Was That a Good Cleaning? A Worthless Cleaning? Do I Need a Deep Cleaning?
First, we need a bit of info…We ask that you answer these 5 questions for us:
1. Do I trust my dentist?
2. Did I try hard to follow SODA’s rules about finding a good, honest dentist?
3. Do I have dental cleanings regularly?
4. How long has it been since I had a dental cleaning?
5. Do I BRUSH my teeth well? (Or do I go to sleep without brushing a lot? Do I brush really quickly and never floss?)
Here are what your answers SHOULD be. But, don’t worry if not, we’re going to help you get there:
1. Do I trust my dentist? Yes
2. Did I follow SODA’s rules about finding an honest dentist? Yes
3. Do I have my teeth cleaned regularly? Yes, every 6 months
4. How long has it been since your last dental cleaning? Only 6 months to a year. (Sometimes, you end up at 2-3 years. Sometimes it’s been 15. All is not lost, but don’t make it your habit any longer)
5. Do I brush my teeth well and floss, or do I do a quick job? I have read SODA’s guidelines for brushing and flossing, and I will do it for the rest of my life! :)
Now that you’ve answered these questions, let’s talk about what happens all too many times…
Many dishonest dentists scare people into getting “deep cleanings,” also known as “Scaling and Root Planings (SRPs).”
At some dishonest offices, it’s almost universal across the board. EVERYONE who walks through their doors gets a “deep cleaning.” Whether it’s been 6 months or 6 years since their last cleaning, they’re told they need a deep one.
Once these offices perform a “deep cleaning” on you, they can then charge your insurance company for a more expensive “periodontal maintenance” cleaning from that point on. They can then recommend that you get your teeth cleaned every 3-4 months instead of 6.
Many times, these offices are also recommending that antibiotics be placed under your gum line. The cost averages $30 per placement, and there are up to 8 spots where this antibiotic can be placed per tooth! More money in their pocket, and it’s not always necessary or beneficial.
It’s important to educate yourself on when you are likely to need these treatments done. We’re so glad you’re here.
Sooo, what should a regular dental cleaning look like???
Many websites and offices will tell you that a deep cleaning is a cleaning performed “under the gumline.”
This is laughably true, but EVERY routine dental cleaning performed by a dental hygienist SHOULD GO UNDER THE GUMLINE! That’s where 90% of the tartar IS, for goodness sakes!
Tartar likes to hide below your gumline, throughout your entire mouth. It only shows itself above the gumline usually, on the cheek side of your upper molars and behind your lower front teeth.
If your hygienist does not clean under your gum line at EVERY appointment, you’re not having your teeth cleaned. They’re leaving everything under there, and you’re most likely going to get gum disease very soon because of it.
If you go to an office and get a teeth cleaning where they “pick a little here, pick a little there,” and then polish your teeth, sending you out in 15 min. . . RUN!…and never look back. That is NOT a normal dental cleaning!! That is not worth paying for. You might as well just go home and brush your teeth.
Tartar should never be left in your mouth. That is exactly what they are doing with a 15 min adult dental cleaning.
Every routine dental cleaning should involve…
Your dental hygienist DILIGENTLY feeling and cleaning around EVERY aspect of every single tooth in your mouth.
The hygienist should have a pattern that you can follow. Cleaning appointments should be scheduled for 45min-1hour.
As they move around, they scrape away plaque but are especially looking for pieces of tartar that have formed on your teeth. The tartar is the dead bacteria that YOU cannot remove on your own with your brushing or flossing. Hence the need for the metal dental instruments that the dental hygienists use.
Plaque and tartar are two different things
Plaque is the soft, live bacteria, that you can scrape off of your teeth with your fingernail. Plaque is responsible for nearly everything that goes wrong in your mouth: cavities, bleeding gums, bone disease.
When plaque is not completely removed with brushing and flossing, your saliva attempts to kill the rest. It’s your own built-in, natural defense mechanism. The saliva shoots minerals into the plaque for you, killing it.
Tartar is, therefore, just hard, dead bacteria. It is now stuck on your teeth, mineralized like a rock.
