When you come into our office for a comprehensive exam, we will spend a significant amount of time during your visit assessing the periodontal health of your teeth and gums. The reason we rarely do same day cleanings with comprehensive exams (patients who haven't been in a while) is because we do not know the extent of cleaning you need before we take x-rays and measurements to assess your periodontal tissue health. It is impossible for us to know how much time and resources to allocate to your cleaning procedure if we haven't yet looked inside your mouth to see what's going on. Some patients can be sufficiently cleaned with just a normal prophylaxis cleaning (above the gums) and some patients will need to be numbed up to get the calculus below your gums. Don't worry, this will not be painful because you will be numb for this procedure (a deep cleaning). If you need this type of deep cleaning ("gum infection therapy"), it is very important to get it done because your teeth are losing their supporting bone and will fall out if not taken care of. We always use the analogy of a post (tooth) being anchored into cement (bone around the tooth). If all of the bone is lost, the tooth can no longer withstand the forces of your bite and will come out.