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.