Getting “deep” to keep our gums and bone healthy

Periodontal disease is a very common oral health concern that affects almost 7 in 10 Canadians (1). You may have heard it called “gum disease”, but it can be more than that. While periodontal disease affects the gums, it can also lead to destruction of the bone that anchors your teeth in place (2-4). When too much bone is gone, teeth can become loose and even fall out, which can make eating difficult (2).

There are two types of periodontal disease:

1. Gum inflammation only, which is called “gingivitis”. If you have gingivitis, you may notice your gums bleed. Luckily, this early stage of the disease can be reversed (2).
2. Bone loss, which is often irreversible, is called “periodontitis” (2-4). This later stage of periodontal disease requires extra treatment to clean out bacteria and prevent further damage (3).

Periodontal disease happens when bacteria cause inflammation. Inadequate brushing and flossing, smoking, and certain medical conditions like diabetes can make this inflammation worse (2;3). Regular brushing and flossing are critical in preventing periodontal disease because they stop the buildup of bacteria and hardened plaque, sometimes called “tartar” (5). You can imagine tartar like a rock stuck to the inside of your shoe causing constant irritation. The only way to remove the “rock” in this case is through professional dental cleanings (3).

The first line of treatment for periodontal disease that has caused bone loss is called “scaling and root planing”, also known as “deep cleanings” (8). Deep cleanings go below the gumline to remove irritants like tartar that your toothbrush and floss can’t reach (7). The goals of deep cleanings are to remove the bacteria causing inflammation, stop further bone loss, and make gum pockets (aka the space between your gum and bone) shallower and easier to clean at home (3;4;7;8).

How effective are deep cleanings? Let’s look at a systematic review comparing deep cleanings and no or minimal periodontal treatment to help us answer this question (8).

What the research tells us

In adults who have periodontal disease with other medical conditions (e.g., type 2 diabetes, cardiovascular disease, rheumatoid arthritis), deep cleanings can reduce bleeding of the gums and gum pocket depths (8). These improvements indicate gum tissue is healing and less inflamed (3;4). It should be noted that because there is variation between the studies included in the review and patients were followed for a short period of time, more research is needed to confirm the long-term impacts (8).

Despite these limitations, deep cleanings remain the “gold standard” treatment for periodontal disease. What does this mean for you? Be sure to get regular check-ups with a dental professional, especially if you have other conditions that put you at higher risk of periodontal disease, so you can help prevent, diagnose, and treat this oral disease.

Considerations for deep cleanings:

• The Canadian Dental Care Plan can help older adults without dental insurance access dental services. Learn more about who qualifies here and what services are covered here (4).
• Deep cleanings are typically done under local numbing for your comfort (7;10). Inform your dental team if you’ve had any adverse reactions to local anesthetic.
• It’s normal for your gums to feel sore after deep cleanings, and you may notice that your teeth look or feel different (temporarily looser) as your gums return to their healthy state (8;11-13).
• More frequent professional cleanings (aka maintenance) for areas that are still hard to clean are usually required after deep cleanings (3;9;10).
• Sometimes, additional treatment, like gum surgery, will be recommended (4).
• Ask your dental team about proper home care and what to expect after your deep cleanings.

References

1. Canadian Dental Association. Gum disease FAQs. [Internet] n.d. [cited April 2026]. Available from: https://www.cda-adc.ca/en/oral_health/faqs/gum_diseases_faqs.asp
2. Centers for Disease Control and Prevention. About periodontal (gum) disease. [Internet] 2024. [cited April 2026]. Available from: https://www.cdc.gov/oral-health/about/gum-periodontal-disease.html
3. Sanz M, Herrera D, Kebschull M, et al. EFP Workshop Participants and Methodological Consultants. Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020; 47:4-60. doi: 10.1111/jcpe.13290. Erratum in: J Clin Periodontol. 2021; 48:163. doi: 10.1111/jcpe.13403.
4. Suvan J, Leira Y, Moreno Sancho FM, et al. Subgingival instrumentation for treatment of periodontitis. A systematic review. J Clin Periodontol. 2020; 47. doi: 10.1111/jcpe.13245.
5. Harrel SK, Yoshimura A, Cobb CM. The reevaluation of subgingival calculus: A narrative review. Dent J (Basel). 2025; 13:257. doi: 10.3390/dj13060257.
6. Chung HM, Park JY, Ko KA, et al. Periodontal probing on digital images compared to clinical measurements in periodontitis patients. Sci Rep. 2022; 12:1616. doi: 10.1038/s41598-021-04695-6.
7. Cleveland Clinic. Tooth scaling and root planing. [Internet] 2024. [cited April 2026]. Available from: https://my.clevelandclinic.org/health/treatments/23983-tooth-scaling-and-root-planing
8. Joseph P, Prabhakar P, Holtfreter B, et al. Systematic review and meta-analysis of randomized controlled trials evaluating the efficacy of non-surgical periodontal treatment in patients with concurrent systemic conditions. Clin Oral Investig. 2023; 28:21. doi: 10.1007/s00784-023-05392-6.
9. Institute for Quality and Efficiency in Health Care. [Internet] 2023. [cited April 2026]. Gingivitis and periodontitis: Learn More – How is periodontitis treated? Available from: https://www.ncbi.nlm.nih.gov/books/NBK279592/
10. American Academy of Periodontology. Non-surgical treatments. [Internet] n.d. [cited April 2026]. Available from: https://www.perio.org/for-patients/periodontal-treatments-and-procedures/non-surgical-treatments/
11. Pihlstrom BL, Hargreaves KM, Bouwsma OJ, et al. Pain after periodontal scaling and root planing. J Am Dent Assoc. 1999; 130:801-7. doi: 10.14219/jada.archive.1999.0303.
12. Kaufmann ME, Wiedemeier DB, Zellweger U, et al. Gingival recession after scaling and root planing with or without systemic metronidazole and amoxicillin: A re-review. Clin Oral Investig. 2020; 24:1091-1100. doi: 10.1007/s00784-020-03198-4.
13. Kerry GJ, Morrison EC, Ramfjord SP, et al. Effect of periodontal treatment on tooth mobility. J Periodontol. 1982; 53:635-8. doi: 10.1902/jop.1982.53.10.635.

McMaster Optimal Aging Blog Posts are written by faculty, staff, PhD students, and external collaborators, and are assessed for accuracy by members of the Portal scientific leadership team.

DISCLAIMER: These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).