Can’t I Just Have a Regular Cleaning?
Patients often ask why they are having “periodontal maintenance” when all they want is to have their teeth cleaned. If your dentist or hygienist has recommended you be scheduled for periodontal maintenance or if you have noticed there is a difference in billing for these procedures, here is a brief explanation:
Prophylaxis or Regular Cleaning
A regular cleaning, also called a prophylaxis, is recommended for patients who do not have bone loss, periodontal disease, or infection around the teeth. There should be no bleeding, mobility of the teeth, receded areas, or gaps where the spaces around the roots of the teeth are exposed. In other words, the mouth should be healthy with no bone or gum problems. A regular cleaning, or prophylaxis, removes soft plaque, tartar, and stains from the teeth above the gum line, and only slightly below.
A regular cleaning is usually done two to three times a year, depending on how quickly stain, plaque, and tartar accumulate. It is considered a preventive procedure by your insurance carrier since regular cleanings will help prevent periodontal disease.
Periodontal Maintenance (PM)
If you have periodontal disease that has resulted in bone loss, gum “pockets” deeper than 4 millimeters, bleeding gums, exposed root surfaces, or if you have had periodontal surgery or root planing to treat periodontal disease, a regular cleaning is not appropriate. Periodontal maintenance scaling is needed to maintain gum and bone health. This procedure includes removal of plaque and tartar from above and below the gum line, all the way down the length of each tooth to where the root, gum, and bone meet. Rough areas of the roots are smoothed if needed, pocket depths are carefully monitored, and inflamed pockets may be irrigated with antibacterial medicines if necessary.
Periodontal maintenance is considered a basic service by your insurance carrier and may be subject to a yearly deductible. PM is usually performed three to four times a year depending on several factors: how quickly the plaque and tartar accumulate, how much bleeding or inflammation is present, how stable the present condition is, how well you are able to maintain your teeth at home on a daily basis, and any health risk factors you may have.
Periodontal Disease is a Chronic Condition
Once you’ve been diagnosed with periodontal disease, you will always have periodontal disease, which means you will have to continue to come in for your periodontal maintenance cleanings. This is a chronic condition that can be controlled with good oral home care and regular maintenance but cannot be “cured,” which is why it is so important to come in regularly.
Maintenance is crucial as it prevents periodontal disease from spreading. Bacteria produced by plaque may colonize on the gum tissue resulting in gingivitis and periodontal disease. The colonies cause irritation and inflammation, which create an inflammatory response inside the body. Consequently, the body starts destroying bone and gum tissue causing the teeth to fall out, shift or become unstable. The voids between the teeth and gums deepen, and more bacteria accumulate inside. The bacteria travel through the bloodstream, causing infections to other body parts.
There is also a relationship between chronic inflammation in the gums and the overall health of your body, especially heart disease and diabetes. Keeping the gums and the bone surrounding your teeth as healthy as possible is an important part of your regular dental visits.
What Does Periodontal Maintenance Involve?
Supragingival cleaning – Our dental hygienists or dentists will thoroughly clean the area above the gum line with scaling tools to rid them of plaque and calculus.
Subgingival cleaning – This is the most important step for patients with periodontal disease because the hygienist or dentist is able to remove calculus and bacteria from the gum pockets and beneath the gum line. They will remove soft deposits of plaque, hard deposits or tartar, and subsequently remove any diseased tissue via curettage.
Root planing - This is the smoothing of the tooth root by the hygienist or dentist to eliminate any remaining bacteria. These bacteria are extremely dangerous, so eliminating them is one of the top priorities of our team.
Medication - Following scaling and root planing, an antibiotic or antimicrobial cream may be placed in the gum pockets. These antibiotic treatments may promote fast and healthy healing in the pockets and help ease discomfort.
X-ray and examination – Routine x-rays can be extremely revealing when it comes to periodontal disease. X-rays show the extent of bone and gum recession, and also aid the dentist in identifying areas which may need future attention.
Keep Up on Periodontal Cleanings
The good news is that with these regular maintenance cleanings, you can shrink the pockets and create healthier gums. In the future, you may even be able to get back on a six-month program (though it will still be a periodontal maintenance cleaning, not a prophylaxis). Keeping up with these cleanings is important to keep the disease at bay. Periodontal disease is the leading cause of about 70% of adult tooth loss, and it affects three out of four people at some point in their life.
If you have periodontal disease, and you want to keep your teeth, you and your dental or periodontal office need to work as a team to keep your mouth healthy. Brush at least twice a day, floss at least once daily, and go in for your periodontal maintenance cleanings every three or four months.
As a bonus, quit smoking or using chewing tobacco. Tobacco products can make periodontal conditions more severe and more difficult to take care of. If you need resources or help on how to quit, make sure to ask the team at Barbara Bell DDS, PA for different options and information.
If you would like to learn more about regular and periodontal cleanings in Frederick, Maryland, please contact our office. We encourage you to schedule an appointment at Barbara Bell DDS, PA, if you are due for your next cleaning.