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After examining your mouth and X-rays, your dentist looks somber and delivers the bad news: Your gums are in such bad shape you’re going to need a rather invasive-sounding procedure called “deep cleaning.” You wonder if it’s really necessary. The answer: maybe.
When the gums have become so diseased that they are pulling away from the teeth creating spaces, called pockets, and exposing bone, the only thing to be done, short of actual surgery, is deep cleaning, said Dr. Georgios Kotsakis, an assistant professor in the department of periodontics at the University of Washington in Seattle. Deep cleaning is officially known as scaling and root planing.
On the other hand, some experts think it's just a chance for your dentist to make a few extra bucks.
“When are deep cleanings appropriate?” asked Dr. Zuri Barniv, a dentist in Sunnyvale, California, whose blog, “Straight Up Doc,” offers advice and education on a wide variety of dental questions. “Many, many dentists will answer: Whenever the insurance company will approve it.”
It’s why he suggests getting a second opinion if you’re in doubt.
That second opinion may save you from an invasive procedure, agrees pediatric dentist Dr. Jeffrey Camm, based in Firecrest, Washington, whose editorial for the American Dental Association’s newsletter highlighted problems with rampant over-treatment among some dentists. One area, Camm particularly noted, was deep cleaning. While stressing there are people who absolutely need it, “that’s not a lot of people,” Camm said.
So, why do some people need deep cleanings? First, some background.
We all have a plethora of bacteria in our mouths. Those bacteria mix with other substances to form sticky plaque on teeth, which is mostly banished by regular brushing and flossing.
Plaques that don’t get brushed away can harden and form a substance known as tartar, which can only be removed with a dental cleaning. When tartar remains on the teeth, it can cause inflammation of the gums, a condition called gingivitis, characterized by red swollen gums that can bleed easily. A mild form of gum disease, gingivitis can usually be reversed through regular brushing and flossing along with cleanings by a dentist or hygienist.
If gingivitis isn’t cured, it can advance to a more severe form of gum disease called periodontitis, in which the inflamed tissue begins to pull away from the teeth, forming spaces, or pockets. As the pockets become deeper, more of the tooth below the gum line is exposed to bacteria, which can damage the bone holding teeth in place.
Eventually, if the pockets become deep enough, teeth can become loose and may even be lost. Dentists measure the depth of the pockets with a probe that has a tiny ruler on the end. Healthy gums have pockets that measure no more than 3 mm — or a little less than a tenth of an inch — deep. More than that and you’re getting into trouble.
One way to slow or halt the process is through deep cleaning, which removes the plaque below the gum line and smooths rough spots on the tooth root, making it harder for bacteria to accumulate there. Studies have shown pockets can be reduced by 0.5 mm with deep cleaning, Kotsakis said. That may not seem like much, but at least the process has been halted.
How does a dentist — and your insurance company — decide you need a deep cleaning? Generally, it takes several factors to lead to a diagnosis of periodontitis and a recommendation for a deep cleaning.
The two most important ones are deep pockets and bone loss. Some dental insurance companies allow diagnosis based simply on the depth of the pockets, Barniv said. Though it's not so easy to size a pocket.
“I can take three dentists and have them measure the same patient and get three different answers,” he said. “If one is heavy handed and pushes down harder, he’ll come up with deeper numbers than a light-handed dentist.”
There are signs you might notice yourself, Barniv explained:
- Red or swollen gums
- Tender or bleeding gums
- Persistent bad breath
- Your teeth look like they’ve been getting longer as gums recede.
- Teeth that are sensitive
- Loose teeth
- Pain when chewing
One thing to keep in mind is that deep cleaning carries some risks. “You could pop out a filling,” Barniv says. “You could damage the gums in an irreversible way. You could end up with an abscess if a tiny piece of tartar is knocked loose and becomes trapped. And there’s a risk that you will have more sensitivity after the procedure.”