Deep cleaning

What is Deep Cleaning (Deep Scaling & Root Planing)?

If plaque and tartar is left on the teeth, as we mentioned before, it provides the right conditions for bacteria to thrive. The bacteria irritate the gums, which means that they bleed more easily. You may notice this if you are brushing your teeth, or eating, and sometimes your gums may bleed a bit. This is the early stage of gum disease called gingivitis[DX1] . If you have gingivitis, your dentist or hygienist will clean your teeth by scaling and polishing them. They may also recommend an antiseptic mouthwash containing chlorhexidine (e. g. Corsodyl in the U.K.), and show you how to brush and floss your teeth effectively. Most adults have some degree of gum disease.

If gingivitis not treated and nothing is done about it, the inflammation will work its way down towards the foundations of the tooth causing a "periodontal pocket". Again, within the confines of the pocket, the conditions are such that the bacteria can have a right old party, and cause more damage.

Gum disease can break down the support (bone) structures of the teeth, so that eventually, they will become loose. The problem is that until it gets quite severe, the person often has no symptoms. Sadly, the damage to the support structures of the teeth is irreversible. The good news is that if gum disease is caught in time, its progression can be halted and improved upon, and that is the key.

To stop gum disease from progressing, your dentist may advise periodontal therapy, or deep cleaning.[DX2]  This gets rid of the bacteria in the pocket and provides the necessary conditions for healing to occur.

What is the difference between an ordinary cleaning and deep cleaning?

There is some confusion about the difference between scaling and root planing. Scaling is basically the process of removing dental tartar from the surfaces of the teeth (see dental cleanings). Root planing is the process of smoothening the root surfaces and removing any infected tooth structure.[DX3]  If you have gum disease or gum pocketing, the gum pockets around the teeth will have deepened, thereby allowing tartar deposits to form under the gumline.

The two processes tend to blur together since during the cleaning process, the dental worker scales away tartar and performs any necessary root planing at the same time. Any roughness can be planed away to result in a silky smooth surface.

Does it hurt?

Depending on the depth of the pocket and severity of the root surface irregularity, the dentist may wish to make the area numb so that the process is comfortable for you. Don't hesitate to discuss with your dentist or hygienist how to best manage any discomfort.

As an alternative to injectable anesthetics, Oraqix might be an option to try with deeper pocket cleaning. It is a special non-injection device that delivers topical anesthetic gel gently into the gum pockets thereby avoiding numbing of the lips and or tongue as can occur with injected local anesthetics. Oraqix mostly numbs the gum pocket itself so it may not be effective in eliminating sensations in the teeth themselves. Some offices may not have this device so it's best to check with your dental office.

Sometimes if the pockets are not too deep, there may be little or no discomfort during the procedure - even without numbing. The only sensation may be the physical scraping feeling along the teeth as the area is cleaned and smoothened. A root planed root surface free of tartar has a better chance of allowing the gum tissues to heal and reattach to it. As a result, some deep gum pockets can be reduced after a deep cleaning.

How long does it take?

Typically with deeper pockets and extensive rough root surfaces, the deep scaling and root planing procedure might be broken down into quadrants of work per appointment. For example, the upper right side of the mouth might be worked on one day, and the three other parts worked on at separate appointments. Or alternatively, one half of the mouth (right or left, upper or lower) might be cleaned per appointment. This also allows for only a part of the mouth being frozen at a time and makes for more manageable, shorter appointments.

The dentist may use antibiotic gels within the periodontal pocket, again to remove any nasty bugs, or may rinse out the pocket with various medications such as chlorhexidine.

What can I expect afterwards?

• Discomfort can vary after root planing, but one can expect it to be more sore afterwards since it's usually in a deeper region under the gums.
• The teeth themselves can become a bit more sensitive to temperature, and bleeding might occur for a little while.
• Over-the-counter painkillers such as ibuprofen work very well to alleviate discomfort, but stronger painkillers can be given should you need them.
• Brushing and flossing can be delayed or done more gently to avoid aggravating any bruised or tender gum areas.
• Your dentist or hygienist may recommend salt water or chlorhexidine rinses.

Periodontal Surgery

If the pocket that has formed is inaccessible to the dentist or does not heal during regular treatment, it may be necessary to gain access to the area to have it cleaned properly. Sometimes this is done by periodontal surgery, under local anaesthetic, when the gum is lifted back so the dentist can clean the area and then pop the gum back in place. It is usually secured in place by a couple of wee sutures, and will then heal normally.[DX4] 

Deep cleaning and other periodontal treatments can largely be avoided if you are careful with your cleaning. One of the ideas of having regular check-ups is to avoid such problems developing. Your dentist is a squeamish soul, who probably faints at the sight of blood, and likes to have things tidy. Therefore they'll be more than happy to show you how to clean your teeth properly if you are unsure how to do it. You might think that this is like teaching your granny to suck eggs, but actually, my granny never sucked an egg in her life, and you'd be surprised how many people don't know how. (To clean their teeth, silly! Not suck eggs!) If there are other areas in your life where you are unsure if you are doing things right, your dentist may not be the best person to ask, but certainly, they should know all about how to clean your teeth!