Deep Cleaning: What To Expect, Procedure & FAQs

dental hygienist working

If you’ve ever been told that you need a deep teeth cleaning procedure (aka “scaling and root planing” or “SCRP”), it’s because your dentist and hygienist want to help you halt an active, aggressive gum infection. But when it comes to deep cleanings, what to expect is slightly different than your typical six-month routine dental cleanings.

Being prepared for your deep teeth cleaning appointment doesn’t just help with any anxiety you might be feeling; it also equips you with the tools you need to help your smile bounce back from gum disease. Ultimately the goal is to eliminate infection and help you save your teeth.

Planning a deep cleaning procedure? Scaling and root planing (SCRP) procedures are predominantly used to combat active periodontal disease. With deep cleanings, what to expect typically includes at least two separate appointments focused on one side of your mouth at a time. Unlike a traditional dental cleaning, deep teeth cleanings are specifically for addressing soft and calcified deposits settled deep under the gums, along the roots of infected teeth. Local anesthetic is frequently used to ensure patient comfort.

What Are Deep Cleanings?

Deep cleanings are a type of therapeutic procedure used to halt periodontal disease and prevent it from progressing.[1] They’re designed to reach tartar and plaque buildup deep below gum tissues inside of infected “periodontal pockets.” Unlike preventative dental cleanings, these periodontal scaling and root planing treatments are focused on areas of infection using special instrumentation or technology.[2]

Most deep cleanings consist of cleaning one quadrant (1/4) of your mouth at a time, scheduling 1-2 quadrants per appointment. It’s common to have half of your mouth cleaned during one deep cleaning teeth procedure and the other half cleaned at a separate visit 1-2 weeks later.

Regular Cleaning Vs. Deep Cleaning

During a regular dental cleaning, your dental hygienist cleans and polishes teeth above the gums and removes isolated areas of buildup just under the edge of gum tissue. They’re preventative in nature, helping you to keep your teeth and gums healthy. But a lapse in dental cleanings and good dental hygiene leads to buildup below the gums and corresponding gum disease. As such, a therapeutic deep cleaning is required.

Why Might You Need A Deep Teeth Cleaning? 

Dental deep cleanings are necessary when you have active periodontal disease with symptoms of tissue detachment. In other words, deep “pockets” around your teeth have formed, where the gums have detached, and the bone has shrunk back. Usually there is also heavy tartar buildup attached to the root surfaces of those teeth.

Periodontitis is an aggressive form of gum disease. Unlike gingivitis, it isn’t reversible on your own. It must be treated by your dental team. The first step is to remove the bacteria inside of your periodontal pockets (plaque and tartar) that are responsible for causing the infection. The goal is to create a clean space where the gum line will re-attach and bone loss will be halted.[3]

Symptoms Of Periodontal Disease

Periodontal disease is the most severe stage of gum disease, with gingivitis being the earliest. Although gingivitis only causes symptoms like minor irritation, redness, mild swelling or bleeding, periodontal infections take it much further. The most common symptoms of periodontal gum disease include things like:

Some of these symptoms, such as periodontal pockets, bone loss, and tartar on root surfaces can only be diagnosed by your dental provider. X-rays and special instruments will be used to evaluate the extent of damage that has occurred (and the classification of gum disease your condition falls under.)

Side Note: If you’re someone who uses tobacco products, you may not experience the same symptoms of gum disease as a typical periodontal patient. In fact, your gums may appear perfectly healthy due to a lack of inflammation and blood circulation.

Risk Factors Associated With Periodontal Disease

Untreated, aggressive gum disease is directly linked to known conditions[4] like:

…and possibly even dementia. So even if you think to yourself, “my teeth really aren’t all that important to me,” the oral infection can jeopardize your overall wellness. And of course, periodontitis is also the leading cause of tooth loss in adults.

Are Deep Cleanings Necessary?

If you have diagnosed with periodontal disease, yes. A dental deep cleaning is a must. Since basic preventative cleanings aren’t thorough enough to reach down into diseased areas and clean away heavy tartar buildup, something more extensive is required. Without a dental deep cleaning, you would be leaving all of that bacteria underneath your gum line. From there, it can spread straight into your bloodstream. Even though the tops of your teeth might look great, their foundation would gradually crumble. Tooth loss would be inevitable and oral bacteria would travel to other areas of your body.

Usually, a deep cleaning is required if you have multiple gum pockets that are 5mm deep or more. Or, if you have multiple symptoms of periodontal disease. Or, if there are visible tartar deposits on your X-rays (which can interfere with measuring accurate pocket depths.)

How To Prepare A Deep Cleaning Procedure  

Your dentist’s office will probably book your deep cleaning for the morning or early afternoon. Earlier in the day is preferred (since the process requires more energy and time on the part of the hygienist.) Remember that the process is typically spread out over two visits, with half of your mouth being cleaned during each one.

