Dental Education Lecture: Deep Cleaning

When we ignore good oral hygiene for a while, plaque and tartar (calculus) accumulate initially above gum line and later below gum line.  For the latter condition, we need deep cleaning.

Fig.1 shows normal gums (pink) between 2 lower front teeth.  Gums become inflamed (red in Fig.2) when we let tartar (yellow) develop on tooth surface.  Upper arrow points to tartar above gum line; lower one to tartar below gum line (subgingival).

To remove subgingival tartar, dental professional places a special hand instrument (curet, black tear-drop shape) deep below the lower end of tartar, removes tartar by an upward motion (arrow).  The doctor usually cannot see subgingival tartar.  He uses curet to feel it and remove it as much as possible.  Once tartar is removed, gum tissue returns to normal in color (pink in Fig.4).  

Deep cleaning is a delicate procedure.  If the dentist does not place the curet low enough (as shown in Fig.5), or upward stroke is too short (short arrow in Fig.5 as compared to long arrow in Fig.3), tartar is not completely removed, leaving rougher surface (yellow). This does not help gums heal after deep cleaning; gums remains reddish (Fig.6).

The curet mentioned above has two ends: one sharp and the other blunt (Fig.3).  The blunt end should face gums to push the latter aside while the curet descends in the space until it passes tartar.  The sharp end, working edge, should be placed against tartar.  If the dentist is so careless that he places the sharp and blunt ends just opposite as shown in Fig.7, tartar will not be completely removed while the gum tissue will receive unnecessary trauma, causing excessive bleeding (several red drops, Fig.8).  After this type of cleaning, gum tissue has unfavorable healing.  In brief, deep cleaning requires 100% concentration of the operator.  Since gums are a sensitive tissue, we need local anesthesia for deep cleaning. 

Before or after careful hand instrument cleaning, the dentist uses ultrasonic cleaning instrument for further cleaning.  After successful cleaning, the patient should practice brushing and flossing to prevent reformation of plaque and tartar.  He or she needs to return to clinic for periodic exam and cleaning on regular basis.  Most of us cannot command good techniques of oral hygiene at home.

Xin Wei, DDS, PhD, MS 1st edition 01/19/2009, last revision 03/20/2010