What is Curettage? Why is it Performed Before Gum Surgeries?

One of the terms our patients hear most frequently in the treatment of gum diseases is “Curettage”. Although it is often confused with simple scaling (tartar removal), curettage is actually a much more comprehensive treatment that repairs the biological structure of the tooth and gum.

So, what exactly is curettage, and why must it be applied specifically before major gum surgeries (operations)?

A Simple Example to Understand Curettage: The Wall and Paint Analogy

To grasp the logic of curettage, think of the walls in our homes. In the past, unplastered walls used in houses were rough and uneven. Because these surfaces were not smooth, they easily trapped dust, dirt filled the gaps, and even if cleaned, they would immediately get dirty again. Whereas today’s satin-painted, plastered walls are smooth; they do not hold dirt and are very easy to clean.

The tooth root surface also normally has a smooth, polished, and slippery structure, like satin paint. However, in long-term gum inflammation, this structure deteriorates:

• Tartar descending below the gum line ruins the root surface.
• The surface becomes uneven, creating a state that traps dirt and bacteria.
• The gum tissue adhering to this irregular surface also becomes diseased; it turns into an oedematous, bleeding, inflamed structure we call “granulation tissue“.
• In this situation, the gum cannot heal itself, the pocket deepens, and the tooth begins to wobble by losing its supporting tissue.

How Does Curettage Reverse This Process?

The curettage procedure is not just a “cleaning”; it is a treatment stage that restores the ruined root surface to a healthy state. Our aims in this procedure are as follows:

• Deep Cleaning: Completely removing the tartar remaining in the pockets under the gum.
• Surface Smoothing: Transforming the ruined, rough root surface back to its former state—that is, a slippery, polished, and smooth surface.
• Tissue Removal: Removing the unhealthy granulation tissue inside to clear the area of infection.
• Reattachment: Ensuring that the healthy gum adheres tightly to this cleaned root surface.

When this procedure is successful, pocket depth decreases, bleeding stops, and tooth mobility (wobbling) significantly regresses.

Why is Curettage Essential Before Gum Surgery?

Many of our patients rightly ask: “If I am already going to undergo a surgical operation, why do I have to have curettage done beforehand?”

Let’s answer with a simple “Renovation” example: Before painting a room or laying parquet flooring, you absolutely clean up the dust, dirt, and debris. Paint applied onto a dirty, dusty, and uneven floor will not stick; it will crack and peel off in a short time. Gum surgery operates on the same principle. The most important factor determining the success of surgery is the preparation done before the operation. Here are 5 vital reasons why curettage is mandatory before surgery:

1. Reduction of Bacterial Load (Safe Surgical Environment)

Very dangerous bacteria such as Porphyromonas gingivalis and Tannerella forsythia are found in periodontal pockets. If surgery is started without performing curettage, the risk of these bacteria entering the bloodstream increases. Curettage reduces the bacterial load by rates of up to 90%, preparing an environment that is safe (“close to sterility”) for surgery.

2. “Biological Compatibility” of the Root Surface

Before surgery, the root surface must be completely purified of toxins and bacterial plaques. Remember: A root surface that has not been prepared with curettage is like tape you try to stick to a dusty surface; it will not stick and will fall off. For the gum or the bone powder (graft) to be added to fuse with the root, the surface must be spotless.

3. Solid Tissue for Sutures to Hold

When sutures are applied to oedematous, infected, and bleeding gum tissue, the tissue can easily tear (falling apart “like cheese”). After curettage, oedema decreases and the tissue gains elasticity. Sutures applied to solid tissue increase surgical success and the speed of healing.

4. No Healing Without Cleaning Granulation Tissue

Granulation tissue is dead tissue that is inelastic, prone to bleeding, and harbours infection. No bone graft or flap operation performed without cleaning this tissue can be successful. Curettage removes this tissue from the environment.

5. Switching the Body to “Healing Mode”

Curettage increases blood circulation and oxygenation in the area. You can liken this to aerating the soil before planting plants. Soil does not hold new seeds without breathing. After curettage, the body activates its defence mechanisms, accelerating post-surgical recovery.

Can Curettage Eliminate the Need for Surgery?

Yes, this is possible. In early and mid-level gum problems, a correctly and meticulously performed curettage procedure:

• Draws the pocket depth to an ideal level,
• Completely dries up the inflammation,
• Stops the tooth from wobbling.

In this case, full recovery can be achieved without the need for surgery in many patients for whom surgery was initially planned. Therefore, in our periodontal treatment protocol, first curettage, followed by (if necessary) a surgical approach is the “Gold Standard“.

Conclusion: The Foundation of Treatment

Curettage is the biological foundation of gum treatments. It is the most critical step that cannot be skipped, both to increase the success of the surgery and to keep your tooth in your mouth.

As DRTU Tansu Uzel Clinic, we care about your gum health down to the finest detail; we plan your treatments in accordance with scientific foundations and surgical discipline.

Do you feel gum bleeding or wobbling in your teeth? You can make an appointment with our specialist physicians for a detailed examination without delay. You can visit our Instagram page for example treatments.