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Risks to Having Deep Cleaning of the Teeth at the Age of 75

Deep cleaning in a dental office is patient slang for the actual procedure, which is root planing with curettage or RPC for short. It is often performed in dental offices by licensed dental hygienists or RDHs. Ordinarily the only time a dentist performs the procedure is in a periodontal or gum specialist's office. There are several risk factors to consider before having the procedure, and the risks pick up with older patients.

  1. Deep Cleaning or Root Planing Curettage

    • Root planing and curettage is part of care and treatment of advanced periodontal (gum) disease. Teeth are held secure in bone with a collar of gum around the base of the teeth. Over time, especially with neglect or improper care, the bone underneath the collar degenerates. Often it goes unnoticed, as the gum is still in the usual position. Periodontal disease is diagnosed with X-rays and a small tool called a perio probe. The probe goes under the gum on all sides of the teeth and measures the depth between the gum and bone. When bone loss is significant, the gap between the gum and bone can be as deep as 10 mm. The normal level is 3 mm to 4 mm in healthy situations. The "pocket" becomes a breeding ground for bacteria, plaque and calculus (calcified plaque), making the situation worse. The bacteria and calculus must be removed, but they can be removed only with an ultrasonic scaler. Alternating between the ultrasonic scaler and a hand scaler is how a deep cleaning gets done.

    Mitral Valve Prolapse

    • One of the most significant risk factors in certain patients, including a number of patients 75 years or older, is the possibility of a heart infection called endocarditis, which can be fatal. Endocarditis is caused by a condition called mitral valve prolapse. With mitral valve prolapse, the ventricles in the heart do not close properly when the heart beats. Patients with mitral valve prolapse must take a prophylactic (preventive) antibiotic before dental procedures and then again at certain intervals afterward. During the RPC, bacteria are introduced into the bloodstream. These bacteria could cause endocarditis if not for the prophylactic antibiotic protection. Endocarditis is a risk factor only for patients with mitral valve prolapse.

    Coumadin Therapy

    • Many elderly patients suffer from conditions requiring a medication called Coumadin or warfarin. Coumadin is in essence a blood thinner. It is often used when people have had a stroke, blood clot or heart attack or have a condition that causes the blood not to clot properly. If a patient is taking this medication, the dentist contacts the physician to gain permission to take the patient off it for two or three days before treatment to prevent excessive bleeding during the deep cleaning. After the procedure, the patient is usually able to resume Coumadin in the evening.

    Healing and What to Expect Post-Procedure

    • Post-RPC discomfort may be present for several days after the procedure. Problems may include sensitivity to hot or cold, pain with acidic foods, prolonged bleeding, gum sensitivity, eating difficulties and trouble sleeping due to discomfort. Older people are at risk of a longer healing time than patients who are younger. Healing delays may be caused by infection or conditions such as diabetes or immune system disorders, including lupus. The dental office usually provides a prescription for pain medication. The medication is often ibuprofen, which acts to reduce inflammation; or the pain may call for something stronger, like Vicodin or Norco. The office also prescribes an antibiotic to prevent infection.

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