When do you need deep teeth cleaning and what can you expect?

Regular tooth cleaning is an important part of our oral hygiene routine. It can be done in the dentist's office by supragingival cleaning (above the gum line) or at home by brushing, flossing, and using other oral hygiene tools.

Deep tooth cleaning, on the other hand, can only be done by your dentist. In addition to cleaning the visible part of your teeth, he will also reach the surfaces below the gum line at the roots (subgingival cleaning). You may also hear the term root planing.

When should you get deep teeth cleaning?

You only need a deep cleaning if you have advanced gum disease that affects your deep tissues (bone, gum tissue, cementum).

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

At your first visit, your dentist will examine your gums for any signs of inflammation.

The first step is to improve your oral hygiene. Your dentist or dental hygienist may recommend additional tools, such as interdental brushes or oral irrigators to help remove plaque and debris from your teeth. He will perform a supragingival scaling to remove plaque and tartar above the gum line, which are the main causes of gum disease.

The purpose of this step is to educate you and reduce the bacterial load in your mouth.

If you have gingivitis, the early stage of gum disease, these measures may help to reverse it. However, you should continue to see your dentist for regular check-ups.

In more advanced cases, where the deeper tissues (bone and ligaments) are affected, a thorough dental cleaning is required to reach the deepest affected areas.

The stage at which the disease progresses to the bone is called periodontitis. The factors that turn gingivitis into periodontitis are:

• 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

Why do you need deep teeth cleaning?

While good oral hygiene is important in preventing periodontitis and reversing gingivitis, it is not enough on its own to treat periodontitis.

Periodontitis leads to the formation of pockets, which result from the widening of the space between the tooth and gum. These spaces provide an ideal environment for bacteria to grow and release toxins.

Oral hygiene measures cannot reach these spaces, hence the need for root planing.

Your dentist will use thin instruments to reach these areas and remove accumulated plaque, tartar, and infected tissue. This will bring many benefits to your gum health, including:

• Decreasing harmful bacteria.
• Promoting friendly bacteria.
• Achieving a clean and smooth dental surface.
• Reduce gingival inflammation and periodontal pocket depth.
• Improve periodontal tissue regeneration.

Deep dental cleaning limitations:

Scaling and root planing are non-surgical methods of treating periodontitis. It consists of removing the main cause of gum disease (plaque and tartar).

It is simple, effective, and tissue-friendly (minimal bleeding, pain, and recession after treatment).

However, sometimes deep tooth cleaning is not enough, especially in cases of advanced periodontitis or deep pockets. Your dentist may suggest periodontal surgery for optimal cleaning.

In addition, deep tooth cleaning cannot rebuild lost bone. In this case, regenerative surgery may be needed.

What are the risks associated with deep teeth cleaning?

Before treatment, your dentist will ask you questions about your current health and any medications you are taking. This information will be carefully checked. Some medical conditions increase the risk of post-operative complications, including bleeding and infections.

A study has shown that bacteria enter the bloodstream immediately after scaling and root planing. In healthy people, this is temporary and decreases significantly within 30 minutes.

However, in people at risk, some of the bacteria can persist and potentially affect vital organs such as the heart. Medical conditions that increase the risk include:

• Cardiovascular diseases;
• Lung diseases;
• Kidney diseases;
• Metabolic diseases such as diabetes;
• Weakened immune system.

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.

Your teeth may become sensitive after the procedure, which is normal. This is because the tartar no longer covers and isolates the roots.

The discomfort and pain are usually temporary and will subside gradually after 1-2 weeks.

After one to two months, you will notice an improvement in the health of your gums. Your gums will return to their natural color (pink) and will no longer bleed when you brush or eat. The swelling will also disappear, which may make you think your gums have shrunk. In fact, a slight receding of the gums after the procedure is a good sign of healing.

When is surgery necessary?

Deep tooth cleaning alone is usually sufficient to treat mild to moderate periodontitis. It is the most recommended method because it is simpler, with fewer post-operative effects.

However, in more severe cases, deep pockets and bleeding gums may remain even after deep cleaning. Surgery is then required.
This involves opening the gum and removing the diseased tissue under direct vision. The gums are then stitched to ensure healing.
This approach allows access to hard-to-reach areas below the gum line.

There are also surgical techniques that promote the regeneration of destroyed periodontal tissues. The bone can then be rebuilt, which may not be possible with a deep cleaning.