Deep dental cleaning, also known clinically as Scaling and Root Planing (SRP), is a procedure done to treat Periodontal Disease (Gum Disease).
Let's start by understanding the anatomy of the teeth and the tissue around it.
The visible part of the tooth when we smile is called the crown of the teeth, and the root is under the gum. Underneath the gum, lies bone that supports both gum and teeth. The teeth are connected to the bone by ligaments. The Bone, gum, and ligaments make up the Periodontium. Therefore, Periodontal disease means those structures have been affected.
The most common reason why Periodontal disease occurs is plaque and calculus. The First step to periodontal disease is Gingivitis, when plaque and calculus accumulate above the gum line, the gum gets inflamed to protect the Periodontium from the bacteria. To reverse inflammation, a regular dental cleaning (prophylaxis) is needed. If the inflammation continues, the ligaments that hold the teeth to the bone start breaking down, the bone starts breaking down as well creating a gap between the gum and teeth. As plaque and calculus grow into this gap, the bone starts breaking down even more, making this gap deeper.
To know if a deep cleaning is needed, a simple procedure called Probing is done during routine checkups or regular dental cleanings. A thin instrument marked in millimeter measurements is inserted in the gap between the teeth and gum. 1-3 millimeters of space is considered a healthy Periodontium. 4 millimeters is the grey zone, and 5 millimeters or above means the bone, gum and ligaments have already been affected.
Signs that indicate a deep dental cleaning is needed are:
1. Probe measurements (above 4mm)
2. Visible calculus under the gum line observed on radiographs
3. Tactile feeling of calculus with dental instruments
4. Inflammation
5. Bleeding
Deep cleanings are usually done by quadrants and local anesthesia is used for the comfort of the patient. After removing all the calculus under the gum, an antibiotic is locally placed in each gap where the measurement is above 4 millimeters. The antibiotic will tighten the gap and reduce the space by 1-3 millimeters. After a deep cleaning is done, the patient is placed in maintenance appointments every 3 months to prevent plaque and calculus from growing into this gap again. Compliance with dental hygiene at home is a must to reduce the plaque and calculus accumulation as well.
If a Deep cleaning is planned and the patient doesn't comply with the procedure, further damage is done to the Periodontium, this includes gum recession, mobility and tooth loss. Once the Probe measurements reach 7 millimeters or above, a surgical approach by a Periodontist is recommended.
Periodontal disease is irreversible, but can be prevented by regular dental hygiene appointments and doing your part at home.