I have heard it from many patients who say “I am brushing, I am flossing.. don’t get why I need a deep cleaning!” and on the other hand there are patients who have not been to a dentist in over a decade, decide to come in for a checkup and don’t need a deep cleaning!
I get the frustration. The thought typically is that if oral hygiene steps are followed, it’s a guarantee that there would be no need for deep cleaning.. but not quite. The health of your gums is not just dependent on the frequency of your brushing and flossing; of course, if you’re doing those greatly, chances are that your mouth is at a good state. Often times though, it depends on other factors such as systemic diseases, medications that one takes, the technique by which teeth are brushed or flossed and sometimes purely genetics!
Folks with diabetes or high blood pressure that goes uncontrolled for years, with red inflammed bleeding gums, or even loose teeth over time. Could be that your saliva has much too much calcium, causing more precipitation of tartar usually on your lower teeth and sometimes on the upper back teeth, depending on which gland produces that type of saliva more. And of course there are those of us who think that the brush touching their teeth means that the work is done.. brushing technique does matter in reducing the accumulation of plaque and consequently tartar (hardened plaque). Needless to say brushing does not remove the plaque entirely out of one’s mouth as those bristles don’t reach everywhere between the teeth and flossing/waterpiking is needed in most cases. And sometimes there are those with thin gums or higher tendency for inflammation in their bodies/mouthes who end up with more puffy gums.
Once plaque has accumulated enough under the gums, because of poor brushing or lack of flossing or change in the bacterial flora/load, or pure bad luck with genetics, that plaque hardens; becomes tartar and would only cause the inflammation of the gums increase as now there is a “foreign object” in the gums that would only cause more inflammation as the body would try to fight it off. Gums are not quite attached anymore, pockets are deepening without being able to clean at their depth, and it becomes a faulty vicious cycle there on.
And that’s where deep cleaning is recommended usually to break the cycle, curettage the gums, remove the tartar under the gums and reset the button in a sense.
Sometimes, patients decide to stay on 3-4 months recare/hygiene instead of doing deep cleaning. And the issue with that is that typically if we’re just maintaining, we’re not going under the gums much which means that the underlying issue (deep pocket or tartar under the gums) is still staying in. So we’d be controlling the symptoms but not the disease per se.
And in more intense cases, deep cleaning alone won’t work. Sometimes a more surgical approach is needed where gums are reflected back and the curretage is done more fundamentally all the way to the bone level, gums are brought down lower to reduce the pockets depths physically to allow the patient to keep the pockets cleaner that way. Usually that is done after at least one round of deep cleaning to assess the patient’s response.
So, regular versus deep cleaning is always being evaluated when you’re being seen for your hygiene appointments. If you are unsure what type of cleaning you need and are in San Francisco, make an appointment with Soothing Dental and get a consult.