Deep cleaning is technically called periodontal scaling and root planing, and is generally performed as the first stage of treatment for gum (periodontal) disease. It is intended to stop the progression of gum disease by removing the tartar buildup from the crown and root surfaces of the teeth. A deep cleaning is essentially picking debris out of a wound so it can heal.
When/Why do I need a deep cleaning?
Your dentist will recommend scaling and root planing (a deep cleaning) if you have periodontitis, which is gum disease that has progressed beyond just the gum tissues and is affecting the bone that supports your teeth.
Periodontal disease, also known as periodontitis, is a chronic infection that develops in response to bacteria building up on the teeth and root surfaces. If you have not had your teeth cleaned for a few years, or if you do not do a thorough job of brushing and flossing daily, you are more likely to have tartar buildup on your teeth that will contribute to periodontal disease.
How is periodontal disease diagnosed?
Periodontal disease is diagnosed by assessing bone levels on x-rays and taking measurements around the gums, which is known as periodontal probing. If your dentist sees bone loss between your teeth on your x-rays, or finds pockets that are 5 millimeters or more when they are probing, you have periodontitis.
The damage from periodontal disease is irreversible, so treating the disease as early as possible is critical. Even though the bone cannot be regrown, with proper care the disease is controllable, so further bone loss can be prevented. If periodontitis is left untreated, the bone loss around your teeth can cause gum recession, shifting teeth, and can eventually cause your teeth to fall out.
What is a deep cleaning vs. a regular cleaning?
Regular dental cleanings are called prophylaxis, which is “an action taken to prevent disease”. During a regular cleaning, the dentist or hygienist uses scalers and polish to remove bacteria and tartar buildup from above the gumline and 2-3mm below the gumline. Scaling and root planing is often called “deep cleaning” because it gets into the deeper periodontal pockets (4mm to 7mm) to clean off the buildup on the root surfaces that is causing the infection around your teeth.
A regular prophylaxis cleaning will not treat periodontitis. Some dental offices will refuse to do a regular cleaning on patients that have periodontal disease and need scaling and root planing because it is substandard care. In some cases, cleaning the buildup from above the gumline but not getting to the bottom of the pockets can make periodontitis worse by causing abscesses when the tissue partially heals and traps the bacteria below.
What does deep cleaning teeth involve?
The same tools are generally used for a regular prophylaxis cleaning and scaling and root planing, but the deeper cleaning will take longer and be more thorough, so you may be scheduled for multiple appointments.
In order to keep you comfortable, you might need to have your gums numbed, either with a numbing gel or with an injectable local anesthetic.
A combination of ultrasonic scalers and hand scalers are generally used during scaling and root planing procedures. Ultrasonic scalers are power instruments that use tiny vibrations to break up plaque and tartar buildup and water to flush debris and bacteria from between your teeth and under the gums. Hand scalers are the traditional dental instruments used to scrape the deposits from the tooth surfaces.
What to Expect After Deep Cleaning
When the numbing wears off, you may find your gums or teeth are a bit sore, but it generally only lasts for a day or two. You can take over-the-counter pain medications like Advil or Tylenol to help, or try a warm salt water rinse to help soothe the irritation.
In order for the gums to heal after scaling a root planing, you need to keep your teeth clean with twice a day brushing, and daily flossing or waterpiking.
Do gums reattach after deep cleaning?
The bone that has been lost with periodontal disease does not grow back, but the gums can heal in several different ways after a deep cleaning. When the inflamed tissues heal, the gums can shrink around the bone, which may lead to root exposure, which is known as gingival recession. Sometimes the gums reattach to the tooth surface, which creates what is known as a long junctional epithelium. In other situations, even though the inflammation is resolved, a pocket still remains as a type of scar tissue.
In any of these situations, the most important thing is that the progression of periodontal disease and bone loss is stopped. When your dentist or hygienist performs periodontal probing to see how your gums have healed after scaling and root planing, the most important factors are lack of bleeding and pocket measurements staying stable.
If your gums do not heal as expected after scaling and root planing, your dentist will send you to a gum specialist called a periodontist for evaluation. You may need more aggressive treatment to control your periodontal disease.
Can I get a regular cleaning after a deep cleaning? What is periodontal maintenance?
After a deep cleaning, your dentist or dental hygienist will recommend you return for periodontal maintenance visits every 3-6 months to monitor your gum disease and keep your teeth clean. If you have areas that still have pockets that are >4mm, you will need more frequent cleanings because you are not able to clean those areas thoroughly at home. Periodontal maintenance appointments are similar to regular prophylaxis cleaning visits, but are appropriate for high risk patients that have bone loss from periodontal disease and are no longer in the preventative category.
Pros and Cons of a deep cleaning:
Pros:
- Stop bone loss: if periodontal disease is not treated, you will continue to lose the structures supporting your teeth.
- Better breath: all that bacteria and infection around your teeth causes bad breath and can leave a foul taste in your mouth. Treating periodontitis will help get rid of halitosis.
- Whiter teeth: during a deep cleaning, tartar buildup and stain are removed, often revealing whiter teeth underneath.
- Improved systemic health: the inflammation from periodontal disease not only affects your mouth, but it can affect your entire body. Gum disease is linked to heart disease, diabetes, Alzheimer’s, and colon cancer.
Cons:
- Expense: deep cleanings cost more, and your insurance may only cover a portion or not cover it at all. However, treating gum disease only gets more expensive as it progresses, and replacing teeth if you lose them is astronomically more expensive.
- Temporary tenderness and sensitivity: you can expect to have a day or two of recovery after a deep cleaning, but usually it is very minor.
How much does deep teeth cleaning cost?
The cost of scaling and root planing varies depending on how much of your mouth is affected. Deep cleanings are charged by quadrant, and the cost is usually $150-$300 per quadrant. If you need scaling and root planing but cannot afford it, contact the closest dental hygiene school in your area, which will offer the procedure for very reduced cost, or even no cost in some situations.
Will insurance cover the cost of my deep cleaning?
It all depends on your plan. When you are reading the fine print on your insurance plan, scaling and root planing and periodontal maintenance are covered under “periodontics” instead of “preventative”, which is often reimbursed at 50-80% instead of 100%, and is sometimes subject to your deductible (which is usually $50-100).
Sometimes the recommendation for a deep cleaning can feel like an “upsell”, which is an uncomfortable situation at a healthcare office. If you are doubting the necessity of scaling and root planing and diagnosis of periodontal disease (or any other condition!), don’t be afraid to get another opinion before proceeding with treatment.