It’s best to dress in layers to keep comfortable. If you like, you can even bring a thin, clean blanket. Feel free to load your favorite playlist onto your phone and pop in your earbuds to help tune things out if you like. And if you’re feeling a little more nervous than usual, it’s completely fine to ask your dentist or hygienist about adding laughing gas (nitrous oxide) onto the appointment if that’s something they offer. The goal is to help keep you comfortable.

You won’t want to go back to work or school the same day, but you can likely return the following day. Plan to expect some minor soreness where the local anesthetic is injected, or along your gums. Have some ibuprofen on hand to take as directed for the first couple of days. Other than avoiding hot and cold foods, you can typically stick to a normal diet. Just keep in mind that your mouth may be numb for a few hours, so your first meal or two may need to be something on the softer side.

Step By Step Procedure 

Here are the steps for a typical SRP (deep cleaning) procedure, some steps may vary for your unique case.

Steps:

1) Exam, X-Rays, And Periodontal Charting

This will likely happen prior to scheduling the actual dental deep cleaning. Each step is necessary to measure the extent of your bone loss and gum disease.

2) Local Anesthetic Or Numbing Gel

Is applied to the area to prevent sensitivity during your cleaning. Some people don’t need any numbing medication while others prefer not to be able to feel a thing. It’s ok to have the hygienist get started and re-evaluate it after a few minutes.

3) Optional Nitrous Oxide Sedation 

Laughing gas can ease your anxiety and help you feel more relaxed during most basic dental appointments (including routine or deep cleanings.) Nitrous oxide starts working quickly and is 100% reversible, meaning you can drive yourself home afterward.

4) Ultrasonic & Hand Scaling

During your periodontal scaling, your hygienist will probably use a thin ultrasonic device to lift away most of the buildup. These ultrasonic instruments move thousands of times per second and irrigate the immediate space around them while tartar is removed. Their technology also destroys the bacterial colonies to create a clean environment within your periodontal pockets.

Following ultrasonic instrumentation, special manual hand instruments (scalers and curettes) will be used to lift away any residual areas of bacterial deposits. These instruments are specifically designed for reaching into deeper periodontal pockets and even different parts of the mouth, due to tooth location and shape.[5]

5) Locally Placed Antibiotic (If Applicable) Or Irrigation

Periodontal pockets with symptoms of severe infection may require additional treatments. Locally placed antibiotic capsules or prescription irrigation solutions are just one example. These small doses of medication are placed with a syringe directly into the pocket(s). Your dentist may even prescribe a strong mouthwash to use for a couple of weeks.

6) Follow-Up Deep Cleaning Appointments

After both of your deep cleaning appointments, you’ll need to return to the dentist’s office about 2-4 weeks later to have your gums evaluated Your hygienist will re-measure the periodontal pockets to see if the tissues have reattached in any areas. A plan will be made for ongoing maintenance, including discussion of grafting if necessary.

7) Referral To A Specialist 

In some cases, periodontal disease can be so severe that your family dentist doesn’t have the resources needed to treat it effectively. Or you simply don’t respond to treatment like they had hoped. With severe gum disease, they will refer you to a gum specialist known as a periodontist. Periodontists have extra technology such as microscopes to see down into gum pockets. They can also perform surgical procedures like “gum flaps” where the tissues are retracted to access the root surfaces, ensuring a thorough cleaning for particularly aggressive areas of gum disease. The periodontist will usually complete the periodontal scaling and then refer you back to your general dentist or have you alternate checkups between the two providers until you’ve recovered.

Recovery After Procedure 

24 Hours After The Procedure

One of the most important keys to success in your gum therapy is the aftercare process. It’s crucial to prevent relapse of infection or new tartar buildup. Since tartar can form within 24 hours, you need to make sure you’re brushing and flossing thoroughly every single day.

Since your toothbrush and floss can’t reach down into deep gum pockets, you’ll need to add in a few extra hygiene tricks, such as using a water flosser. Water flossers can reach several millimeters below the gum line, flushing plaque and food particles out of periodontal pockets. They’re a must-have if you plan to have a scaling and root planing. Use it daily and chances are you’ll see even better results once you return for your follow-up assessment.

Weeks After Procedure

About 2-4 weeks after your deep cleanings have been completed, you’ll go back to your dentist’s office for a re-evaluation and final deep cleaning. That’s when you’ll usually have your teeth touched up, polished, and then the gum pockets re-measured to evaluate how well you’ve responded to treatment.

In most cases your dentist will place you on a 3-4 month re-care schedule to prevent relapse and monitor your recovery process.

FAQs

1) Are Deep Cleanings Painful? 