Plaque is the live bacteria that tartar once was.
We like to call them “barnacles,” to create a visual for our patients. Hygienists are your little “scuba divers,” picking the barnacles off of your “boat.”
As a hygienist feels around your teeth, they are looking for those “barnacles” and also for cavities.
When they find a tartar barnacle on your teeth, you’ll feel them add some extra muscle to remove it. You’ll also hear a “click” sound as the piece pops off. That “click” sound is music to a hygienist’s ears. In a sick and twisted way, we actually enjoy picking the tartar off and hearing that sound.
After the tartar is removed, polishing finishes the cleaning up at the end.
Polishing removes the rest of the plaque. It also helps to remove much of the surface staining that may be present from coffee, tea, wine, tobacco etc…
Finally, your hygienist will floss to remove any leftover polish and any loose tartar that is still in between your teeth.
The hygienist also helps screen for cavities in your mouth as well, so diligence and length of time spent are DOUBLE necessary. A good hygienist cares about you and your dental health, not about production. Dentistry is called health CARE for a reason.
You don’t want to go to an assembly line, in-and-out dentist. You don’t HAVE to go to one, just because your insurance says so. Click the link to learn how to navigate the dental insurance world.
What about that fancy ultrasonic cleaning tool they use? It’s faster and better, right?!
Some hygienists swear by it, but the ultrasonic scaling machine does not do as thorough of a job in our experience. It is great for certain things, but not-so-great for routine cleanings and maintenance.
I was taught at USC that the ultrasonic scaler should be used as a tool to help the hygienist with the larger, more stubborn areas of tartar/calculus. The hygienist should always follow with hand instruments after using the ultrasonic, though, because the hand instruments allow for a more thorough and fine-tuned job.
With the ultrasonic scaler, the hygienist can’t actually FEEL all of the tartar unless it’s a larger piece. Hand instruments have what we call “tactile sensitivity,” allowing every last bit of roughness to be felt.
The ultrasonic is a great tool for cleaning and maintaining the deeper periodontal pockets.
Deep pockets are harder for the hygienist to reach and clean efficiently. They say that a hygienist isn’t truly able to clean a pocket thoroughly if it’s more than 6mm deep.
If a patient chooses to try and maintain deep pockets like this, instead of having periodontal treatment, the ultrasonic tool is the best bet. It flushes the pockets out with water and helps the hygienist reach deeper tartar.
Still, the hand instruments are necessary to provide the fine tuned, smooth, detailed cleaning that is needed for your dental health.
We have concluded that the ultrasonic scaler is most effective for the large, stubborn pieces of tartar.
Hygienists should follow with the hand instruments to fine tune the rest and be sure that the teeth and root surfaces are diligently cleaned.
Very often, when a patient has been having cleanings with the ultrasonic scaler only, we find LARGE tartar chunks left behind.
These tartar “barnacles” are left in the same places much of the time, too. Most commonly, tartar is found between and behind the top front teeth. It is also found on the “mesials of the upper premolars,” “distals of the second molars,” and on the “distals of the canines.” These are common areas where hygienists don’t get their ultrasonic scalers in between the teeth well, and tartar gets missed. It’s left under the gum line.
Once you have had a thorough dental cleaning, you’ll know what it’s worth. You’ll be able to feel that the hygienist is diligent and truly cares. You’ll know what a good, REAL cleaning feels like.
To determine if a DEEP cleaning is needed, the dentist or dental hygienist should be performing the following exams and explaining them to you:
1. They should check the depths of your “pockets” around your mouth.
Pocket charting measures the “pocket” under your gumline.
This depth is measured from the edge of your gums, to where the instrument stops at your bone level underneath. Its measured in millimeters, using a probing instrument.
Normal depth numbers are 2mm-3mm. If you happen to have a few 4-5mm pockets in the back teeth, this does NOT automatically mean that you need a deep cleaning!
It could simply mean that you haven’t been flossing and that your gums are inflamed and puffy. Inflamed gums make the edge of your gum line higher and “puffed up,” causing the reading to be higher.
