Deep Cleaning

The routine cleanings patients get at the Anderson Dental office are called deep cleanings when the dentist or hygienist goes, well, deep. Deep below the gumline, that is. Right down to the roots of the teeth. In fact, a full-bore deep cleaning includes what’s called root planing. As with regular cleanings at the dentist’s office, deep cleanings accomplish what brushing and flossing cannot.
The problem is that even with diligent home care, plaque becomes tartar.  The evolution happens at slower or faster rates depending on factors specific to the individual.  Quick refresher? Plaque is the transparent, sticky film (biofilm) that forms on our teeth continuously. It’s home to the bacteria that cause our common dental problems, decay and gum disease. The gumline is plaque’s favored location. Plaque, in short, is what we’re trying to remove when we brush and floss. If we brush and floss properly and regularly, it works pretty well at removing plaque.
Pretty well, even very well, but not perfectly, and therein lies the tale. It’s impossible to keep teeth completely plaque-less all of the time. And plaque becomes tartar. It’s a bit ironic. Our saliva contains minerals (calcium) that reinforce tooth enamel to keep it strong. That’s a great defense. Unfortunately, plaque also absorbs this calcium and also gets hard and anchors itself to tooth surfaces as tartar. That’s why toothbrushes and floss can’t remove tartar.
Worse still, tartar penetrates the seal the gumline is supposed to form around the teeth. Tartar, like the plaque it comes from, is full of aggressive bacteria. The gums and teeth are under attack. Defenses are crumbling. The progression from gingivitis through periodontitis to even more serious issues is underway in earnest.
 
SIGNS AND SYMPTOMS
It’s all about gum disease. Patients may experience red/swollen gums, bad breath, bleeding gums, loose teeth, or teeth that seem to be growing longer.  The red flag, indicating the need for deep cleaning, is deep pockets. Not the financial kind, the ones in a patient’s gums. These periodontal pockets are spaces between the teeth and gums. In healthy gums, these spaces are about 3mm deep. When the dentist or hygienist observes pockets that appear deeper than this, he or she probes the pockets with a special tool and measures pocket depth. No worries, it doesn’t hurt a bit. Deep pockets (5mm or more) argue for deep cleaning. The final call, taking into account the pocket measurements and overall conditions, is the dentist’s.
 
DEEP CLEANING
Professional cleanings in the dentist’s office all aim to remove the tartar that brushing and flossing cannot. The difference between a “regular” cleaning and deep cleaning is mainly (but not always entirely) about location, location, location.
Deep cleaning goes way below the gum line, to tooth and root surfaces that are covered by gum tissue. The hygienist uses a metal scraping tool and/or a high-tech ultrasonic  “wand”. The ultrasonic scaler’s tiny tip vibrates at between 25,000 -50,000 cycles per second. A super-fine spray of water (lavage) keeps things from overheating. The vibration creates tiny, tiny air bubbles and then implodes them. The implosions release bursts of heat and pressure that dislodge and disintegrate tartar.
All of this happens at a near-microscopic scale, so patients don’t feel any heat. No pressure, either. The hygienist lets the ultrasonic vibrations do the work, and doesn’t press the wand onto the patient’s teeth at all. The laser (of course!) is beginning to find a role for itself in deep cleaning, too.  These new tools show promise in terms of less bleeding, swelling, and overall discomfort. Stay tuned!

DEEPER DEEP CLEANING
Roots get special attention. The procedure called root planing conditions the roots’ surfaces in addition to removing tartar from them. Planing gets rid of bumps and irregularities that those aggressive bacteria love to hide out in. It also prepares  (conditions) the root surface (cementum) so healing gums get a better “grip” on them. This helps to form a better seal and keep bacteria and plaque out going forward.
When the cleaning’s done, the dentist may elect to place anti-microbial medication down in the pockets. Another option is a prescription for a course of oral antibiotics after the procedure. This is, after all, a campaign against aggressive bacteria.
 
HOW DOES IT FEEL?
Patients are usually numbed for a deep cleaning, so the procedure itself doesn’t feel like much at all. It can take around 45 minutes per quadrant, so at least two appointments are the norm. There’s nothing to be anxious about.
Afterward, when the numbing agents wear off, a patient may well experience some sensitivity. Maybe soreness, perhaps some bleeding.  The hygienist provides detailed instructions for getting through the post-procedure hours and days. These include common-sense advice to avoid foods and beverages that make it feel worse. Patients generally should avoid using aspirin as an over-the-counter pain reliever. Aspirin tends to defeat the body’s efforts not to bleed. The dentist prescribes antibiotics for some patients and provides instructions for use. A less obvious post-procedure counsel is for smokers: don’t smoke for 7-14 days after a deep cleaning. It slows the healing, in addition to all the other well-known harm it does.
 
WHY ME?
When we inform patients of the need for a deep cleaning, some ask “Why me??”.  It isn’t good news, of course, but it isn’t terrible. It doesn’t necessarily mean a patient has been negligent about brushing and flossing. Has the patient been postponing checkups and “regular” cleanings, thus allowing tartar to get the upper hand? Some people simply need more frequent dentists visits for checkups and cleanings. Things change, too. The older we get, the more we’re prone to tartar buildup. Hence, we’ll need more frequent cleanings to control it and avoid gum disease. Diets change. All that said, the unfortunate truth is that neglect is a major culprit.
 
LIFE AFTER A DEEP CLEANING
Nobody’s in love with the deep cleaning experience, however comfortable our skill and technology have made it. Who would want to go through that again? Two or more long appointments – the time alone is an inconvenience at best.
The thing is, if a deep cleaning patient has had periodontitis, it’s likely there’s been bone loss. The worse the periodontitis, the more the bone loss. The bone loss from periodontitis is irreversible and leaves the patient more vulnerable to plaque sneaking past the gum line and setting up another go-round. It’s likely to be a persistent issue that patient and dentist have to adapt to and manage.
The first line of defense is, naturally, self-care. A deep cleaning is a good time for a review of dental health habits with the hygienist and/or the dentist. Everything should be on the table. When to brush, how to brush, best toothbrush. Perhaps an electric (sonic or ultrasonic) toothbrush would be best.  Same for flossing. There may be opportunities to switch to a better toothpaste, or to start with a recommended rinse.
Depending on the individual patient’s history and condition, the dentist may recommend more frequent visits for checkups. Perhaps as frequently as every three months. If this seems like an unreasonably heavy burden – consider the alternatives.  As noted earlier, a full-out deep cleaning with root scaling is a forecast of more such in the future. The goal becomes one of making them as infrequent as possible.