How Often Do I Need a Cleaning?

Dr. C - Feb 17, 2019

How often do you need a cleaning?

Short answer: How often you need a dental cleaning depends on the status of your oral health.

Seriously. The 3, 6, 9, 12 month recall interval is a byproduct of insurance cycles. There’s very little scientific basis for set interval cleanings.

But first, back to basics. You’re getting a cleaning to remove plaque, which contains the bacteria that causes gum disease. More specifically, to prevent periodontal disease, defined as the bacterial destruction of bone and tissue supporting the teeth. A cleaning may include scaling, root planing, and polishing. Scaling is the removal of plaque and tartar. Root planing and polishing are ways to smooth down your teeth to reduce the accumulation of plaque.

Alright, cool. Remember that we’re cleaning your teeth to treat gum disease, right? What category of gum disease do you have?

Diagnosis of biofilm induced periodontitis.png

If you don’t know or diagnosis or why you’re getting cleanings, you’re likely on some arbitrary recall interval that coincidentally resembles your insurance plan. In my experience, that’s the industry standard in North America - insurance-driven dentistry.

But you need a reason for treatment - a rationale. Your individualised diagnosis will ultimately decide what therapy you get. That’s right, you should know your diagnosis before consenting to treatment. Shocker, right?

 

So if you’re a healthy adult without active periodontal disease, how often do you really need a cleaning?

According to a Cochrane systematic review:

  • there is little or no difference in gingivitis, probing depths, plaque levels, and oral health-related quality of life between routine and non-routine cleaning patients

  • there’s also little or no difference between 6 and 12 month recall intervals

  • they found small levels of calculus reduction in 6 month recall patients

    • the clinical importance of such outcome is questionable

To be clear, we’re talking about healthy adults without severe periodontal disease. If you fit that category, there really is no recommended interval. If you’d like to have regular cleanings and checkups because you’d feel better doing so, be my guest. There’s nothing wrong with that.

 

However, if you do have active periodontal disease and/or specific risk factors, you may need more frequent cleanings and examinations.

For example, if your periodontal diagnosis was “generalized severe chronic periodontitis,” you’ll need scaling and root planing, then a 4-6 week re-evaluation, and depending on treatment outcomes and the stability of your oral health, an updated treatment plan. You might even need surgical intervention.

The bottom line is that we’re supposed to adjust your treatment on the basis of your personal risk and progression of your periodontal disease.

Periodontal treatment tree.png

I read through Carranza’s Clinical Periodontology. It’s like the GP’s reference guide for perio. No where in the textbook does it suggest set cleaning intervals.

We’re supposed to measure your risk objectively. Pocket depths, clinical attachment loss, levels of gingival inflammation, redness, bleeding, radiographs, microbial cultures, etc. These measurements yield a diagnosis, from which we formulate a treatment plan. If you have implants, wear removable prosthetics, you’re a smoker, got diabetes, osteoporosis, or just old, those factors will affect your diagnosis and prognosis, which affects how often you’ll need cleanings.

If you don’t know your diagnosis and why you’re getting regular cleanings, ask.

Oh, and none of this treatment works if you’re not putting in the effort at home to maintain things yourself. Seriously, your treatment outcomes depend on how seriously you take oral hygiene into your own hands.

Stay vigilant out there. Don’t trust, verify.

-Peace out - Dr. C