Scaling and root planing, or deep cleaning, is a professional dental procedure that removes tartar and plaque beneath the gum line. Your routine cleanings deal with deposits at the surface level, while this treatment is designed to clear out bacteria accumulation in your periodontal pockets. When pockets become too deep, they collect bacteria, and you can develop gum disease.

When a dental professional sees signs of periodontitis or gum disease, they could recommend a deep cleaning. Getting a deep cleaning for any of the issues associated with gum disease will stop the gum disease from progressing and prevent potential bone loss. Ultimately, this will help preserve your teeth. Below, we comprehensively explain everything you need to know about deep cleaning.

What is a Dental Deep Cleaning?

A dental deep cleaning, also known as scaling and root planing (SRP) or periodontal cleaning, is a specialized therapeutic procedure distinct from regular dental cleaning.

After a dentist or periodontist confirms that you have gum disease, he/she could recommend a deep dental cleaning. Based on the gum disease diagnosis by the dentist or periodontist, this treatment focuses on the subgingival environment, specifically areas below the gum line where bacteria and hard plaque or calculus form in the pocket. Unlike a prophylactic cleaning that involves removal of plaque and tartar that are on the surface of visible teeth, as well as just below the gum line for preventive purposes, a deep cleaning goes much deeper to deal with an existing infection and the cause of it.

The detailed procedure of scaling and root planing involves two steps:

  • Scaling — This is done by experts using special tools like ultrasonic scalers and hand instruments to carefully remove plaque, calculus, and bacterial toxins from every tooth surface, including inside the pockets below the gum line.
  • Root planing — This procedure is done after scaling. Smoothing the root surfaces reduces but does not entirely prevent future bacterial colonization and will help the gums to heal and re-establish their attachment.

By focusing on this subgingival environment, inhabited by pathogenic bacteria that induce inflammation and destructive processes in the supporting bone and tissues, SRP becomes a fundamental treatment for gum disease. The goal of this procedure is to remove causes of infection and promote healing.

Comparing Deep Cleaning and Regular Cleaning

Getting a dental deep cleaning, also called scaling and root planing, is very different from a regular dental cleaning or prophylaxis. A deep cleaning treats gum disease, whereas a regular cleaning prevents gum disease. To that end, the goal of this procedure is to remove causes of infection and help with healing. Deep cleaning goes below the gum line, inside the periodontal pockets where the bacteria and tartar form, while regular cleaning goes above the gum line to remove the plaque and tartar. Because dental deep cleaning is more involved, it will take two to four appointments at first to treat all the areas of the mouth. In contrast, a regular cleaning requires an appointment every six months.

Local anesthetic is usually required to keep patients comfortable during the more extensive deep cleaning treatment, whereas it is not usually needed for a regular cleaning. Moreover, the average time for a deep cleaning appointment is, in fact, longer. A deep cleaning appointment is generally between 1 and 2 hours per session. This is compared to a regular cleaning, typically between 30 and 60 minutes.

Why You Need Deep Cleaning: Gum Disease

The primary origin of deep cleaning is gum disease, also called periodontal disease. The plaque on your teeth is a sticky mixture of bacteria that constantly forms on them. If plaque is not removed with regular brushing and flossing, it hardens into tartar, also called calculus. This rough deposit firmly attaches to the tooth surface, above and, importantly, below the gum line. This tartar cannot be removed by regular brushing. The rough texture of tartar and the bacteria-filled spaces between the gums and teeth allow bacteria to flourish.

The irritants and toxins produced by these bacteria damage the gums. When inflammation continues long-term, it damages the gum tissue and adjacent bone (periodontitis). A deep cleaning removes the tartar and bacteria in these pockets where they grow and infect the gum tissue, enabling the gums to heal.

Gum disease progresses through two main stages:

  • Gingivitis is the first stage, where there is inflammation in the gums. Gums that are red, swollen, and bleed easily point to gingivitis. At this stage, there is usually no loss of bone, and most cases of gingivitis can be reversed with a good oral care routine. You cannot cure periodontitis, but manage it and slow its progression.
  • Periodontitis occurs when the tissue that supports the teeth becomes inflamed. Evidence of gum disease is periodontal pockets, which are 4mm or deeper, but not its cause. These pockets hold more bacteria and are difficult to clean at home. Deep cleaning is mainly prescribed for a periodontitis case or severe gingivitis, where standard cleaning can no longer overcome the subgingival infection and inflammation.

As seen above, an accumulation of bacteria will lead to gum disease development. If plaque is not adequately removed, it hardens into tartar, or calculus. This rough, porous surface offers a perfect habitat for further bacterial build-up. This tartar goes below the gum line and helps keep anaerobic bacteria (living without oxygen) safe from elimination. These bacteria trigger an inflammatory response in the human body.

