When should you get deep teeth cleaning and what to expect?

root planing
Regular dental cleaning is an important part of our oral hygiene routine. It can be performed at your dentist's office by supragingival scaling (above the gum line) as well as by you at home through the oral hygiene measures available (tooth brushing and flossing).

Only your dentist can perform deep teeth cleaning. In addition to cleaning the supragingival surfaces, he will also clean the surfaces below the gum line at the roots (sub-gingival cleaning), also known as root planing.

You will only need a deep dental cleaning if you have advanced gum disease that reaches the deep tissues of the tooth (bone, ligament, cementum).

periodontal tissues

Otherwise, if your gums are healthy, a regular cleaning that includes good oral hygiene and supragingival scaling twice a year at your dentist's office is more than enough to maintain good oral health.

In this article, you will learn:
  • When do you need deep teeth cleaning?
  • The benefits of deep teeth cleaning
  • The limitations of deep teeth cleaning
  • What are the risks associated with deep teeth cleaning
  • The procedure
  • Medications associated with deep cleaning
  • When should deep cleaning be done in conjunction with surgery?

When should you get deep teeth cleaning?

When you visit your dentist for a problem with your gums, such as if you bleed during brushing or eating, your dentist will organize a treatment plan.

dental floss

The first treatment goal is to improve your oral hygiene. Your dentist or hygienist will recommend additional tools such as interdental brushes or oral irrigators.

He or she will perform supragingival scaling to remove plaque and tartar above the gum line, considered the main factors of periodontal disease.

The purpose of this step is to inform and motivate you about your oral hygiene. This will help reduce the bacterial load of your mouth and bring you as close as possible to the treatment plan so that you become an integral part of it.

If your problem is gingivitis, the initial stage of gum disease, this step is usually enough to reverse it. However, you should keep visiting your dentist regularly for check-ups.

In an advanced case, especially periodontitis where the deep tissues are affected (bone, ligament, and cementum), a deep dental cleaning is necessary since it is the tissues inaccessible to brushing that are affected.

From gingivitis to periodontitis

The leading cause of periodontitis is the accumulation of bacteria under the gum line.
When the inflammation is limited to the gums, the disease is reversible. But some factors will trigger the progression of the inflammation to the deep tissues, resulting in irreversible damage. Among these factors:

  • Bad oral hygiene
  • Stress
  • Smoking
  • Certain general diseases that compromise the immune response
  • Certain medications such as Nifedipine, Phenytoin, and Cyclosporine
  • Certain viral infections such as HIV
  • Genetics

To diagnose periodontitis, your dentist will:

Do a visual test: He or she will look for signs of inflammation, including redness, swelling, and bleeding.

Do a periodontal probing: Using an instrument, your dentist will examine the space between the gum and the tooth. This will help assess bleeding from the gum line and check for periodontal pockets that are only found in periodontitis.

Ask questions: He or she will also ask you questions about your oral hygiene habits, your health status, and any pain or discomfort you are experiencing.

May do an x-ray examination To check the bone surrounding the teeth. Bone lysis will confirm the diagnosis.

Why do you need deep teeth cleaning?

While maintaining good oral hygiene is important to prevent periodontitis and reverse gingivitis, it is ineffective alone to treat pre-existing periodontitis.

Periodontitis leads to the formation of pockets, which result from the widening of the space between the tooth and the gum. These spaces constitute an ideal environment for bacteria to grow and express their pathogenicity.

Oral hygiene measures cannot reach these spaces, hence the importance of deep teeth cleaning.

Using periodontal instruments, your dentist will reach these spaces and remove the plaque and tartar build-up and infected tissues. This will eliminate 90% of the bacteria accumulated in the pockets. After treatment, bacteria will recolonize the tissue, but friendly bacteria will predominate.

benefits of deep teeth cleaning

Among the benefits of deep teeth cleaning:
  • Purify periodontal pockets and surrounding tissues from bad bacteria responsible for periodontal destruction.
  • Obtaining a clean tooth surface and a smooth, biologically compatible root surface to support the newly regenerated tissue after healing.
  • Removal of diseased and infected tissues from the teeth surfaces.
  • To reduce gum inflammation and periodontal pocket depth.
  • Enhancing the regeneration of periodontal tissues

What are the limitations of deep teeth cleaning?

Deep dental cleaning is a non-surgical way to treat periodontitis. It consists of removing the main cause of gum disease (plaque and tartar).

It is easy, effective, and tissue-friendly (minimal recession after treatment). It is also less painful and causes less bleeding compared to surgical cleaning.

Despite the postoperative side effects, the benefit of deep cleaning remains important because it stops the progression of periodontitis and prevents complications such as tooth loss and periodontal abscess formation.

But, sometimes deep teeth cleaning is insufficient. Your doctor may suggest periodontal surgery for optimal cleaning. Especially in moderate and advanced periodontitis as subgingival plaque and calculus removal becomes more difficult as pocket depth increases.

A deep teeth cleaning can be limited due to irregularities and obstacles below the gum line preventing instruments from accessing the affected deep tissues.

