Deep Cleaning vs. Regular Cleaning

Routine Cleaning

In many cases we can get away with a simple cleaning. If the teeth are not severely stained, do not have deep pocketing and do not have subgingival (below the gumline) calculus (tartar), then a simple routine cleaning is all that is required. In these cases, the cleaning is mostly above the gumline.

Need for Deep Cleaning

When we run into a mouth that has bone loss, deep pockets and tartar that goes below the gumline, then cleaning well below the gumline is indicated to prevent the progression of periodontitis and potential tooth loss. Periodontitis is a serious gum infection that damages the soft tissue and destroys the bone that supports your teeth. Periodontitis can cause tooth loss or worse, an increased risk of heart attack or stroke and other serious health problems.If we simply clean above the gumline with a routine cleaning, two potential problems arise. One is that the causative factors of periodontitis are not removed and the patient’s condition will worsen. A second less commonly known issue is the development of a periodontal abscess. This occurs because the gums at the neck of the teeth may heal and close off the pocketing. The pocket is still there, but now we don’t have access to the deeper areas. The bacterial flora changes from primarily aerobic bacteria to anaerobic. These bacteria are much more pathogenic (disease causing) and so instead of helping the patient, we actually make things much worse for our patient.

Deep Cleaning Procedure

After measuring the depth of the pockets, the dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather and helps remove bacteria that contribute to the disease. After scaling a planning, the pockets are irrigated with an antiseptic solution of chlorhexadine. In some cases a laser may be used to remove plaque and tartar. Laser cleaning may result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.
Deep cleaning usually takes 2 office visits, as each visit treats one side of the jaw. So only one side of the mouth is numbed and, during the healing, the patient may chew normal foods on the other side. After the scaling, root planing and irrigation, it is common to apply a topical antibiotic to eradicate any remaining bacteria.

Frequently Asked Questions:

What is Gum Disease?
Gum disease, or periodontal disease, is a bacterial infection of the gums which causes inflammation, loss of gum tissue, and pockets between the gums and teeth. As it advances, it leads to bone loss and deeper pockets. Eventually, if not treated in time, it causes tooth loss.

Can I get gum disease from kissing?
Yes you can! A person with periodontal disease has advanced bacteria that causes bone loss in their mouth. This bacteria can be passed onto another individual through saliva.

What are these white spots on my teeth?
White spots are demineralized areas of enamel. They are a very early stage of cavity formation. It is possible to remineralize the tooth before it turns into a full-blown cavity by treatment through MI paste and fluoride varnish.

What is Deep Cleaning?
Deep cleaning is removal of plaque and calculus below the gumline using a special scaling tool. This is followed by root planing with another tool to smooth the root area, in order to help the gums reattach to the tooth root. The area cleaned is rinsed with an irrigating solution, and, usually, a topical antibiotic gel is applied. This treatment will often reduce the depth of the pockets. Deep cleanings are recommended when pockets reach 4mm or more. Those with pockets of 1-3mm should get regular professional cleanings every 6 months. The deep cleaning process is usually accomplished in 2 appointments, cleaning half of the mouth each time. The dentist will determine how often deep cleanings are needed.

How long does deep cleaning take?
In most cases, one side of the mouth is cleaned in each of two office visits. The average time per visit is 45-60 minutes. In some cases, depending on the needs of the patient, the dentist may do only one quadrant in each of 4 visits.

Does deep cleaning hurt?
Sometimes there is no pain when pockets are not too deep. If there is any discomfort, your dentist will numb the area. Frequently a topical gel anesthetic such as Oraqix is applied directly to the gum pocket instead of an injectable anesthetic. This eliminates the sting of a needle and does not numb the tongue or lips.

What can I expect afterwards?
After deep cleaning, the gums will be somewhat sore and sensitive to hot foods and liquids. There is often a slight amount of bleeding for a short duration. For the first few days after cleaning, the patient is advised to avoid very hot, crunchy, hard and sticky foods. It is also advisable to delay brushing the area for a few days and delay flossing for a week. Be sure to brush and floss the area that was not treated. Patients may take over-the-counter pain medication if needed.

How often should I get a cleaning?
There are many factors that contribute to the length of time between cleanings, such as home care, rate of buildup between each cleaning, progression of gum disease. The dental hygienist will work with you and tailor a recall plan specific to your needs. The “6 month cleaning” is an outdated principle in Dentistry, and is only applicable to individuals who have had no history of gum disease, meticulous home care, and a perfect history of dental visits.

Why should I floss?
There are areas around your teeth that can not be reached with a tooth brush, so floss must be used. As long as plaque is regularly removed it will not turn into hard calculus. Once calculus forms, it is only removable by a Dental professional. The calculus and plaque buildup in turn create deadlier forms of bacteria if they are not removed, which will lead to the development of gum disease.

Why do my gums bleed when I floss or brush?
The plaque and tartar that is under your gums are irritation and causing inflammation to your gums. If it is only gingivitis, your gums will stop bleeding upon careful daily flossing and brushing combined with a cleaning from your hygienist. If you have gum disease, bleeding is a serious sign of bacterial infection.

What is the purpose of irrigation?
Irrigation is necessary after deep cleanings to disrupt and dilute the bacteria from within the gums. Deep cleanings remove the plaque and calculus in the pocket, and irrigation helps to destroy the rest of the bacteria inside of the pockets.

Is a rotary toothbrush better than a manual brush?
Yes. A rotary toothbrush removes plaque more efficiently and requires less effort than a conventional manual brush. A perfect analogy would be the difference between a power screwdriver vs a manual screwdriver. The rotary toothbrush cleans more effectively while using less brushing force, which leads to reduced soft and hard tissue trauma. The rotary toothbrushes head also help you clean better in the hard to reach spaces between your teeth

Why do I need a deep cleaning instead of a regular cleaning?
You need a deep cleaning because bacteria has created a deep pocket between your teeth and your gums. There is a larger than normal pocket because of bone loss. If you get a regular cleaning, we will not be able to reach down into the area where the bacteria is doing damage to your bone. A regular cleaning will only clean the surface of your teeth, leaving the infection untouched and free to continue to harm your health.

Why is gum disease a serious disease?
Gum disease can affect other areas of your body too. The bacteria in your mouth can cause respiratory complications when they are inhaled into your lungs. Recent studies have also found a direct correlation between gum disease and heart disease. It has been proven that gum disease bacteria can travel from your mouth through the rest of your body through the bloodstream.

How is gum disease diagnosed?
Gum disease is diagnosed by measuring the pocket depths of your gums. 1-3mm is normal, 4-5 is the caution area, and 6+ means that you have severe gum disease. We also take into account amount of bleeding, swelling of the gums, and how much buildup of tartar and calculus is in your mouth.

What can I do to prevent gum disease?
You can prevent gum disease by brushing twice a day for at least 2 minutes with a power brush, meticulous flossing, and using a dentist recommended mouthwash. A crucial component of preventing gum disease is regularly seeing the dentist for checkups so that we can monitor your mouth and tailor a personalized plan according to your needs. Routine checkups are also important so that we can treat trouble areas as they arise before you develop full blown gum disease.

What are Arestin and Atridox and how do they help?
Arestin and Atridox are topical antibiotic gels that are applied directly into the gum pockets following deep cleaning. The gel is formulated to release the antibiotic slowly. Deep cleaning removes most of the plaque and calculus but a little will remain along with disease-causing bacteria. These medications have been proven to speed healing of deep pockets faster than scaling and root planing alone.