Why can't a regular cleaning treat gum disease?
A regular cleaning is built for healthy gums. It clears tartar from above the gum line and just below it, then polishes the teeth.
Gum disease changes that. The gum comes away from the tooth to form a pocket, and tartar and bacteria collect on the root at the bottom, out of reach of a toothbrush and of an ordinary cleaning. Polishing the tops of the teeth treats the part you can see and leaves the part doing the damage.
That is why the gums are measured at every cleaning and exam. The readings and X-rays of the bone tell us whether pockets have formed, and we show you both before anything is decided.
What happens during scaling and root planing?
The area is numbed with local anesthetic, and we check it is numb before starting. If you are anxious, say so: nitrous oxide is available on request, and we can agree on a signal for you to stop us.
Scaling clears the tartar and bacteria out of each pocket, down to the bottom. Root planing smooths the root surfaces, so there is less for bacteria to cling to and the gum can tighten back against the tooth.
It is often done a section of the mouth at a time, here in the office on Tazewell Street. Most people feel pressure and scraping rather than pain. A sharp feeling means you need more anesthetic, so tell us and we will stop.
Where do ARESTIN and laser therapy fit in?
The cleaning is the treatment. For pockets that need more help to heal, two things can be added to it.
ARESTIN is an antibiotic in powder form, placed directly into a deep pocket once it has been cleaned, where it releases slowly rather than going through your whole body. If we place it, we will tell you how long to leave that spot alone with floss.
Laser therapy can also be part of gum disease treatment here, for the pockets that need it. Neither replaces scaling and root planing, and not every mouth needs either.
What to expect after a deep cleaning
Wait until the numbness wears off before you eat. The gums are often tender afterward and the teeth can be sensitive to cold for a while. Both settle as the gums heal, and an ordinary pain reliever is usually enough.
Keep brushing and cleaning between your teeth, gently at first, except anywhere we have asked you to leave alone. Warm salt water rinses can soothe tender gums. Call if the soreness gets worse instead of better, or if the gum swells.
As the swelling goes down, the gums tighten and can sit a little lower, so some teeth may look longer. That is the gum healing, not the treatment going wrong, and shallower pockets are easier to keep clean.
Measuring again, then maintenance every 3 to 4 months
Once the gums have healed, the pockets are measured again and compared with the readings from before. Where one stays deep, the next step might be ARESTIN, more treatment or a referral to a gum specialist, and we will explain why before anything is arranged.
From then on, cleanings come every 3 to 4 months rather than every six. These periodontal maintenance visits clean below the gum line and measure the pockets each time, because treated gum disease comes back if the bacteria are left too long.
Do you really need a deep cleaning?
Not everyone does. Gums that bleed but have shallow pockets usually mean gingivitis, the early stage, which reverses with a thorough regular cleaning and better cleaning at home. If that is you, we will say so, and if another office has told you that you need a deep cleaning, a second look is a reasonable thing to ask for.
If it has been years since your last cleaning, that is the usual reason people call, and nobody here is going to make you feel bad about it.
Does insurance cover a deep cleaning?
Insurance lists scaling and root planing as a different procedure from a routine cleaning, so your plan may pay a different share of it. The fee depends on how many areas need treatment, and you get a written estimate first.
We file the claim for you; see insurance for the plans we work with. If you have no dental insurance, ask about the Virginia Dental Club.
Questions patients ask
Does a deep cleaning hurt?
The area is numbed first, so most people feel pressure and scraping rather than pain. The gums can be tender afterward while they heal. If you are nervous, nitrous oxide is available on request.
How many visits does scaling and root planing take?
It depends on how many teeth have pockets. Some people need only one area treated, and others have it done a section of the mouth at a time over more than one visit. We will tell you how yours will be split up before anything is booked.
Can mouthwash or antibiotics treat gum disease instead?
Not on their own. Tartar on the roots has to be cleaned off, and a rinse cannot reach the bottom of a deep pocket. ARESTIN goes into a pocket after it has been cleaned, as an addition to a deep cleaning rather than a replacement for one.
What happens if I put off a deep cleaning?
The pockets can deepen and the bone around the teeth can keep breaking down, often without pain to warn you. Bone lost that way does not grow back on its own, and in time teeth can loosen. If you have been putting it off, come in anyway, because it is easier to deal with now than later.