Since deep cleanings extend down under your gum tissues and involve the roots of teeth, they’re potentially a sensitive type of procedure to complete. That’s why most dental offices will use either local anesthetic or some type of numbing gel to desensitize the area that’s being cleaned. As long as those spaces are numbed, all you’ll feel is a little pressure as your hygienist cleans the tartar away.

If your dentist or hygienist uses local anesthetic, that part of your mouth will usually be numb for a few hours. That’s one reason why deep cleanings are typically performed on one side of the mouth at a time. Temporary numbing gels like Oraqix can last 20-30 minutes at a time without an injection. 

2) How Long Does Deep Cleaning Take?

You’ll need to reserve approximately 1.5-2 hours for deep cleanings. What to expect is a longer visit than traditional checkups. And if your hygienist is cleaning one half of your mouth at a time, multiply the time by two. 

Due to the tedious nature of removing tartar from gum pockets and roots of teeth, more time is required. Many of these spaces are just out of eyesight, so much of it is done by hand (unless you’re seeing a periodontist and they have a microscope!) Leaving any tartar behind will result in delayed healing. Accuracy is key.

Ultimately the length of your procedure will depend on how deep your periodontal pockets are, how much tartar there is, the tenacity of the buildup, and similar factors.

Plan on scheduling at least two deep cleaning appointments (around an hour and a half each) as well as a follow-up appointment about 2-4 weeks later to see how your gums have responded. 

3) Disadvantages Of Deep Cleaning Teeth?

The disadvantages of a deep teeth cleaning are minimal when compared to the benefits. First of all, the cost of a deep cleaning procedure is significantly more than a preventative cleaning. Second, more time is involved. And thirdly, it’s common to experience a bit of soreness for a few days as your mouth begins to heal. Removing tartar buildup from infected gum pockets can trigger a bit of sensitivity, due to the bacteria also acting as a cover to your tooth.

4) Can Teeth Fall Out After Deep Cleaning? 

Can teeth get loose or fall out after a deep cleaning procedure? If you have aggressive gum disease with severe bone loss, possibly. However, your dentist should be able to screen for extensive bone loss ahead of time (by looking at your X-rays) and advising tooth extractions if necessary. It’s common for teeth to feel loose after a deep cleaning procedure if you have extremely deep pockets and extensive tartar buildup. But with good home care, the goal is for your gums to reattach and tighten the teeth back into place.

5) How Often Do I Need To Get A Deep Cleaning?  

Theoretically, your dentist and hygienist will only want for you to get one deep cleaning procedure in your lifetime. The goal from there is to maintain your oral health by alternating periodontal maintenance appointments or traditional dental cleanings on a regular basis. Daily brushing and flossing are essential to keep buildup at a minimum. Intermittent cleanings will remove tartar from hard-to-reach areas before it gets too heavy. But if you don’t keep up with your home care or professional cleanings, gum disease will relapse, and you’ll need another series of deep cleanings all over again.

6) How Much Are Deep Cleanings?

The cost of a deep cleaning depends on a lot of factors, one of being where you live. If the cost of living is higher in that area, the price for a scaling and root planing will cost more. On average, deep cleanings run between an average of $150-300. If you have dental insurance, the claim your dentist sends in will be broken up into quadrants (1/4 of your mouth) instead of the entire mouth. You’ll probably see a single charge listed four times on your total bill as opposed to once (like a regular cleaning is.)

7) Does Insurance Cover Deep Cleanings? 

Dental insurance typically covers preventative cleanings and exams at 100% (or close to it) twice per year. Unfortunately, deep cleaning procedures are not “preventative” in nature, as they’re meant for treating active gum disease. As such, the amount of coverage for a scaling and root planing is reduced from 100% to the next tier of coverage set by your plan. Depending on your dental insurance company and type of policy you (or your employer) choose, the deep cleaning might be covered at around 50-80%

8) Are Deep Cleanings Safe?

Absolutely. With deep cleanings, what to expect is a therapeutic procedure designed to enhance your oral health. Without them, periodontal disease can run rampant. Untreated oral infections can jeopardize your overall health and will eventually lead to tooth loss. The safest option there is, is to schedule the deep cleaning as soon as possible. The longer you wait, the longer that bacteria has to spread throughout your body.[6]

What To Expect From A Deep Cleaning Procedure 

Planning to schedule visits for upcoming deep cleanings? What to expect isn’t anything to be afraid of. Although the deep cleaning procedure is lengthier and more involved than a routine cleaning, your dentist and hygienist will keep you comfortable and provide the support necessary to help you save your smile (such as using local anesthetic). Without periodontal therapy, you run the risk of not just losing your teeth but suffering overall medical side-effects due to the bacterial load on your immune system. You just can’t risk it.

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