Do I really need a deep cleaning? What the numbers on your chart mean, and the questions patients ask most

How the decision is made

At a periodontal exam, a thin marked probe is slid gently between the gum and each tooth at six points around it. The depth at each point is recorded, along with whether the site bleeds. Healthy, firm gum usually measures 1–3 mm and does not bleed. X-rays are read for the level of the bone around the roots, because bone loss cannot be seen by looking in the mouth.

These ranges are a framework, not a verdict on any one tooth. A single 4 mm site that does not bleed may simply be watched; many bleeding 4–5 mm sites across the mouth point clearly to treatment.

Signs you may notice yourself

Periodontitis is often painless until it is advanced, which is why so many people are surprised by the diagnosis. Signs worth mentioning at your visit:

• Gums that bleed when you brush or floss, even a little
• Gums that look red, puffy, or have pulled back so teeth look longer
• Bad breath or a bad taste that does not clear with brushing
• Teeth that feel slightly loose or have shifted, or a bite that feels different
• Sensitivity to cold on exposed root surfaces

None of these alone proves periodontitis, and the absence of all of them does not rule it out. The probe and the X-rays are what settle it.

Questions patients ask most

"My gums don't hurt. How can I have gum disease?" Periodontitis rarely hurts. Bone loss is slow and silent; by the time teeth feel loose or ache, the disease is usually well established. Bleeding and pocket depth are earlier and more reliable warnings than pain.

"I had a cleaning six months ago. Why wasn't this caught then?" Sometimes it was starting and has since progressed; sometimes the earlier visit was a cleaning without full probing. A comprehensive periodontal exam, with all six measurements per tooth, is what picks up change, which is why we re-measure rather than rely on an old chart.

"Can't you just do a regular cleaning and I'll brush better?" Better brushing matters, but it cannot remove hardened tartar from a root surface 5 mm under the gum. A regular cleaning does not reach there either. Treating periodontitis with a regular cleaning leaves the cause in place.

"Why do I need a deep cleaning when my spouse never has?" Susceptibility varies a lot from person to person. Genetics, smoking, diabetes, dry mouth from medications, hormonal changes, and how quickly your own tartar forms all play a part, independent of how well you brush.

"Do I need the whole mouth done, or just a few teeth?" It depends on how many sites are involved. Isolated pockets can be treated tooth by tooth; widespread pockets are usually treated by quadrant or by half of the mouth. Your plan should state which areas are included and why.

"What if I wait?" Untreated periodontitis typically continues to destroy bone, and bone that is lost does not grow back on its own. Treatment later is still possible, but with less support left to save. There is also growing evidence linking periodontitis to harder-to-control diabetes and to cardiovascular risk; see gum disease, heart disease and stroke and diabetes and gum disease.

What to ask before you say yes

1. Which teeth have pockets, how deep, and which ones bleed?
2. Can I see the bone loss on my X-rays?
3. How many areas are being treated, and over how many visits?
4. Is anything listed on the plan besides the scaling and root planing, and what does it add?
5. What happens at the re-check, and what will my maintenance schedule look like?

If you are unsure whether a deep cleaning you were offered is right for you, bring your chart and X-rays and we will go through them with you. Request an appointment or call (805) 565-5111.