My dentist is pushing for me to to get deep cleaning, or periodontal treatment. I apparently have a couple spots where deep pockets have formed between tooth and gum (4 mm, one spot is 5). I'm highly skeptical. I suspect they are pushing an expensive procedure. They've shown me the test numbers and they do show a slight increase over 3 years. But I still want to know how beneficial this process really is. Anyone else have any experience?

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Tags: cleaning, dental, extraction, gums, implant, teeth, tooth

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Thanks for your reply. I reviewed 3 years of pocket numbers with the hygienist last visit. I have about six 4's and one or two 5's. No 6's at all. The staff really said nothing about deep cleaning until 4 months ago, when they changed me from a 6 month cleaning schedule to a 4 month schedule. Then there was unexpected news about my pockets and a push to get the deep cleaning. At present, I have conditionally agreed while the get a preapproval. Any adice you might have based on this info?

Hi Joe...I still maintain you just need a regular cleaning. I do agree with a 4 month schedule as I think everyone can benefit from this. You have to understand that the perio probe is a subjective read. They are usually marked in 3 mm increments. Therefore a reading of a 4 could really be a 3 on the borderline. I like to call any 4 reading just gingivitis which is usually resolved with plaque and tartar removal. In any event, I think you would be safe to forego the deep quad scaling and just stick to a 4 month cleaning regime.

Please don't take this the wrong way, but if Joe has had 4-5 mm readings (indicating gingivitis) for 3 years and regular cleaning has not been sufficient to reduce these pockets, is that not a reason for concern?

When I went to the periodontist and had a deep cleaning done, I had only 3s and a couple of 4s. I had the deep cleaning and now am on a 3 month cleaning schedule rotating between the periodontist and the regular dentist.

I'm glad I did it honestly. I look at it like preventive maintenance that certainly kept it from progressing and will hopefully keep me from having to have anything worse done like gum surgery. My periodontist visits are just like my visits to the regular doc and they send notes back and forth on the in-between visits. It's worked really well for me. Like other health issues, I'd rather catch it early.

On the question of why the 'deep' cleaning now, part of it is that dentists are becoming more aware of the research on the relationship between an unhealthy mouth and heart disease, like bsc said, as well as respiratory infections. Many people in nursing homes, especially, die because they did not get proper mouth care and ended up with heart disease or pneumonia. Pockets in the gums harbor germs such as bacteria that can spread elsewhere and cause disease.
I think you have to make your own decision depending on the state of your mouth.
I actually am searching for a dentist because my previous one was so expensive. I find that dental care is outrageously high these days. And, they do push things like teeth whitening and bonding and more expensive crowns, etc. Of course, I doubt I will find a less expensive dentist because, like gas stations, their charges are all similar.

I'm quite certain this relationship is correlation, not causation. The bacteria in the mouth aren't spreading to the heart.

I have to tell you, we can argue about causation, but there is a strong relationship between gingivitis (periodontits) and heart disease. I think most argue that it is related to systemic inflammation.

There is a difference between gingivitis and periodontitis. Gingivitis is an inflammation of gum tissue in response to certain bacteria. Periodontitis is the progression of bacterial destruction to the bone which results in bony-walled defects that must be repaired through surgical flap procedures, debridement and replacement of osseous structures with synthetic bone. While bone cannot be repaired once it is lost, there is the ability to regenerate some attachment. This can only be done surgically.

I have been in practice for 26 years and actually do a lot of periodontal procedures in my practice. I have a very good understanding of the whole process. I have also run a dental business for 26 years and I have a good understanding of that as well. In my opinion of Joe's circumstances, limited as that may be without actually seeing him myself, I still stand by my original statement. Root planing removes deep tartar. If he was being seen on a regular basis I am not sure why this tartar was not debrided earlier by his dental team. In any event, I am sure he could get a thorough cleaning (one that will sufficiently clean 4 mm pockets) without having to be injected per quadrant and needing to return on four separate occasions. True root planing should be done by quadrant, with anesthesia and take at least 45 minutes per quadrant.

In joe's case it still seems like overkill to me.

Thanks for the clarification. Sadly, I know the difference between gingivitis and periodontitis, I have periodontitis. While we can say call them different names, I consider them the same condition along a continuum.

But as I learned more about gingivitis, I also learned of the strong connection between the inflammation in your mouth and other conditions like heart disease. I think there is still a lot we don't know, but I think we would both encourage Joe to work to clear up his gingivitis, not only because of the risks to his dental health but because this condition may in fact present real and serious risks to his overall heart health.

ps. Joe, maybe you should go see drsoosie.

I so appreciate everyone's interest and concern about their oral health. I try every day to impart this knowledge to my patients. Some are accepting and others not so much. Brian you are correct that inflammation in the mouth is the same as inflammation anywhere in the body. It activates the immune response which in turn can trigger a whole host of other problems.

That said, and possibly because I am old school and may give away a lot of free dentistry, when I clean teeth (and I do about 70% of my own cleanings) I always scale to the depth of each pocket of each and every tooth. It's just that I don't charge my patients for root planing. The only time I schedule root planing is when a new patient comes in with a gross amount of tartar and I know there is no way on earth I can properly clean in one visit.

Interesting to note that when I do surgical procedures (and I do quite a lot of perio surgery) I always find a lot of tartar remaining on the roots below...even on those who are root planed. I do believe for those who suffer from periodontitis that surgical reduction of pockets is the only way

Thanks again to you and all here offering insight and experience. Can you offer any fact or opinion regarding risk inherent in this procedure?

BTW, my dentist planned to do only two sessions of 2 hours each. Each would be under local anesthesia.

Mine was done in two sessions of 2 hours each also under local anesthesia. Honestly the worst part for me was keeping my mouth open that long; maybe because my pockets were less advanced I really did not have alot of pain. Some soreness after but nothing to the point of affecting my normal activities.

To me, it was just sort of like an "advanced" regular dentist visit. I was really apprehensive about it beforehand but it was not nearly as bad as I imagined it would be.

Now the thought of the gum surgeries, etc. scare me to death so that's one reason why I went ahead with it to avoid something worse.

I find the hygenists at my periodontist have a much better "touch" than at my regular dentist. I don't know if that's just coincidence or if they have additional training of some sort.

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