Scaling and root planing involves careful cleaning of the root surfaces to remove plaque and calculus (tartar) from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins. Scaling and root planing is often followed by adjunctive therapy including locally-delivered or systemic antibiotics or host modulation therapy. Scaling and root planing is performed under local anesthetic with ultrasonic cleaners as well as scaling instruments. Both hygienists and dentists are trained to perform root planing.