Diabetes, dental deep cleaning - questions

My dentist is pushing for me to to get deep cleaning, or periodontal treatment. I apparently have a couple spots where deep pockets have formed between tooth and gum (4 mm, one spot is 5). I'm highly skeptical. I suspect they are pushing an expensive procedure. They've shown me the test numbers and they do show a slight increase over 3 years. But I still want to know how beneficial this process really is. Anyone else have any experience?

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Hi, Joe. My dental hygienist recommended it for me. I thought about it, put it off, then my pockets got worse and my jaw bone was almost exposed in the back...not pretty. I had the cleaning done just over a year ago, and I haven't had any problems my last two cleaning (I go every 4 months). I have increased the amount of time I spend on my teeth, gums, and flossing as well. My last visit I had no pockets. My BGs have been lower and my overall A1c has been lower as well. I know a better BG range helps with the gums, too. So I thnik it is a wise investment. Do you have insurance that may cover it? Check into it with the insurance company to see what they cover and see if they cover "maintenace" periodental treatments. Best of luck!

If you don’t see the 5 progress or bleed you may be able to hold. I wind up cleaning my teeth 4 times a year to keep the 5 from getting deeper. But I did start with pockets deeper than 5. I got the deep cleaning and that did not help the pockets close. They said i waited too long to be effective with the deep cleaning. I wound up having Periodontal (Osseous) Surgery. That is when they cut pieces of your gums out to make the pockets smaller. That was not fun and expensive. Deep cleaning early on is way cheaper than gum surgery. So if you want to maintain the 5 mm pocket you may have to get cleaning more frequently.

I had very deep pockets about 10 years ago and had both deep cleaning and gum surgery. It was painful but my mouth is now in much, much better shape. I strongly recommend not putting it off.


I purchased a water pick that helped with keeping the pockets clean. Mine went from a 6 to a 4.

The goal should be no more than 3.

Hi Joe. Same thing happened to me and I was skeptical also. It seemed to me that my dentist was always trying to sell me something else. My dentist wanted to do the deep cleaning herself. So I brought myself to a periodontist for a second opinion where they also recommended the deep cleaning so I had it done. I figured pay now or pay later, especially since the periodontist concurred. I will say I preferred having the periodontist do the deep cleaning since they are the specialists...and they never try to sell me anything.

That was 5 years ago. I haven't had any further issues and no gum surgery. I alternate peridontist visits with my regular dentist visits so am having my teeth cleaned and gums checked 4 times a year. My dental insurance covers most of the cost.

So, I'm a little in the dark here, I guess. What is the difference between a regular cleaning you get from the dentist at every check up and a "deep cleaning"? Does dental insurance cover deep cleaning?

I have to tell you, gum disease is a serious threat. Untreated gum disease is an ongoing inflammation, it will raise your blood sugar and stress your body. And there is a strong connection between gum disease and heart disease.

I have gum disease, I have had it for years, no doubt another one of those complications of diabetes. And I have had a number of deep cleanings (also called deep scaling or root planing). I have had gum surgery (do not even go there). And I have lost teeth, most recently I had to surrender due to deep pockets and bone loss and have a tooth yanked out and bridgework done. And this is not because of sloppy dental care. I brush and floss three times a day, I use a proxy brush and I use an oral irrigator on top of all all mouthwashes and antibiotics. I have had to see a periodontist constantly for the last four years.

So I hope you will take this seriously. Deep scaling can be effective. Once your pockets are down to 4-5 mm, normal dental cleaning cannot reach down to remove plaque and infection from your pockets. Deep scaling pulls back your gum flaps and uses tools to scape away buildup all the way down into the pocket. Normal cleaning will generally not reach much below your gum line leaving deep pockets untouched. And obviously your normal at home care cannot get at these infections. Deep scaling is pretty effective at removing these infections, you often get an antibiotic treatment at the same time. In many cases your pockets will heal back up and be reduced back to normal levels. So it can be quite successful.

But I have to be honest, it is expensive and painful. And there is good chance it may not "cure" your gum disease. But we have diabetes. The odds are stacked against us. But you are unlikely to just get better without treatment. I don't regret any of my deep scalings, they were important to have done. I wish they were cheaper and less painful, but sometimes life just s*cks.

ps. If I recall, my deep scaling was at least partially covered by dental insurance.

pps. After my last deep scaling, my fasting blood sugar dropped like 10-20 mg/dl (I wasn't on insulin then), so it seriously affects your blood sugar.

Well heck. I guess I'll have it done. I hope my crappy insurance pays part of the cost.

I just have to wonder how the world got by before this kind of wonder treatment...I know more people lost teeth...but EVERYONE didn't. It's kinda like peanut allergies...kids weren't dropping dead from peanuts twenty years ago. And people weren't having their gums hacked on twenty years ago.

