An SRP (Scaling and Root Planning) cleaning also known as “deep cleaning,” is diagnosed and necessity is determined by the doctor or hygienist. A patient who has been told they need a deep cleaning has active gum disease. Active gum disease is based on bone loss, gum inflammation, deep gum pocket depths, and/or bleeding gums. There are different stages of gum diseases. It begins with gingivitis, which is the buildup of calculus. Calculus is a hardened form of plaque. Both plaque and calculus are masses of bacteria that continue to cause tissue and bone damage if left in the mouth. Leaving large quantities of bacteria for longer period of time leads to periodontitis, which is an advanced form of gum disease. At this stage, the gums are infected and detach from the teeth leaving spaces also known as pockets. The deeper the pockets, the more advance gum disease the patient has. Eventually as the pockets gets deeper, it continues to house bacteria and eat away at the bone surrounding the teeth.
Patient who require a deep cleaning may at this point already have bone loss or is at high risk for bone loss. Bone loss is determined by looking at x-rays. An x-rays of a patient with healthy gums should reveal a bone level that is right beneath the coronal (visible tooth or ‘crown’ of the tooth) portion of the tooth. The whole root of the tooth in an x-ray should be buried in bone. When only a partial portion of the root is buried in bone, this is an indication of bone loss. When there is significant bone loss, teeth will begin to become mobile. When a tooth is mobile and no longer supported by surrounding bone, it needs to be extracted. Leaving a diseased tooth in the mouth will continue to infect other surround bone and teeth. However, an extraction is the last resort.
A periodontal evaluation also know as pocket depth measurement can be done to establish the level of pocket depths around each tooth. A patient requires a deep cleaning because they have pocket depths that are more than 3 millimeters and not necessarily because they have bone loss. With a deep cleaning procedure we are attempting to prevent bone loss and not waiting for bone loss to occur before we do something about it. During a periodontal evaluation, each tooth’s gum depth is measured in six different spots. Three areas in the front of the tooth and three areas in the back of the tooth. A small periodontal probe is used to measure pocket depth. The small probe has markings along its length at different millimeters. The deeper the probe can enter the gum, the deeper the pocket depth is. Any depth at 4mm is considered to be at the beginning stage of gum disease (gingivitis). Depths at 5mm are considered to be moderate stage of gum disease. Pocket measurements at 6 or more millimeters are at advance stage of gum disease. A deep cleaning is required and more advance treatment for gum disease may be recommended with a periodontist (gum specialist doctor).
A periodontal evaluation (aka pocket depth measurement) that reveals pocket depths with more than 4+mm, bleedings gums, inflammation, and/or bone loss is an indication that a deep cleaning is needed. During this treatment, the hygienist uses local anesthetics to numb half your mouth and proceeds to remove all the plaque and bacterial buildup in that numbed area. Numbing is required to allow the hygienist to go deep below the gum line without letting the patient be uncomfortable. This procedure takes one hour for just half of the teeth to be cleaned. Usually the teeth in the upper right and lower right are done together in one visit and the teeth in the upper left and lower left are done at another visit. Typically a deep cleaning is done in two visits that requires one hour each visit; however, we may be able to do a deep cleaning in one visit for a two hour period.
Patients can expect to resume their regular, daily schedule right away after their deep cleaning treatment. A deep cleaning is a relatively conservative treatment for gum disease that doesn’t require a lot of aftercare. There is generally no pain or small soreness afterwards. No pain medication is prescribed for this treatment. A regular over-the-counter medication like Tylenol or Advil can be taken if patient feels some soreness after the local anesthesia wears off.
Additional Recommended Treatments in Conjunction
with Deep Cleaning:
Arestin® is recommended for patients with pocket depths that are 6mm or more. Arestin® is an antibiotic medication that is injected into deep pockets. Each dose of Arestin® 1 mg of antibiotics that is in powder form and compacted into little pellets. Arestin® is a form of antibiotic, minocycline hydrochloride, that is developed into microspheres. These small microspheres injected into gum pockets work overtime to reduce bacteria and allows your gums to heal and re-adhere back to your tooth, reducing your pocket depth.
Patients are strongly urged to get prescription grade medicated mouthwash after the treatment also known as Peridex™. Peridex™ is used like a regular mouthwash after brushing and flossing before bed. We recommend use for 7-10 days after a deep cleaning to prevent gum infection and bacterial buildup. Peridex™ is a antimicrobial that works to destroy bacterial cell surface, essentially destroying the bacteria cell.
Click on the following links for more information on teeth cleanings: