Wednesday, October 8, 2014

What is a Deep Dental Cleaning?

I've read a bit recently online about dental cleanings. Many people are angry with their dentists. Many believe that their dentists are trying to scam their patients into getting unnecessary services. Many are angry that some insurance companies don't pay for deep cleanings. Seeing many of these comments prompted me to write about the differences between routine cleanings and deeper cleanings.


Take a look at the chart above.

You'll notice a progression of severity as we move from left to right. The top row demonstrates deeper gum pockets (measured with a probe in millimeters). When these pockets exceed 3 mm, it becomes increasingly difficult to access the deeper areas with a toothbrush and floss. In advanced cases, the probing depths can be 10 or more millimeters. When this occurs, even if the tooth itself is healthy, it will still be lost since there are inadequate amounts of bone to anchor the tooth in place.

The second row demonstrates the visible condition of the mouth. As you can see, a healthy mouth is exemplified by gums that are pink (as opposed to red or even purple). In addition, the gums do not bleed readily and are not tender. On the other hand, unhealthy gums will bleed readily and are very tender. When gums are chronically irritated, a loss of the gums and bone progresses much more rapidly as the disease process worsens.

The radiographs (X-rays) in the third row demonstrates what happens to the bone as the progression of periodontitis advances.

When a patient comes in for a "cleaning", either a routine cleaning or a deeper cleaning is indicated.

Routine Cleaning

In many cases we can get away with a simple cleaning. When we have a situation where the teeth are not severely stained, do not have deep pocketing and do not have subgingival (below the gumline) calculus (tartar), then a simple routine cleaning is all that is required. In these cases, the cleaning is for the most part above the gumline.

Deep Cleaning

When we run into a mouth that has bone loss, deep pockets and tartar that goes below the gumline, then cleaning well below the gumline is indicated to prevent the progression of periodontitis and potential tooth loss.

If we simply clean above the gumline with a "routine cleaning", two potential problems arise. One is that the causative factors of periodontitis are not removed and the patient's condition will worsen. A second less commonly known issue is the development of a periodontal abscess. This occurs because the gums at the neck of the teeth may heal and close off the pocketing. The pocket is still there, but now we don't have access to the deeper areas. The bacterial flora changes from primarily aerobic bacteria to anaerobic. These bacteria are much more pathogenic (disease causing) and so instead of actually helping the patient, we actually make things much worse for our patient.


So, in essence, when a routine cleaning is performed in a mouth that requires a deep cleaning, we are actually creating bigger problems. If you doubt the recommendations of your dentist, it's okay to get a second opinion.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit 

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