And I know diabetics are at greater risk. But a well controlled diabetic may be at less risk than some think. A lot of the medical community doesn't recognize that. And a dentist damn sure doesn't.

same here. The deep cleaning can improve the health of the gums and is worth the time/effort/cost. Surgery is real expensive and even if you have coverage for dental they only pay a small portion. So if a cleaning can keep you from that process it is worth it. Even diabetics with excellent control can have periodonal issues, genetics play a role, too.

Get the deep cleaning (scaling - as bsc discussed), Joe, they go under the gums and clean where you cannot reach and if your periodontist recommends other procedures you can always say no.

I am a dentist and I have to agree with you. With pockets of 4 you really don't need a deep cleaning...just a thorough regular cleaning. Ask your dentist how many 5' and 6's you have. I do not know your exact case but I do find that other dentists out there are a bit too agressive with root planing to get better compensated. I have been in practice for over 25 years. I would be happy to answer any other questions you might have.

That is an interesting perspective. While I understand the concern that some dentists may be a little gungho. My periodontal treatments were successful in getting all my pockets down to just a couple of 5s and 6s. But those 5s and 6s have proven to be "incurable" for years. Do you really think that regular cleaning and diligent care can avoid more serious problems, particular for us glucosally challenged diabetics. I think my problems were exasperated by always having higher than normal blood sugars.

Thanks for your reply. I reviewed 3 years of pocket numbers with the hygienist last visit. I have about six 4's and one or two 5's. No 6's at all. The staff really said nothing about deep cleaning until 4 months ago, when they changed me from a 6 month cleaning schedule to a 4 month schedule. Then there was unexpected news about my pockets and a push to get the deep cleaning. At present, I have conditionally agreed while the get a preapproval. Any adice you might have based on this info?

Hi Joe...I still maintain you just need a regular cleaning. I do agree with a 4 month schedule as I think everyone can benefit from this. You have to understand that the perio probe is a subjective read. They are usually marked in 3 mm increments. Therefore a reading of a 4 could really be a 3 on the borderline. I like to call any 4 reading just gingivitis which is usually resolved with plaque and tartar removal. In any event, I think you would be safe to forego the deep quad scaling and just stick to a 4 month cleaning regime.

Please don't take this the wrong way, but if Joe has had 4-5 mm readings (indicating gingivitis) for 3 years and regular cleaning has not been sufficient to reduce these pockets, is that not a reason for concern?

On the question of why the 'deep' cleaning now, part of it is that dentists are becoming more aware of the research on the relationship between an unhealthy mouth and heart disease, like bsc said, as well as respiratory infections. Many people in nursing homes, especially, die because they did not get proper mouth care and ended up with heart disease or pneumonia. Pockets in the gums harbor germs such as bacteria that can spread elsewhere and cause disease.
I think you have to make your own decision depending on the state of your mouth.
I actually am searching for a dentist because my previous one was so expensive. I find that dental care is outrageously high these days. And, they do push things like teeth whitening and bonding and more expensive crowns, etc. Of course, I doubt I will find a less expensive dentist because, like gas stations, their charges are all similar.

Yes, I have had a procedure done on two separate occasions, but it didn't include a deep cleaning, it was just treating the pockets. I have dental insurance, and my out of pocket expense was just a $10 copay. It really isn't much of a procedure, though. The hygenist performed it on me and she just injected some gel in the pockets with a plastic syringe type instrument. It didn't hurt, and all of the areas she treated improved with the exception of 1. I had the one area re-treated two weeks ago and will find out how that worked in March. Good luck.


Joe, as usual, I agree with bsc on this one, while also reminding you that drsoosie's first response included the caveat of not knowing your specific case.

If you are still conflicted and unable to make a decision based upon the comments posted, make an appointment with another provider. smileandnod sought a second opinion, you should too. That may be problematic given your relatively rural locale, but do not underestimate the value of the option.

The overarching objective of scaling and planing is not to send the provider to the Mediterranean. It is one major tool in the PROCESS of getting your mouth to be less expensive to maintain over the long haul. Yes, it is expensive, but undergoing scaling and planing NOW, and following with proper ongoing maintenance, minimizes the likelihood of having to undergo scaling and planing again in the future. ("Proper" maintenance being floss AND a proxybrush, and brushing with a good electric toothbrush after every meal. If you don't use an electric now, get one -- aggressive brushing with a manual can cause further damage to the tissues.)

Good luck.

I had it done once and glad I did as it helped me get back on track. I still have one 5 on a crown area near my molars and it is a bugger to reach to get food out of between the teeth. I do my best. I have had the dentist measure my numbers in problem areas too as a second check from the hygienist. Perhaps droosie does that too.

I feel there is a difference in hygienists too as some do a more thorough cleaning. Not that I dont take some blame in always brushing and flossing too.

In any event the more aggressive you can be in brushing, rinsing, and flossing helps. I have also added using a stimulator.

I have reversed many of my 5's.

Good luck.