A Cleaning is a Cleaning, Or is it?

You may think all dental cleanings are the same, but in reality, there are different cleaning types for different circumstances. The type of cleaning you need is determined by how much space there is between your tooth and gum (periodontal pocket) and how much plaque/tartar/calculus you have on your teeth. Your periodontal pockets are measured using a ruler type instrument called a periodontal probe.

The standard dental cleaning by your dentist or hygienist is meant to clean the enamel covered portions of your tooth and slightly below the gumline (usually the 1-3 mm pockets which are considered in the normal range). Surface stains, soft plaque, and hard calculus/tartar are removed. This can be done for adults or children. Your insurance company calls it a PROPHYLAXIS, sometimes abbreviated to pro or prophy. People often call them routine cleaning, regular cleaning or “just a cleaning”.  It’s meant for people with good gum health or with slight or localized areas of gingivitis. (If you have widespread gingivitis, you may need scaling in the presence of gingivitis discussed below.)

Since the standard cleaning only cleans to about 3 mm below your gumline, it will not be any help if you have periodontal pockets that are 4 mm or higher. At that point you are considered to have gum disease or periodontal disease, and  you need a different type of cleaning. Depending on your insurance, these may be covered at the same level as the prophylaxis or they may be considered under the periodontics section of your insurance. What are the other types of cleanings?

FULL MOUTH DEBRIDEMENT: If you haven’t been to the dentist in a while and if you have so much plaque and tartar/calculus that your dentist doesn’t think he or she can do a complete, full mouth examination because of it, this type of cleaning may be use to remove the bulk of the plaque and tartar/calculus. If you need this, you will need to return to your dentist at a separate visit for your dental exam and treatment plan. You may also need additional types of cleanings once your examination has determined your dental condition. Your teeth will probably not be polished after a full mouth debridement.

SCALING IN THE PRESENCE OF GENERALIZED MODERATE TO SEVERE GINGIVAL INFLAMMATION: For ease of reading, I’m going to abbreviate this long name to scaling with inflammation in this paragraph. Your dentist should perform your dental examination and find that your gums are swollen, inflamed, or bleeding, but you should not have periodontal pocketing that’s over 4 mm. This type of cleaning removes surface stains, plaque, and calculus/tartar from areas both above and below your gumline. (This is where it differs from the standard cleaning where going below the gumline is not as common.) Your teeth will probably be polished after a scaling with inflammation.

PERIODONTAL SCALING AND ROOT PLANING: I’m going to abbreviate this to SRP for this paragraph. SRP is done when your periodontal pockets are 4 mm and higher. It involves using instruments to clean plaque and tartar/calculus from both the enamel-covered portion of your tooth and the root of your tooth. During instrumentation, some soft tissue and bacteria may be dislodged as well. According to the definition, SRP is therapeutic treatment not preventive treatment which may be why many insurances consider it under the periodontics section of your insurance coverage rather than the preventive section of your insurance coverage. Some people will refer to this type of cleaning as a “deep cleaning”.  Most times we will focus on half your mouth, or even a quarter of your mouth, at a time in order to make sure we are removing as much of the plaque and calculus/tartar as we can reach. In most cases, the side worked on that day will be polished. Sometimes, we may wait until both sides are done and polish all your teeth at the same time. At this point, you will need to return to your dentist more frequently than the average—usually 3 or 4 periodontal maintenance cleanings a year. (See below for Periodontal Maintenance). It differs from a standard cleaning because it: 1) goes below your gums and 2) is designed to treat your gum problem.

PERIODONTAL MAINTENANCE: This type of cleaning is begun after scaling and root planing or other gum treatment/therapy and continues usually at 3 or 4 month intervals for the remainder of the life of your teeth. It includes removing surface stains, plaque, and calculus/tartar from above and below your gumline as well as site specific scaling and root planing where needed. Periodontal Maintenance differs from a standard cleaning in that it does go deeper below your gumline and in some cases it is treating early recurrences of your gum disease before it can take firm hold, especially if you keep to the recommended time between your visits.

Unfortunately, if you do have gum disease or periodontal disease we cannot do “just a cleaning” on you as it is asking us to be negligent in our treatment—something we can’t ethically do. This doesn’t mean that you must have gum treatment. You can refuse the treatment, but most dentists shouldn’t go ahead with a standard cleaning when they know it is not addressing your problem.

*Note: Information in this article is not meant to replace the clinical judgement of your healthcare professionals.

Dr. Jennifer Robb is a general dentist who sees both adults and children in her dental practice.
1612 Cooper Foster Park Rd., Lorain, OH 44053
440-960-1940
www.drjrobb.com            www.facebook.com/DrJenniferRobb