Deep Cleanings, Demystified
written by samantha tillapaugh from the debtist
As the world begins to see slivers of hope for opening up again, I would wager that some people are preparing to visit their dental home for a routine exam and cleaning. If quite some time has passed since your last appointment, the need for a deep cleaning may be recommended by your dentist. This is especially true if they diagnose a periodontal condition such as gum disease! In order to avoid skepticism around the need for a deep cleaning (which some may confuse with nothing-more-than-a-glorified- more- expensive-regular-cleaning), I want to take some time to present a few facts about maintaining good gum health and deep cleanings.
What is a deep cleaning?
A deep cleaning is the layman term for what dentists call “scaling and root planing”. How does this differ from a regular cleaning? A regular cleaning removes plaque and calculus above and around the gum line. A deep cleaning reaches to the depth of your gum pocket and removes debris underneath the gums, in the areas where your toothbrush can’t quite reach, and therefore you can’t clean on your own at home. These deep areas are where build-up tends to accumulate.
A deep cleaning is more invasive and may require local anesthetic (or a numbing agent) to achieve. The extent of the deep cleaning depends on the depth of the gum pocket around the tooth (the space between our gums and our teeth), as well as how much build up has accumulated under the gum tissue. Instead of using dental instruments around the crown of the tooth, deep cleanings also instrument around the roots of the teeth.
Why would I need a deep cleaning?
Often, a deep cleaning is recommended when there is an active gum infection, otherwise known as periodontal disease. Periodontal disease occurs when our body responds to plaque and calculus accumulation through inflammation. We know that toothbrushes can remove plaque and food debris. However, inadequate removal of plaque can lead to the formation of a harder substance known as calculus.
Studies have shown that it takes approximately three months for plaque to turn into calculus, which is why 3-month recalls are recommended for those who have deep gum pockets. We also know that our toothbrushes can clean gum pockets up to 3-millimeters deep. But as plaque and calculus accumulate, our gums get inflamed and swollen, which can lead to deeper pockets that perhaps our toothbrush bristles can no longer reach.
Have you ever heard the dentist call out numbers when evaluating your gums? Those numbers refer to the depth of your gum pockets, measured in millimeters. Smaller numbers are good, because they equate to smaller gum pockets that your toothbrush can easily reach and keep clean. Numbers larger than 3-millimeters are bad, since it leaves an area that you and your toothbrush cannot clean on your own at home.
It’s like washing a tall drinking glass. Imagine cleaning only the top half of the glass. You wouldn’t want to drink from that glass if the bottom half isn’t clean, would you? If you have deep gum pockets, you are constantly cleaning the top half of your gum pocket, without reaching the bottom half. This means that plaque continues to sit at the unreachable depths of your gum pockets, and eventually, it turns into calculus after three months. And yes, you are swallowing all that bacteria as if you were drinking from a dirty water glass! A deep cleaning at the dental office is required to remove the debris deep in the gum.
What happens after a dental cleaning?
Sometimes after treatment the gums heal well and the pockets resolve to 3mm or less once inflammation goes away. After all, removing the source of inflammation results in your gums calming down to its regular state. Your body is no longer trying to send a response to the area, so the amount of blood flow to the area decreases, and your gums will return to a healthy pink color. It is possible that your dentist recommends a recall appointment in 3 months to re-evaluate the treated area. If the pockets do not go back down to 3mm, it is likely because they are too deep for you to be able to manage cleaning at home on your own. In this case, the dentist will help to remove the calculus at the deeper pocket levels that your toothbrush may not reach, and the recommended interval is every 3 to 4 months.
What can failure to do a deep cleaning lead to?
Essentially, periodontal disease is a gum infection. The plaque and calculus in the pocket of your gums contain bad bacteria that thrive in acidic environments. At first, your gums will become inflamed as a normal response to any infection. You may notice puffy or red gums, and bleeding of the gums when you brush or floss is a sign of inflammation. Your gums may start to recede, which I explain to my patients is a signal from your body that it’s trying to protect itself from the infection. Think of it as moving away to keep you safe.
If you don’t treat the gum infection, the periodontal disease enters Stage II. The more aggressive bacteria erodes bone, resulting in bone loss around the teeth. At this stage, the damage is not reversible, but is still manageable. Lost gum tissue and bone will never grow back (which is why the earlier the treatment, the better the prognosis), and frequent cleanings every 3 -4 months is imperative. This is still considered light periodontal disease. It is not too late!
Moderate periodontal disease is when the infection enters the bloodstream and affects the immune system. This is now a systemic health issue. Periodontal disease has been linked to heart disease and early onset Alzheimer’s. Recent studies show that periodontal disease increases the chances of complications from Covid-19. If the gum infection is left untreated for a long period of time, advanced periodontal disease can result in so much bone loss that the roots of the teeth are exposed leading to cold sensitivity. It is also possible to see further loosening of the teeth, which makes chewing painful. Severe infections can lead to bad breath, and eventual loss of teeth.
All of this to say, routine dental visits are essential for diagnosing early signs of gum infection. If it has been a minute since your last appointment, ask your dentist what your gum pockets look like. Ask them if they notice any gum recession or bone loss in the radiographs. If they recommend a deep cleaning, you now know why! Please don’t ignore it, or assume it means nothing. Patients will usually tell me, “But I don’t feel like I have periodontal disease”, to which I always say, “You also can’t feel heart disease, diabetes, or high cholesterol.” Not feeling an infection does not mean it is not there. With this knowledge, you can check for the signs yourself!
we’ve partnered with samantha tillapaugh, a general dentist practicing in southern california, to help spread the word about all cool things dental. when she isn’t sharing informative posts about teeth with us, she is writing at her own lifestyle blog as thedebtist. aside from writing, she travels the world, reads plenty of books sidled up next to her adopted, toothless cat, bakes sourdough bread and works as a tooth-fairy.