Deep Cleanings Stop Bone Loss Due to Periodontal Disease

Deep Cleaning (a.k.a. Scaling and Root Planning) is necessary to treat periodontal disease, a non-resolving chronic inflammation in the gingival tissues that is initiated and perpetuated by the subgingival bacteria (Van Dyk 2008).

Diagnosis:
On an annual basis, we will chart the health of your gums with periodontal charting. A mm ruler, the periodontal probe, is used to measure the depth of your periodontal pockets.  A normal healthy pocket depth is usually 3 millimeters or less, according to the National Institute of Dental and Craniofacial Research (NIDCR). Deeper probings  (4 mm or greater) are indicative of infection and inflammation.

Initially, periodontal disease starts with gingivitis which is reversible gingival inflammation and infection that is limited to the soft tissue. Improved biofilm removal with effective brushing and flossing is typically enough to correct gingivitis. Occasionally, we may recommend increased cleaning frequency to 3 or 4 mo so that we provide more help with biofilm removal and hygiene coaching/feedback.

As the disease progresses, the inflammation and infection in the gingival tissues spreads to the bone leading to the permanent bone loss. Signs of this bone loss are evidenced by increased periodontal pocket depths and radiographic bone loss.  With advanced periodontitis, the teeth are mobile and have a hopeless prognosis.   Unfortunately, once the bone is lost in the horizontal dimension it cannot be grafted or replaced.  Thus, the key to periodontal disease is early detection and treatment.

Treatment:
Deep cleanings are evaluated by quad. The disease may only be prevalent in certain areas of the mouth. If all four quadrants require treatment, we typically split treatment over two appointments by the right and left sides. Unlike a regular dental cleaning, aka prophylaxis, deep pockets require numbing to comfortably remove the infected calculus deposits.

The treatment outcome is dependent two controllable factors: your dental provider’s ability to remove the calculus  AND your ability to keep the periodontal pocket clean. Your flossing is critical as there is initially an increased susceptibility to food impaction after deep cleaning as the calculus removal leaves a larger potential space in the short term. Effective flossing and brushing and postoperative care facilitate reattachment of the gingival tissue to the root.

After 4-8 weeks the tissue will have healed. At that time, a follow-up periodontal charting evaluation will be made to check for healing. Some periodontal pockets may be unresponsive to deep cleaning in which case additional treatment may be needed to eliminate the pockets.

Systemic implications:
Periodontal disease is propagated by both the bacteria present and the host inflammatory response (Teles 2012). Which means that when it comes to periodontal disease risk, life is not fair. Some may have terrible hygiene but luck out with healthy oral biome and low systemic inflammatory markers. These fortunate folks will still have a low risk of periodontal disease. Other patients have great hygiene, but high risk due to virulent biofilm and high systemic inflammatory response.  Other factors such as smoking, diabetes, cardiac disease, hormones, calcium channel blocker medications, and systemic health will influence your gingival health (Kinan 2000, Humphrey 2008, Preshaw 2012, Fardal 2015 ). Untreated gum disease has been shown to be correlated with poor diabetic control, low birth weight and early term birth in pregnant women, and decreased fertility in women (Vergnes 2010,  Saini 2010, Paju 2017)