comfort and less time in the chair ^[18][19][20].

Polishing with a soft prophy brush or rubber cup follows, and only where stain remains. Polishing removes very little enamel, even when repeated over a lifetime ^[21], but over time it can wear the softer root surface and the outer, fluoride-rich layer of enamel ^[21][22], so it is kept to the places that need it.

Then fluoride, where your risk calls for it. A fluoride varnish painted on after the cleaning adds protection where the teeth need it, for example on exposed roots, with a dry mouth or after a run of new decay; in adults over 60, a 5% sodium fluoride varnish prevented about 64% of new decay on exposed roots ^[23]. More is on the fluoride treatment page.

Then a few minutes of coaching, the part that makes the cleaning last. You see what was missed, and where the gums are inflamed, Dr. Khalid shows you interdental brushes, the device European guidance recommends for cleaning between the teeth ^[8][24]. Cleaning and coaching work together: a professional cleaning added to coaching gave a further benefit over coaching alone ^[4], and for gums that are already inflamed, professional plaque removal improved the inflammation and lowered plaque, with some evidence that reinforcing home care adds to it ^[24].

Finally, your next visit. Dr. Khalid sets it at 4 months, 6 months or a year, from what your teeth and gums showed today, and reviews it each time you come. That sits within the UK's national guidance (NICE), which asks for every patient's interval to be set individually and never to be longer than 24 months for an adult or 12 months for anyone under 18 ^[25].

Veneers, bonding, composite fillings and crowns need a cleaning that keeps their surfaces smooth and their edges sealed. In laboratory studies, ultrasonic tips and coarser powders roughened some restoration surfaces, while erythritol and glycine powders were the least abrasive and are the ones recommended for removing stain and soft deposits ^[14]. So around bonded work, the low-abrasive powder does most of the cleaning, and the ultrasonic tip is kept to where there is tartar to remove.

Implants are checked and cleaned at every visit as well. Maintenance at a set interval lowers the risk of disease around implants, and a review of the evidence suggested a visit at least every five to six months ^[26]. When implants are part of your plan here, Dr. Khalid, our periodontist in the same clinic and the team make one plan together, from the same scans and X-rays, before anything is booked, so the finished result meets the standards of function, aesthetics and biomimetics. The finished tooth is designed first and becomes the brief the implant is placed to, rather than the tooth being fitted to wherever the implant ends up; our periodontist places the implant, Dr. Khalid makes the crown and stays on the case throughout, and they review the result together. More is on the dental implants and peri-implantitis pages.

Braces and clear aligners make some surfaces harder to keep clean, so cleanings during treatment matter. Orthodontic treatment here is team care: Dr. Khalid, our orthodontist in the same clinic and the team plan the case together from the same records before treatment starts, so the finished result meets the standards of function, aesthetics and biomimetics. That result is agreed first and becomes the brief the tooth movement is carried out to, and our orthodontist carries out the braces or aligner treatment. Dr. Khalid stays on the case throughout, with cleanings and gum checks along the way and any restorative finishing at the end, and they review the result together. More is on orthodontics and on treating white spots.

Regularly, at an interval set for you. After your check-up, Dr. Khalid sets your next visit at 4 months, 6 months or a year, depending on what your teeth and gums need, and reviews it every time. In his practice, gum disease, implants, diabetes, smoking, braces or aligners, pregnancy or a recent run of new decay usually mean a shorter interval, and a mouth that has stayed healthy and stable can usually be seen once a year. National guidance in the UK works the same way: the interval is chosen for each person, as short as three months when needed, and never longer than 12 months for under-18s or 24 months for adults ^[25].

Keeping the routine is what pays off. In long-term studies, people who kept up regular check-ups had less decay and lost fewer teeth ^[27][28]. In a four-year trial of adults who attended regularly, every group kept coming for check-ups, because the trial compared how often people came, not whether they came ^[29][30]; their decay and gum results were similar across the intervals, which is why your interval can be fitted to you.

Sometimes the gum check at the start shows more than a routine cleaning can treat. Pockets that bleed and measure deeper than 4 mm, with bone loss on the X-ray, point to periodontitis, the condition many people still call pyorrhoea, and tartar below the gum tends to form alongside it ^[1]. The aim of treatment in the European guideline is that no pocket deeper than 4 mm still bleeds ^[8], and reaching it calls for a deep cleaning below the gum line, a separate course of treatment explained on the gum disease treatment page. If your gums bleed when you brush, start with bleeding gums; if an X-ray has shown bone loss, see bone loss around teeth.

Deep cleaning is planned from your own gum chart. Deeper pockets, over 5 mm, are treated by our periodontist in the same clinic, on one plan that Dr. Khalid, our periodontist and the team make together from the same charts and X-rays before anything is booked, so the finished result meets the standards of function, aesthetics and biomimetics. What the gums and teeth need to look like at the end is agreed first and becomes the brief for the gum treatment; our periodontist carries out the treatment of the deeper pockets and any gum surgery, and Dr. Khalid stays on your case throughout, does any restorative work himself and reviews the result with our periodontist. Afterwards, your cleanings continue here at the interval set for you.