Any good hygienist can clean two or three 5mm pockets DEEPLY and THOROUGHLY, at a normal cleaning appointment, without charging you for a full-mouth deep cleaning.
If you have many numbers that are 4-5mm or higher though, throughout your ENTIRE mouth, please read the SODA that we have spilled for you about Periodontal Disease.
If you have generalized deep pocketing and bleeding while they are checking your pocket measurements, this means that you most likely need a deeper cleaning. It means that bone loss is present or that it could be in your very near future. This means that the plaque bacteria are creating disease by eating away at your gum and bone.
If this is the case, you may need some additional treatments done, and you may need to add some products to your home routine. You want to do everything possible to prevent that inflammation and bone loss from worsening. That bone is what holds your teeth in your mouth! You want to keep it around by all means necessary.
2. They should check all around your mouth for LARGE amounts of tartar/calculus.
As we said above, tartar (also known as dental calculus) is DEAD bacteria that is stuck on your teeth like a rock. It forms into large “barnacles,” kind of like lava rock, when you haven’t been diligent at brushing, flossing, or getting your teeth cleaned regularly.
When you get your teeth cleaned on a regular basis, your hygienist can remove small deposits of tartar as they build. It removes easily. Your mouth will be maintained well and stay healthy.
When you DON’T get regular cleanings, though, this is what happens:
If tartar is left there, more plaque attaches to it, and the process continues. More plaque is killed, and more tartar piles on, over and over and over again.
The longer you wait, the larger these “barnacles,” or MOUNDS of “lava rock,” become. The larger the mounds of tartar get, the more live bacteria that the mounds trap.
That live bacteria is responsible for the cavities and gingivitis in your mouth. This whole process will allow it to hide in there and eat away at your gum and bone.
If you have these large amounts of tartar, you may be able to see “spurs” of it on your x-rays.
You will definitely be able to hear that the hygienist is “clicking” on the large pieces with his or her instrument. Your hygienist will be having a HECK of a time getting it off of your teeth.
You’ll also typically see large amounts of tartar on the backside of your lower front teeth. This is the place where EVERYONE builds the most tartar in their mouth, though. It doesn’t ALWAYS indicate that your mouth has tartar throughout the rest of it.
If the tartar barnacles are large, you’re also likely to catch on it when you floss. You will probably bleed when you floss as well.
In health, your teeth should feel smooooooth when you scrape them with the floss, and there should never be any bleeding. (click to learn the proper floss technique)
What it looks like to assess the need for a deep cleaning
Our usual approach to a cleaning is this:
We first asses the pocket depths. If they are manageable numbers of 4mm or below, we begin the cleaning.
We get as much done as possible, according to how difficult or easily the tartar is removed. If it turns out that there is a lot of tartar and it’s difficult to take off, we assess the number of additional appointments needed from there.
This first visit is considered a “Gross Debridement,” if additional appointments are needed to bring a patient’s mouth back to health.
If 2 or more additional appointments are needed, this is what we call a “Deep Cleaning” or “Scaling and root planing.”
This is needed to get your mouth back into shape.
Sometimes only one additional appointment is needed, though. In this case we consider the first appointment a “gross debridement,” and follow up with a “fine scaling.”
If it turns out that the tartar removes easily, and we are able to complete everything in one appointment, the patient leaves the office with just a good, thorough, REGULAR dental cleaning.
Should I be numb for a deep cleaning?
We have found that most patients, with pockets 5mm and below, do perfectly fine having a good, thorough cleaning done, even a DEEP cleaning, without the need for anesthesia. This depends on your pain tolerance, of course, and how heavy your dental hygienist’s hand is.
We have a topical gel that helps mitigate any gum pain as well. Many patients choose to try this over the “you know what (shot)” and do perfectly fine.
Others would prefer to have nitrous oxide, “laughing gas,” to help with their anxiety and pain. Not all offices offer this option, though.
If your pockets are 6mm or higher throughout your whole mouth, it would probably be best to go the numbing route. It’s easier for you and for the hygienist. The periodontal cleaning involves cleaning deeper under your gums, and it can hurt a little bit more.
