Dental cleanings are a foundational part of maintaining oral health, focusing on the professional removal of plaque, tartar, and staining from the teeth. These deposits accumulate over time and can lead to gum irritation, decay, and bone loss if left untreated. The specific type of cleaning performed is determined entirely by a dental professional based on the current health of the patient’s gums and the presence or severity of existing gum disease. The goal of any cleaning is to restore the mouth to a healthy state, though the method varies significantly depending on whether the treatment is preventative or therapeutic.
The Standard Preventative Cleaning (Prophylaxis)
The most common procedure is the standard preventative cleaning, known professionally as adult dental prophylaxis (code D1110). This cleaning is performed on patients who have healthy gum tissue with no active periodontal disease or bone loss. The gum pockets measured around the teeth are typically shallow, three millimeters or less, with little to no bleeding upon examination.
During a prophylaxis, the dental hygienist focuses on removing soft plaque and light deposits of hard calculus (tartar) located above the gum line. The procedure is primarily a preventive measure intended to maintain the current healthy state of the mouth. The cleaning is completed with a final polishing of the teeth to remove surface stains. For most individuals, this type of cleaning is recommended on a regular schedule, typically once or twice per year.
Therapeutic Cleaning for Active Gum Disease (Scaling and Root Planing)
When a patient is diagnosed with active periodontitis, which is the presence of inflammation and bone loss, a therapeutic procedure called Scaling and Root Planing (SRP) is required. Often referred to as a “deep cleaning,” SRP is necessary for patients who exhibit periodontal pockets measuring four millimeters or deeper, along with bleeding and radiographic evidence of bone loss. The procedure is coded as D4341 (four or more teeth in a quadrant) or D4342 (one to three teeth per quadrant).
The process differs significantly from a standard cleaning because it involves meticulous removal of calculus and infected tissue from below the gum line and along the root surfaces. Local anesthesia is often administered to ensure patient comfort, as the hygienist must access the deeper parts of the gum pocket. The goal of root planing is to smooth the tooth’s root surface, which removes bacterial toxins and allows the gum tissue to reattach to the tooth. This therapeutic cleaning is typically performed one or two quadrants of the mouth at a time and is the first non-surgical step in treating moderate to severe gum disease.
Specialized Procedures for Unique Oral Health Needs
Beyond routine and deep cleaning, two specialized procedures address unique health circumstances.
Full Mouth Debridement (FMD)
Full Mouth Debridement (FMD), coded as D4355, is a preliminary procedure used when a patient presents with such heavy calculus and debris that a proper oral examination cannot be completed. The substantial buildup of tartar prevents the dental professional from accurately measuring the periodontal pockets or making a definitive diagnosis of the patient’s gum health.
FMD is not considered a final treatment but a gross removal of deposits to allow the gum tissue to heal and reduce inflammation before a comprehensive exam can occur. After the tissue has healed, the dentist can then correctly diagnose the patient and determine whether a standard prophylaxis or scaling and root planing is required. This contrasts with Periodontal Maintenance, which is a procedure reserved for patients who have already completed active periodontal therapy like SRP.
Periodontal Maintenance
Periodontal Maintenance (code D4910) is a lifetime requirement for individuals with a history of periodontitis to prevent the recurrence of disease. This procedure is more involved than a standard cleaning, including site-specific scaling and meticulous removal of plaque and calculus from both above and below the gum line. These appointments are typically scheduled more frequently than routine cleanings, often every three or four months, to provide the ongoing supportive care necessary to maintain a stable periodontal condition.