When inflammation happens, it initially serves as a protective mechanism. However, when inflammation of the gums goes on for a long time (chronic inflammation), the connective tissue and bone that keep the teeth in place begin to break down. Eventually, periodontal pockets will form. These pockets are spaces between the teeth and gums. Over time, these pockets deepen. As more bacteria and tartar accumulate in these pockets, the cycle continues.

A surface cleaning will not resolve the infection and stop the progression of gum disease since the harmful bacteria and tartar below the gum line are lodged inside those pockets.

Symptoms and Diagnosis of Gum Disease

Be on the lookout for indications of gum disease so you can treat it early. If you notice any of these warning signs, you may require a deep cleaning:

  • Constant bad breath (halitosis) that your toothbrush and mouthwash cannot fix
  • Red, swollen, or tender gums
  • Bleeding gums during brushing or flossing
  • Receding gums, where gums pull away from teeth, making them look longer than usual.
  • A change in the way your teeth fit together when you bite, or you have loose teeth
  • Pus between your gums and teeth

Gum disease can progress without pain in its early stages. Therefore, it is necessary to visit a dentist regularly. A dentist or hygienist will conduct a periodontal probing on your gums during an exam to see if you need a deep cleaning.

Dental Examination for Gum Disease

A thorough dental exam will be done to diagnose gum disease and determine whether a deep cleaning is necessary. This includes probing your gums with a periodontal probe and usually taking dental X-rays.

During periodontal probing, the dentist or hygienist puts a small tool beside each tooth and measures how deep the little pocket between the tooth and gum is. Normal pocket depths in healthy gums range from 1 to 3 mm. Pockets 4mm or deeper indicate gum disease that needs treatment, usually scaling and root planing. The important pocket depth measurement shows how far below the gum line the infection and tartar are present.

Dental X-rays are also important to evaluate how much bone loss has occurred due to periodontitis. This thorough check helps the dentist diagnose the level of the gum disease and suggest the correct treatment, which includes a deep cleaning.

The Deep Cleaning Procedure

The deep cleaning procedure is done over one or more appointments, depending on the severity of the gum disease. Here is a simple step-by-step of the deep cleaning procedure:

Assessment

Before deep cleaning the dental area, the dentist or hygienist will review your medical history (if applicable). Furthermore, they could re-examine your gums and periodontal pocket depths.

The dentist usually numbs the location where he/she will be treating you with local anesthesia to keep your mouth comfortable throughout the procedure. This stops you from feeling pain or severe discomfort.

Scaling

A dentist will perform scaling, remove plaque, tartar (calculus), and toxins in the bacterial film. This is done as part of the deep cleaning procedure. The scaling removes plaque, tartar (calculus), and harmful bacterial toxins from all surfaces of the teeth. However, it pays particular attention to the gaps between your gums and teeth, where plaque and tartar cleaning procedures are performed. Scaling removes plaque, tartar (calculus), and harmful bacterial toxins from all surfaces of the teeth, but it pays particular attention to the gaps between your gums and teeth where plaque and tartar build up.

Dental experts often use an ultrasonic scaler that uses high-frequency vibrations and a stream of water to dislodge and flush away the deposits. Dental professionals also use instruments with specially designed tips to scrape away any lingering tartar under challenging areas for maximum accuracy.

The primary goal of scaling is to eliminate the existing bacteria and smooth any rough surface on the teeth that would promote bacteria.

Root Planing

After the scaling process, root planing is another deep cleaning procedure. It aims to smooth out the surfaces of the tooth roots properly. The goal is to create a smooth and clean surface that will prevent more bacteria from sticking, help the gums heal, and reattach to the tooth. The root surface is naturally rougher than the smoother enamel of the tooth's visible crown.

Rough surfaces have irregularities that can harbor bacteria. So, root planing is done to remove any leftover calculus stuck in these root surfaces and to remove these irregularities.

This treatment and scaling will smooth out the root surface, rendering it biologically compatible, and promote healing and reduce the depth of periodontal pockets. The two procedures are known as periodontal debridement.

Irrigation

During the cleaning, the dental team will irrigate the teeth. Irrigation is a procedure that flushes the pockets out with a liquid solution. At times, this solution includes an antibiotic. After the scaling and root planing procedures, a dentist or hygienist uses a special syringe or device to inject a medicated rinse into the cleaned pockets.

This antibiotic irrigation aims to reduce or eliminate bacteria in the pockets. The removal of bacteria, tartar, and biofilm by scaling and root planing is enhanced further by antibiotic irrigation, which contributes to greater detoxification of the root surfaces, as well as the healing of the gum tissue and disease control. The targeted delivery of these antibiotics at that specific site can be more effective than systemic antibiotics in some instances. It also helps to minimize the side effects related to oral antibiotics.

