Can’t I just get a regular cleaning?
Your dentist has just explained that you have gum disease and that you will need a deep cleaning in order to treat your gum disease. You ask “Can’t I just get a regular cleaning?” The answer is no. A regular cleaning or prophylaxis involves cleaning tooth surfaces above the gums. A diagnosis of periodontal or gum disease involves the presence of pockets or spaces under the gums and a deep cleaning or scaling and root planing is required to remove plaque and calculus or buildup from under the gums.
Scaling and root planing is more time intensive and often requires anesthesia for patient comfort during the procedure. If only a regular cleaning was to be completed the calculus or buildup under the gums would continue the progression of the periodontal disease. Untreated periodontal disease will result in damage to the supporting structures of your teeth which include the soft tissue and supporting bone. With more severe periodontal disease teeth are often lost. Periodontal disease has been linked to other serious health problems such as diabetes and heart disease.
Periodontal disease can progress from gingivitis. As plaque and tartar remain on teeth, they accumulate more bacteria. Periodontal disease is caused by bacteria. Our mouths are full of bacteria. These bacteria reside on sticky, colorless “plaque” on teeth. The body senses these bacteria and mounts an immune response against the bacteria which causes inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease which can usually be reversed with daily brushing and flossing, and a regular cleaning by your dentist.
When gingivitis is not treated the plaque that is not removed can harden and form bacteria-harboring “tartar” or calculus that brushing and flossing can’t remove and the gingivitis can advance to “periodontitis” (which means “inflammation around the tooth.”) Only a professional cleaning by a dentist or dental hygienist can remove calculus. In periodontitis, the gums pull away from the teeth and form “pockets” that are infected. The normal pocket space between tooth and gum is usually 1-3 mm. Pockets 4 mm and greater signify periodontal disease. As the body’s immune system fights the bacteria present in the tartar, bacterial toxins and the body’s enzymes fighting the infection actually start to break down the bone and connective tissue that hold teeth in place causing deeper pocket depths. If periodontal disease is not treated, the loss of bone support causes teeth to become loose and they eventually need to be extracted or pulled.
Symptoms of periodontal disease include bad breath that won’t go away, red or swollen gums, tender or bleeding gums, painful chewing, loose teeth and/or sensitive teeth. Because periodontitis progresses slowly people usually don’t pay attention to the symptoms of gum disease until they get a sudden swelling and/or a loose tooth which needs to be pulled. Men are more likely to have periodontal disease than women and although teenagers rarely develop periodontitis, they can develop gingivitis.
The main goal of treatment is to control the infection by removal of plaque and calculus through a deep cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. After scaling and root planing you will need to visit the dentist every three months for periodontal maintenance. It is impossible to clean pockets deeper that 3 mm at home and so when pockets are present greater than 3 mm it is important to have a dentist clean your teeth every three months. At this visit the dentist will measure your pockets to see if your periodontal disease is getting better or worse and treat accordingly.
You can prevent periodontal diseases by brushing your teeth twice a day (with a fluoride toothpaste), flossing daily and visiting your dentist routinely for a check-up and professional cleaning.
Written by Carlos Vallecillo, DDS and Rossana Menna, DDS