Also, deep teeth cleaning is not enough if your goal is to rebuild the destroyed tissue. Only surgery can achieve this.

What are the risks associated with deep teeth cleaning?

Cleaning below the gum line will cause bleeding during the procedure, which involves two main risks: infectious and hemorrhagic risk.

Before treatment, your doctor will ask you questions about your current health state and the medications you are taking. This information will be carefully checked to take the necessary measures.

Certain medical conditions increase the risk of these complications, including:
  • Cardiovascular diseases
  • Pulmonary diseases
  • Renal diseases
  • Endocrine diseases such as diabetes
  • Compromised immune response

How is the risk of bleeding managed?

The risk of bleeding is high in people taking blood thinners such as heparin, aspirin, or coumarin. People who have a cardiovascular diseases such as myocardial infarction or angina are also at risk.

To avoid life-threatening bleeding, your doctor will order blood tests to assess your risk. He or she will also discuss with your treating physician the possibility of temporarily stopping or replacing blood thinners.

How infectious risk is managed:

The infectious risk is manifested mainly by endocarditis of bacterial origin. Some bacteria from the mouth, through a gum wound, will reach the bloodstream and get on a heart valve.

They will form a bacterial plaque and lead to ulceration or even perforation of the affected valve. It is a serious situation that can lead to heart dysfunction with fatal consequences.

Transient bacteremia (bacteria present in the blood temporarily) is a natural, daily occurring situation that can occur during chewing or tooth brushing.

In healthy persons, oral bacteria that enter the bloodstream are efficiently eliminated by the host defense system.

But people at risk, with one of the conditions mentioned above, are more vulnerable. If it is your case, talk to your dentist about your illness and give him/her the contact information of your treating physician. He or she will suggest an antibiotic before the procedure to avoid the worst complications.

The procedure of deep teeth cleaning

Before the procedure

Your dentist will begin by assessing your general health. After checking your gums and possibly taking an x-ray of your jaws, he or she will make a diagnosis and inform you of your condition.

The first step of the treatment is to instruct you on the necessary hygiene measures and schedule supragingival scaling sessions.

The goal is to reduce the bacterial load and control the amount of plaque and tartar on your teeth and gums.

Maintaining good oral hygiene is essential during all phases of treatment, as it will ensure its success.

In the absence of periodontal pockets, these measures may be sufficient to treat gingivitis. Additional sessions will be scheduled to evaluate the results and redo teeth scaling if necessary.

In the presence of periodontal pockets (the case of periodontitis), deep teeth cleaning is necessary.

During the procedure

Your dentist usually divides the procedure into two or more appointments, with intervals of one to two weeks.

The duration of the session varies depending on the severity of the periodontal disease. Treatment of a single tooth with moderately deep pockets may require 4-10 min. During the first appointment, he will clean one or two quadrants on one side of your mouth. The quadrants remaining will be cleaned at subsequent appointments.

After each session, your dentist will insist on your oral hygiene to keep the bacterial load low and avoid contamination of the treated sites.

The steps of the deep cleaning procedure are performed under local anesthesia to ensure your comfort.

The treatment consists of removing plaque and tartar accumulated below and above the gum line.

The periodontal pockets are cleaned with a combination of manual and ultrasonic instruments with a high-frequency vibrating tip. They help remove infected tissue that prevents the healing of the periodontal tissues and provide a healthy root surface that will support tissue regeneration.

After the procedure

The treatment can be followed by applying antiseptics in the periodontal pockets. They will eliminate the bacteria inside the tissues that are inaccessible to the instruments.

Your dentist may also prescribe antibiotics depending on your general condition and the severity of the periodontitis.

The long-term effectiveness of deep dental cleaning depends mainly on your dental hygiene. You should brush your teeth with a soft-bristled toothbrush twice a day and use interdental brushes or floss once a day.

Maintenance sessions will also be scheduled after the deep cleaning to assess healing.

What to expect?

The postoperative effects of the procedure depend on the severity of the periodontal disease, the number of teeth affected, and the amount of tartar deposit.

Tooth sensitivity may occur after treatment. The roots that have been cleaned and cured may also be slightly sensitive to cold.

The pain associated with root planing is usually transient and will subside on its own after 1 to 2 weeks.

After two months of deep teeth cleaning, you will notice an improvement in your gum condition. It will find its natural color (pink), will no longer bleed during brushing or eating, and will no longer be swollen, which may give you the impression that it has shrunk from what it was before.
A slight gum recession after deep cleaning is a good sign of healing.

When is surgery necessary?

surgical root cleaning

Usually, deep tooth cleaning without surgery is sufficient to treat mild to moderate periodontitis.

It is more recommended because it is easy, more conservative with minor postoperative effects.

However, in more severe cases of periodontitis, deep periodontal pockets and bleeding gums persist even after deep cleaning. A surgical cleaning is therefore indispensable. It consists of opening the gums and removing the diseased tissue under direct vision, then suturing the gum to ensure healing.

This approach will reach areas under the gums that regular deep cleaning cannot.

There are also surgical techniques that promote the regeneration of destroyed periodontal tissues. In addition to stopping the progression of periodontal disease, they can restore esthetics.