Picture grabbing a piece of lint out of the regular pocket of your pants. Now picture getting that piece of lint out of a pocket that goes down to your ankle. That’s the difference. The plaque and tartar are down much deeper under your gums.
Honestly, patients with generalized pockets around their whole mouth get referred straight to the periodontist in our office. We believe that it’s better for the patient to have ONE thorough treatment done with the periodontist. If not, the patient would have to pay for and endure a deep cleaning at our office and then undergo ANOTHER, more extensive treatment with the periodontist. This is our “patient first” preference.
A periodontist has other methods of helping the periodontal condition as well. They are the gum and bone specialists. They are amazing at what they do.
What does tartar look like?
Once tartar “barnacles” are large and stubborn, they can be seen on your x-rays. Here is another example.
If your x-rays look like this, believe your dentist and dental hygienist. You definitely need a “deeper” cleaning.
Here is what tartar looks like above your gum line. It’s an example of a very heavy amount of tartar. We think you’ll find it so satisfying to see the before and after pictures.
Before and After cleaning
Tartar hides below your gum line throughout your mouth as well. You can usually only see it above the gums on the back side of your lower front teeth though. Sometimes, on the cheek side of your upper molars.
Regardless of how many appointments it takes, the “barnacles” will be removed completely.
From there, brushing and flossing instructions are given. It is now the patient’s job to keep the “barnacles” from coming back like that again.
Maintenance is key. Floss, brush, mouthwash, and get a dental cleaning every 6 months at least.
As long as you stay current on your routine dental cleanings moving forward, and try your best with your “homework,” you should NEVER have to endure a deep cleaning again.
Your dental hygienist should be able to explain to you exactly WHY you would need a deep cleaning. You should be able to trust them on that. “Deep Cleanings” shouldn’t be a regularly scheduled maintenance plan for the average person, though.
Deep cleanings should not become a routine.
A good hygienist will follow up at each of your future visits with a good, thorough cleaning. They should be able to maintain you from there…AS LONG as you help them with your brushing, flossing, and mouthwash routine.
You see yourself 365 days a year. Your hygienist cannot create miracles in your mouth when they only see your mouth 2-4 days a year.
So, to break that down simply…
A deep cleaning is needed when there is a profound amount of gingivitis (bleeding gums/gum disease). This will be in combination with large CHUNKS and ledges of tartar or roughness that is stubborn and hard for the hygienist to remove.
Bleeding gums alone does not indicate the need for a deep cleaning. Bleeding gums without large amounts of tartar present will heal with a proper flossing, brushing, and mouthwash routine. It usually takes just 1 week of thorough flossing and brushing to make the gingivitis go away. You must continue with the routine though, or it will return quickly.
A regular, good, thorough dental cleaning can still take care of inflamed gums. Tartar that removes EASILY, with a few 5mm pockets is no problem for a good hygienist. From there, the healing is up to you and your brushing and flossing.
A deep cleaning may also be needed when there are pocket measurements of 5mm-6mm or higher all throughout your mouth.
If the tartar gets to be too much at a regular cleaning, or the pockets are too deep (6mm+) in multiple areas, you’re back to the deep cleaning. Try your hardest not to let that disease and tartar build back up to that point.
Some dishonesty from hygienists has been created because some are payed based on commission.
Deep cleanings cost more and bring in more profit.
So, some dishonest offices may tell you that you need a deep cleaning in order to make more money. See the problem there?
This is why it’s extremely important to find an honest dentist that you trust, FIRST.
Honest offices will thoroughly explain to you WHY you need what you need…. you’ll feel confident and trust that they are telling you the truth. You’ll feel that they have your best interest at hand.
If something doesn’t feel right, PLEASE seek another opinion from another dentist. It is always worth it. If you don’t trust your dentist and dental hygienist, you should not be at that office.
A second opinion exam at another office shouldn’t cost much if you take your x-rays with you.
In the end
A deep cleaning is not needed JUST because you have a few 4mm-5mm pockets in your molars or JUST because you haven’t had a cleaning in a whopping year or so.
We’ve even seen people after three years with hardly any tartar/calculus or infection! Truly! If you floss and brush well, you will have a healthy mouth! We are just there to pick off what you miss.
