What’s Next if Deep Cleaning Doesn’t Work?

Is it possible that deep cleaning would not do all that it promises? Would it be that you’d be seen and be informed that there is still inflammation at the gums or that there is still tartar remaining under the gums that’s not accessible? The answer is yes! And then the question is why?

Let’s review what happens during a deep cleaning session typically: once you’re numbed (either with numbing rinse or injections), then not only the portions of the teeth above the gum level but also the root areas under the gums, up to about 4-5 mm is accessed and scaled. So the cleaning is deeper than what the eye meets above the gums only. There is a limitation however as to how far underneath the gums the hand instruments can reach to and as mentioned, it’s typically 4-5 mm and not more. Now that’s usually is just great and enough to remove almost all the tartar under the gums but not always. There are cases where tartar is quite tenacious and honestly the tartar can’t be dislodged with the limited angulated access with deep cleaning. Furthermore, sometimes the pockets around the teeth are much deeper than 5 mm (sometimes 7-9 mm or even more) which means that the hand instruments during a deep cleaning wouldn’t get all the way to the depth of those pockets. So there would be debris and bacterial load still present there. And in either one of these cases, the healing of the pockets around the teeth would not be full and ideal. There would still be tartar or bacteria present, causing inflammation or discomfort, or even harm to the tooth/teeth in that area.

So then what do we do? The next step could be a surgical approach called open flap debridement which typically is done by a periodontist (gum specialist).In that scenario, gums are typically opened up; they are curretaged, tartar is removed all the way to the bone level and gums are brought back to a lower level (typically) to reduce the pockets around the teeth. This would help long term with keeping them accessible to the person and ultimately clean.