By Elyse Brumfield, RDH
Supervised and Edited by Dr. Levy Do, DDS

It doesn’t make sense: you go to the dentist expecting to get your normal, routine dental cleaning. This time the doctor has diagnosed you with periodontal disease and says you need a periodontal scaling and root planing (SRP) which you probably know as a “deep cleaning.” You just came for your basic cleaning, so you ask, “Can I just get my regular cleaning, please?”

Maybe it has been a while since your last cleaning, maybe this is a new dental office for you, maybe you haven’t really been keeping up with your routine oral care of brushing and flossing at home, or maybe it is genetic and runs in your family. Whatever the situation, the doctor has diagnosed you with periodontal disease and that means a “basic cleaning” just won’t cut it.

What Is Periodontal Disease?

Periodontitis, also known as gum disease, is caused by an infection in the gums. A recent CDC report provides the following data related to prevalence of periodontitis in the U.S.:

• 47.2% of adults aged 30 years and older have some form of periodontal disease.

• Periodontal disease increases with age, 70.1% of adults 65 years and older have periodontal disease. It starts with bacteria in the mouth getting into the gums and causing irritation, inflammation, and bleeding when brushing or flossing. This is called gingivitis and it is a warning sign that the disease is starting. Source: Central For Disease Control & Prevention

When left alone due to the lack of brushing around the gums and flossing daily, food particles along with proteins in your saliva and bacteria harden and form a cement-like substance around the crevices and roots of your teeth, called calculus or tartar. The presence of this tartar allows harmful germs to thrive to produce endotoxins with causes the gums to be irritated and to push away from the tooth. As the gums pull away from the teeth, the bacteria and food are able to get further and further down into the gum pockets around your teeth, making the problems worse. Calculus around a tooth root is as tenacious as barnacles on a rock, and the bacterias are like little sea creatures that live on the barnacles. And they’re not so friendly. As it sits undisturbed, the inflammation and endotoxin cause more bone loss around the teeth which could lead to pain when chewing, loose teeth, and if left untreated the teeth can fall out. Bleeding gums or gingivitis is usually the beginning signs of periodontal disease or periodontitis.

There are several factors that can cause gum disease: smoking and alcoholism, poor oral care at home (especially not flossing!), lack of professional dental cleanings, crowding of teeth, pregnancy, and even genetics.

Think of it like this: You visit your doctor and he says you are dangerously close to getting Type 2 diabetes and need to cut back on sugar to avoid getting the disease. If you listen to him, you can prevent further damage, eat better and stay healthy. As they say, an ounce of prevention is worth a pound of cure. It is the same with periodontal disease. If treated early, it can stabilize, allowing you to keep your own healthy teeth instead of spending money and time replacing them later.

Why Can’t I Have the Regular Cleaning?

Once diagnosed with severe gingivitis or periodontal disease, what you know as a “regular” cleaning will not be enough. We need to get under the gums to clear out all of the tartar build up and remove the bacteria so that the gums can heal and we can begin to control the disease. Periodontal disease treatment is a therapy since it’s not a cure but a means to help your body fight the disease. Like physical therapy, it also takes effort, focused education, and a change in habits along with practice to get better. In cases of severe disease, when left untreated for too long, surgical intervention is necessary. The bone is the boss and once it’s gone, the road ahead gets much tougher.

There is a lot that goes into diagnosing whether or not your gums are healthy or if you have periodontal disease. At each appointment, we use a tiny little ruler, called a periodontal probe, to measure the depth from the top of the gumline to the areas where they attach to the teeth, called “pockets.” We look for signs of disease while measuring the pockets which are indicated by any bleeding or measurements greater than 3mm. We also look at evidence of bone loss in the x-rays of your teeth to be able to verify that the pocket numbers we are measuring are accurate, check for loose teeth in areas where we see significant bone loss, as well as look for any areas of tartar that have accumulated on the teeth or under the gums.

What Are the Different Types of Cleaning?

• Prophylaxis (“Basic or Preventive Cleaning”) - The regular cleaning that people are used to getting every 6 months is called a “prophylaxis.” You may know it as a “basic” or “regular” cleaning. With this cleaning, we clean any mild build-up around the gumlines and on the surface of the teeth, followed by polishing and then flossing between all of the teeth.
  What many people don’t understand about this type of cleaning is that it is a preventative cleaning. This means that your gums are generally healthy, meaning there are not any signs of disease- bone loss, bleeding, or heavy accumulation of tartar. We can prevent this from happening with routine visits.

• Gingivitis Therapy - Sometimes if there are lapses in your dental visits, you haven’t been flossing daily, or maybe you’re pregnant and the hormones are kicking in, then the gums can be inflamed, swollen, tender, and bleed. These are early signs of periodontal disease and we call it “gingivitis.” At this point, it has not yet progressed into the full periodontal disease, but it is warning you that it needs to be treated ASAP or it will get worse. We want to stop it before it does. We do this with a cleaning called gingivitis therapy.
  During gingival therapy, we may use a topical gel to make your gums more comfortable and then clean around all your teeth, going a little deeper into the gums to remove the irritating, disease-causing bacteria. Once cleaned, we use an antimicrobial rinse called Chlorhexidine to flush around the gingival pockets and decrease the number of bacteria which in turn reduces inflammation, tenderness, and bleeding. Before leaving, we help you understand some good at-home oral care habits that will help get the gums back to a healthy status.

• Non-Surgical Periodontal Scaling and Root Planing (“Deep Cleaning”) - If you haven’t had a dental cleaning in a long time, haven’t been flossing or brushing well, or even have genetic bone loss, there is a chance that there is already periodontal disease present. At this point, a basic cleaning or gingivitis therapy won’t get far enough into the pockets due to bone loss to remove the tartar build up or the bacteria that live deep in those pockets. We need to get the disease under control with a cleaning called periodontal scaling.
  Before the cleaning, we get you comfortable and numb so that we can clean all the way to the bottom of the gum pockets to remove any tartar buildup and disease-causing bacteria. Just like with the gingivitis therapy, we flush the pockets out with Chlorhexidine and then have you return about 6 weeks later to re-measure your pockets for signs that the disease is getting under control which include tightening of the gums with less inflammation and bleeding, smaller gingival pocket numbers when measuring, and better at-home habits which are evident at your visit. After this cleaning, we will schedule you for your perio maintenance, about every 3-4 months to maintain the control of the disease.

• Surgical Periodontal Scaling and Root Plaining - If you already have severe bone loss, have puss coming out of the pockets due to infections around the teeth, or your gingiva didn’t respond to the periodontal scaling as we had hoped, then surgical intervention might be necessary to save your teeth. Surgical protocols can include osseous surgery or bone surgery, grafting, and/or laser-assisted treatments such as LANAP. These procedures are usually referred to a dental specialist called a Periodontist. After successful completion of this type of treatment, you will likely rotate between our office and the periodontist’s office for your routine periodontal maintenance cleanings every 3 months to keep the disease under control.

So when you come in and are expecting a regular cleaning and are surprised to find that we recommend a more advanced type of cleaning, it isn’t a sales pitch. It means that we found scientific evidence that you are either beginning to get periodontal disease or already have it and we want to get it under control before you start losing teeth.

Has it been a while since your last cleaning or just looking for a new dental home? At Pine Cove Dental, we genuinely care about you and want to help you maintain the health of your teeth so that you can keep them for the rest of your life! Click below to schedule your appointment today!