You will be given post-procedure instructions regarding your mouth after it is done. Depending on the seriousness of the gum disease and how far it is into the system, the entire process can take one to several hours for each visit.

Anesthesia and Comfort Management During the Procedure

Many patients undergoing a deep cleaning worry that their treatment could cause them pain. Local anesthesia is usually administered to numb the parts of the mouth being treated. You can expect to feel comfortable during the procedure and will not suffer significant pain. What local anesthetic is used and how much is administered will depend on what is being treated and your needs. Scaling and root planing can be nerve-wracking for some patients.

Therefore, dentists will provide extra help using nitrous oxide (laughing gas) or oral sedation for added comfort. It is essential to communicate openly with your dental professional about your level of anxiety so they can adjust your experience.

How Long Does a Deep Cleaning Take?

Depending on the degree of your gum disease and the amount of tartar on your teeth, this could take a few deep cleanings to fix. Most deep cleaning procedures occur over a series of 2 to 4 appointments. This method, known as quadrant scaling, involves treating one to two quadrants (sections) of your mouth at each session.

For example, the upper right and lower left quadrants could be treated together at the first appointment, and the opposite in the next appointment. Splitting the sessions allows enough time to get a thorough cleaning in each area, which also helps you be comfortable and heal because doing the whole mouth can cause a lot of postoperative soreness.

Each session will generally last 1 to 2 hours, depending on how much scaling and root planing is needed in that quadrant. Your dentist will create a treatment plan for you, with the likely number and length of your appointments.

Recovery and Aftercare Essentials After the Deep Cleaning

Proper aftercare after deep cleaning is vital for healing and preventing infection. For the next few days, the areas that have been treated could feel a little sore and sensitive, and could bleed. It is crucial to adhere to your dentist's specific recommendations, which most likely entail:

  • Pain management — For your pain, you can use any over-the-counter painkillers such as ibuprofen, acetaminophen, or any other recommended drug
  • Diet — For the first few days, consume only soft foods to avoid irritation of the gums. Avoid hot, spicy, or acidic foods.
  • Dental care — Keep brushing gently with a soft-bristled toothbrush, being careful around the treated areas. Your dentist could instruct you to initially refrain from flossing in the treated areas for a short duration.
  • Saltwater rinse — After teeth scaling, your dentist could recommend rinsing your mouth with saltwater (1/4 teaspoon of salt in 8 ounces of water) several times throughout the day. The gentle solution is effective in reducing inflammation and aiding healing.
  • Avoid smoking — It is best to stop smoking for healing and to avoid complications.

Feeling your teeth a little sensitive to hot and cold is normal after a deep clean. Usually, this discomfort goes away after a few days or weeks as the gums heal. Using a desensitizing toothpaste can help alleviate this.

It is also normal for the gums to feel sore after the procedure. After a deep cleaning, over-the-counter pain relief can also manage this. Warm salt water rinses can calm down the irritation in your gums and keep them clean. Do not use mouthwashes that contain alcohol, as they can irritate the mouth. Call your dentist immediately if the bleeding persists and the swelling and pain worsen.

Follow-Up Appointments and Periodontal Maintenance

After a deep cleaning, follow-up appointments are critical because your dentist or periodontist will assess how the gums are healing and whether the treatment worked. The follow-up appointments usually take place a few weeks post-final deep cleaning. After your gum pocket depth check and gauging how well your body is healing, your dentist will create a schedule for your future periodontal maintenance visits. This maintenance is different and more frequent than regular six-month cleanings.

Usually, dentists will initially recommend that you have 3-month dental cleaning appointments. People with a history of gum disease require more frequent professional cleaning to disrupt bacteria and reduce disease progression. Stopping gum disease in its tracks is a key benefit of this procedure. The periodontal pockets must be kept clean to prevent infection recurrence and bone loss. Visiting your hygienist regularly is vital for the long-term health of your gums.

Find a Dental Deep Cleaning Expert Near Me

A dental deep cleaning is more than just a cleaning. It is a crucial treatment that targets gum disease lurking beneath the surface. The first step towards protecting your gum health is recognizing the signs, including bad breath, bleeding gums, recession, looseness, and more. If these signs are ignored, serious issues can arise. Do not wait for pain before things get worse.

If you see any of these signs, and it has been over six months since your last cleaning, take a proactive step. Schedule a comprehensive evaluation at Tayani Dental Group today. Our Fullerton dental experts will assess your needs. Contact us today at 949-741-0795 and start your journey to healthy teeth and gums.