“Deep cleanings” should be done on patients who have many, many areas of periodontal pocketing of 5-6+mm.
They should be done on patients with extensive amounts of tartar/calculus that is difficult to remove and cannot be cleaned off in one visit.
The ultrasonic instrument is helpful, but it should always be followed by the metal, hand scalers for fine tuning and perfection.
Any patients with periodontal pockets higher than 6mm should ideally be sent to a periodontist if they want to save their teeth. Our measuring instrument goes up to 12mm. We’ve had cases of so much bone loss, that we’ve had to guess the depth after that.
Even the best dental hygienist truly cannot clean a pocket greater than 6mm thoroughly and consistently. The infection will just continue to eat your bone away if you don’t get the professional help from a periodontist that you need.
Did you know that you may or may not have a genetic tendency for periodontal disease?
We have noticed a consistent trend over the years.
People who tend to get cavities don’t tend to get as much tartar.
People who build up tartar quickly don’t tend to get many cavities. It’s a saliva thing. It’s a genetic thing. It’s a pretty good rule of thumb across the board.
People who can go 10-15 years without seeing a dentist aren’t prone to cavities because they would have had a toothache before then. It’s HIGHLY likely though, that these people will need a deep cleaning to catch up and remove all the “barnacles” that built up on their teeth over those years.
It is also highly likely that they will need a trip to the periodontist. The gum and bone specialist. Their type of bacteria don’t like to eat their teeth, they like to eat their gum and bone instead.
If you’re more prone to cavities, it is because your specific type of bacteria likes to eat at your teeth instead of your gum and bone. Your saliva also isn’t as good at making tartar, so the plaque stays alive and eats at your teeth.
It’s very important to get your dental cleanings done. You still get smaller bits of tartar, and the cleaning also allows the dentist and dental hygienist to find your cavities EARLY on for you. They will find them BEFORE they hurt, and before they cause major issues. It’s much better to have small fillings done than to wait until crowns and root canals are needed. Regular maintenance is key.
Everyone needs the dentist.
So, please don’t ever think that you’re immune to the dentist. No-one is. It’s soooo important to see your honest dentist regularly.
Again, once you get your teeth cleaned and all of your barnacles are gone…
Once you have had your thorough or deep cleaning, if you stay consistent on your cleanings every 6 months, you should most likely not need a deep cleaning ever ever again.
Many offices try to use them as a “maintenance” program, but a good hygienist is doing that for you with every cleaning anyways. DILIGENT and THOROUGH should be the qualities your hygienist possesses.
If the hygienist can prove that your mouth is not maintaining well with the currents cleanings, and you’ve been good with your brushing and flossing, then you may need some extra help. Something is amiss.
Make sure that your routine at home is consistent and thorough first, though. Floss, brush, and mouthwash regularly to see if the bleeding gums improve. That is your first line of defense. Your home care is free and is much more likely to help you than if the hygienist sees you 4 days a year or for one extra deep-cleaning. You see yourself 365 days a year. The power is YOURS!
If you have deep pocket depths, it is very important to understand something. Your flossing and brushing can only improve those numbers by 2mm at MOST! So, 8mm can only improve to 6mm. 6mm can only improve to 4mm, etc.
It’s important to understand when the periodontist is needed to help fix a bone loss and pocketing problem. We can only truly only maintain pockets that are at or below 4-5mm. So, your goal is to have pockets no deeper than 4-5mm. 2-3mm is ideal health.
Well, we hope this helped answer your questions and gave you a little extra knowledge too!!!
Please remember that this is just advice. We can’t diagnose you through the computer.
You must go find a good, honest dentist and be confident enough to believe them. Your SODA knowledge will help you make the best dental decisions possible.
SODA will never claim to know it all, all of the time. No one knows it all. We do claim honesty, though, and we sincerely want to help as many people as we can! Our patients have maintained beautifully, following our conservative recommendations :)
So, thanks so much for reading and letting us spill our SODA! Remember to take the time to find your HONEST DENTIST, and be sure to browse around our links and follow us on social media for answers to more of your exciting dental questions, like:
