If plaque and tartar is left on the teeth, as we mentioned before,
it provides the right conditions for bacteria to thrive. The bacteria
irritate the gums, which means that they bleed more easily. You may
notice this if you are brushing your teeth, or eating, and sometimes
your gums may bleed a bit. This is the early stage of gum disease called
gingivitis. If you have gingivitis, your dentist or hygienist will clean your teeth by scaling and polishing
them. They may also recommend an antiseptic mouthwash containing
chlorhexidine (e. g. Plac-out), and show you how to brush
and floss your teeth effectively. Most adults have some degree of gum
disease.
If gingivitis not treated and nothing is done about it, the
inflammation will work its way down towards the foundations of the tooth
causing a “periodontal pocket”. Again, within the confines of the
pocket, the conditions are such that the bacteria can have a right old
party, and cause more damage. Gum disease can break down the support (bone) structures of the
teeth, so that eventually, they will become loose. The problem is that
until it gets quite severe, the person often has no symptoms. Sadly, the
damage to the support structures of the teeth is irreversible. The
good news is that if gum disease is caught in time, its progression can
be halted and improved upon, and that is the key.
To stop gum disease from progressing, your dentist may advise
periodontal therapy, or deep cleaning. This gets rid of the bacteria in
the pocket and provides the necessary conditions for healing to occur.
What is the difference between an ordinary cleaning and deep cleaning?
There is some confusion about the difference between scaling and root
planing. Scaling is basically the process of removing dental tartar
from the surfaces of the teeth (see dental cleanings).
Root planing is the process of smoothening the root surfaces and
removing any infected tooth structure. If you have gum disease or gum
pocketing, the gum pockets around the teeth will have deepened, thereby
allowing tartar deposits to form under the gumline.
The two processes tend to blur together since during the cleaning
process, the dental worker scales away tartar and performs any necessary
root planing at the same time. Any roughness can be planed away to
result in a silky smooth surface.
Does it hurt?
Depending on the depth of the pocket and severity of the root surface
irregularity, the dentist may wish to make the area numb so that the
process is comfortable for you. Don’t hesitate to discuss with your
dentist to best manage any discomfort.
Sometimes if the pockets are not too deep, there may be little or no
discomfort during the procedure – even without numbing. The only
sensation may be the physical scraping feeling along the teeth
as the area is cleaned and smoothened. A root planed root surface free
of tartar has a better chance of allowing the gum tissues to heal and
reattach to it. As a result, some deep gum pockets can be reduced after a
deep cleaning.
How long does it take?
Typically with deeper pockets and extensive rough root surfaces, the
deep scaling and root planing procedure might be broken down into
quadrants of work per appointment. For example, the upper right side of
the mouth might be worked on one day, and the three other parts worked
on at separate appointments. Or alternatively, one half of the mouth
(right or left, upper or lower) might be cleaned per appointment. This
also allows for only a part of the mouth being frozen at a time and
makes for more manageable, shorter appointments.
The dentist may use antibiotic gels within the periodontal
pocket, again to remove any nasty bugs, or may rinse out the pocket with
various medications such as chlorhexidine.
What can I expect afterwards?
- Discomfort can vary after root planing, but one can expect it to be more sore afterwards since it’s usually in a deeper region under the gums.
- The teeth themselves can become a bit more sensitive to temperature, and bleeding might occur for a little while.
- Over-the-counter painkillers such as ibuprofen work very well to alleviate discomfort, but stronger painkillers can be given should you need them.
- Brushing and flossing can be delayed or done more gently to avoid aggravating any bruised or tender gum areas.
- Your dentist or hygienist may recommend salt water or chlorhexidine rinses.
Dr. Claudio A. Sorrentino
