What is a deep cleaning?
A deep cleaning, or scaling and root planing, is a different type of cleaning than your typical six month cleaning visit. At your six-month recall visit, a hygienist works to remove plaque, stain and calculus from areas on your teeth above your gums. Occasionally, plaque and calculus can accumulate below the gum line in “pockets” that form around each tooth.
These plaque deposits cannot be removed with brushing and flossing and require a special cleaning visit to rid the gums and bone of infection. We are leaning more and more the effects these infections can have on the rest of the body. The bacteria involved in infections of the gums have been shown to have an association to heart attack, stroke, high blood pressure, diabetes, COPD, and even Alzheimer’s disease… If you have, or are at risk for any of these systemic issues, please notify your dentist.
Who needs a deep cleaning?
Patients who have active periodontal disease often need a deep cleaning. At your six month check up, the hygienist or dentist may take a series of measurements at each tooth. The numbers are the depth, in millimeters, of the pockets around your teeth.
Essentially, these numbers are measuring the distance between where your gums rest against your tooth and the height of the bone supporting each tooth. Infections in the gum tissues around a tooth can cause the bone to resorb, shrinking away from the height of gums and creating a “pocket” of tissue.
As these pockets get deeper and deeper they become harder to clean. Eventually a deep cleaning, or even a surgery may be needed to rid the bacteria from these areas. Pockets of 1-3 millimeters are considered normal but as pocketing deepens beyond 4 millimeters it indicates that infection or trauma has caused a loss of bone around a tooth. Over time, this infection can cause the loss of a tooth or several teeth if left untreated.
Periodontal disease has been called a “silent disease” since there may be no symptoms or pain associated with its presence. Gums that bleed when brushing or flossing may be an early indicator but patients may not notice the progression of this disease until its too late.
As the bone around a tooth is lost, the tooth will become loose and wiggle slightly in the socket. It is not uncommon for patients to fail to perceive severely loose teeth from periodontal disease.
What should you expect at your deep cleaning appointment?
Deep cleanings are only effective if they rid the deep pockets around the teeth of plaque and debris. To remove these deposits, your gums will be numbed at the start your appointment. This allows the hygienist to adequately clean these areas without any discomfort to the patient. Specially shaped hand tools similar to the ones you often see at your regular cleanings are used to reach below the gums and scrape off the plaque deposits from the roots.
Your hygienist may also use an ultrasonic scaler to help in this process. These instruments vibrate very fast and use water to flush the tissues clean. Occasionally, a laser may even be used to kill bacteria at the bottom of the pockets. These treatments are painless and have a very easy recovery. Some patients report very moderate soreness of the gums after a deep cleaning but generally, people describe a new, clean sensation. Some patients report sensitivity in the teeth following the deep cleaning.
Sometimes, if calcified plaque has been covering large parts of the tooth for longer periods of time, the removal can result in a temporary sensitivity until your tooth acclimates to being clean and exposed to air and the fluids of the mouth.
What maintenance is required following a deep cleaning?
A deep cleaning is often just the first step in eliminating periodontal disease. You will likely be prescribed an antibiotic mouth rinse to use in the week or so following your deep cleaning but pockets will not heal overnight. In the weeks and months immediately following your appointment it is essential that you maintain a very regular brushing and flossing schedule.
Keeping food and plaque out of the pockets is the only way to promote healing and resolve the disease. Some pockets may never fully heal but clean pockets, even if deep, can be healthy and stable. You will be asked to return between four and six weeks following your deep cleaning to “touch up” some areas and to assess your healing.
Most patients will also be directed to get regular cleanings every three months (rather than six) to be sure the pockets remain clean and to help establish a healthy, consistent condition in the mouth. Once the gums and hygiene appear stable, you may return to cleanings every 6 months.
On occasion, the deep cleaning procedure does not produce the results intended. Every person is different and people respond to treatments differently. If adequate healing and elimination of infection is not achieved, surgery may be indicated. Please ask your doctor if you have any questions about the prognosis or goals of your periodontal therapy.