Dental Exam

A comprehensive dental exam will be performed by your dentist and hygienist.  At regular check-up exams, your dentist and hygienist will include the following:

• Examination of diagnostic x-rays (radiographs): Essential for detection of cavities, faulty restorations, tumors, cysts, and bone loss.  X-rays also help determine tooth and root positions.
• Oral cancer screening: Check the face, neck, lips, tongue, throat, tissues, and gums for any signs of oral cancer.
• Gum disease evaluation (probing): Check the gums around the teeth for any signs of periodontal disease.
• Examination of tooth decay: All tooth surfaces will be checked for decay.
• Examination of existing restorations: Check current fillings, crowns, etc.
• Examination of occlusion (bite) and joints (TMJ): Affects how your teeth wear over time.

Gingivitis

Gingivitis is the first stage of periodontal disease.  Plaque and its toxin by-products irritate the gums, making them tender, inflamed, and likely to bleed. 

Periodontitis

Plaque hardens into calculus (tartar).  As calculus and plaque continue to build up, the gums begin to recede from the teeth.  Deeper pockets form between the gums and teeth and become filled with bacteria and pus.  The gums become very irritated, inflamed, and bleed easily. Slight to moderate bone loss may be present.

Professional Dental Cleaning

Professional dental cleanings (dental prophylaxis) are usually performed by Registered Dental Hygienists.  Your cleaning appointment will include a dental exam and the following:

• Removal of plaque: Plaque is a sticky, almost invisible film that forms on the teeth.  It is a growing colony of living bacteria, food debris, and saliva.  The bacteria produce toxins (poisons) that inflame the gums.  This inflammation is the start of periodontal disease!
• Pocket probing – Gentle measurement of the gum pockets around your teeth. Normal pocket depths range from 1mm-3mm.  
•  Removal of calculus (tartar): Calculus is hardened plaque that has been left on the tooth for some time and is now firmly attached to the tooth surface.  Calculus forms above and below the gum line and can only be removed with special dental instruments.
• Fluoride Treatment: Fluoride is a naturally occurring element that prevents tooth decay from within (systemically) when ingested during tooth development and on the surface (topically) when applied to erupted teeth. For more information on Fluoride, please go to OUR PRACTICE / PROCEDURES / PREVENTIVE DENTISTRY / FLUORIDE TREATMENTS.
• Teeth polishing: Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.
• Oral Hygiene Instructions: As an integral part of every hygiene appointment, personalized interactive home care instructions are given.

 

Gross Scaling

 

        We often see patients, who for various reasons, haven’t been to the dentist for a cleaning and check-up in a while.  Many of these patients have built up a larger than usual accumulation of plaque and tartar on the teeth since their last professional cleaning.  These bacterial deposits on the teeth almost always result in puffy, inflamed and bleeding gums; a condition we call gingival inflammation.  Gum pockets may also begin to form next to the teeth as a result of this inflammation.

 

        When this condition occurs, the American Dental Association recommends that the patient receive as treatment a Gross Scaling, which is sometimes referred to as a Full-Mouth Debridement.

 

        During the debridement procedure, large deposits of tartar are removed, gum pockets are measured and recorded, and home care is reviewed with the patient.  The hygienist may use special medicines to lower the bacterial population in your mouth.  This is the first step in diagnosing and treating gum disease and bringing your gums back to a healthy state.

 

        Following the gross scaling appointment, the patient is seen again by the hygienist in two weeks to evaluate the response of the gums and gum pockets to the treatment.  During this visit, the gum pockets are measured and recorded again, and the overall health of the gums is evaluated.  If at this point the pockets have returned to normal and the inflammation has improved, a regular cleaning or Prophylaxis may be performed.  Any small remaining deposits on the teeth will then be removed and the teeth will be polished.

         

        If any gum pockets greater than 3mm remain, your hygienist and your dentist will decide the best course of action to take in order to restore the health of your gums.

 

        The keys to success of healthy gums are regular dental hygiene appointments and of course, regular brushing and flossing at home.

Periodontal Treatment

     Periodontal pockets… If after a gross scaling and two weeks of healing, pockets greater than 3mm and/or bleeding remain, further evaluation and/or action should be taken to restore the health of your gums. These pockets may be indicative of the presence of periodontal disease in your mouth.   

 

Periodontal disease is the major cause of tooth loss in adults.  It is an inflammatory disease that results in the destruction of tooth-supporting bone.  The gum inflammation is caused mainly by the accumulation of bacterial plaque below the gumline.

 

          Bacterial plaque is a soft, sticky, toxic mass, which attaches to teeth along and underneath the gumline.  If the plaque is not removed by regular brushing and flossing, it hardens and becomes tartar.  As the tartar develops, it forms a cohesive bond with the root surface of the tooth.  Tartar can only be removed by the dentist or hygienist through Scaling and Root Planing.

 

          Unremoved bacterial irritants and toxins cause the gums to become inflamed and tender.  The tooth-supporting bone responds to this inflammation by simply “melting away”.  Left untreated, the resulting bone loss will leave behind pockets of gum around the affected teeth. These pockets will harbor still more plaque and tartar in an area that is inaccessible to the patient.  The progress of the disease will usually accelerate.  Periodontal disease is often painless in its early and moderate stages.

 

          Scaling & Root Planing refers to the meticulous polishing of the root surface and cleaning of the surrounding tissues, establishing an environment necessary for healing.  In many instances, SRP is the only procedure necessary.  However, in more advanced cases additional treatments may be necessary to eliminate periodontal pockets.  For your comfort, a local anesthetic is used during the procedure.

 

            Periodontal disease is a chronic bacterial infection and, as with any infection, treatment with an antibiotic is common. As an adjunct to Scaling and Root Planing, the addition of locally administered antibiotics (such as Arestin or Atridox) may be recommended. Localized  antibiotics are placed directly into the site(s) of infection where bacteria hide. This is commonly performed at the end of a Scaling and Root Planing visit. This site specific antibiotic treatment:

• Can help reduce the bacteria that Scaling and Root Planing (SRP) leave behind deep in the periodontal pockets
• Clinical studies prove that SRP is more effective at reducing the harmful effects of periodontal disease when antibiotics are added
• These effective treatments can reduce harmful bacteria before infection spreads and gum disease worsens

Maintenance

It only takes twenty four hours for plaque that is not removed from your teeth to turn into calculus (tartar)!  Daily home cleaning helps control plaque and tartar formation, but those hard to reach areas will always need special attention.

Once your periodontal treatment has been completed, your dentist and dental hygienist will recommend that you have regular maintenance cleanings (periodontal cleanings), usually four times a year.  At these cleaning appointments, the pocket depths will be carefully checked to ensure that they are healthy.  Plaque and calculus that is difficult for you to remove on a daily basis will be removed from above and below the gum line.

In addition to your periodontal cleaning and evaluation, your appointment will usually include:

• Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss.X-rays also help determine tooth and root positions.

• Examination of existing restorations: Check current fillings, crowns, etc.

• Examination of tooth decay: Check all tooth surfaces for decay.

• Oral hygiene recommendations: Review and recommend oral hygiene aids as needed. (Electric toothbrushes, special periodontal brushes, fluorides, rinses, etc.)

• Teeth polishing: Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.

Good oral hygiene practices and periodontal cleanings are essential in maintaining dental health and keeping periodontal disease under control!

Home Care

A beautiful, healthy smile that lasts a lifetime is our ultimate goal when treating patients.  Your personal home care plays an important role in achieving that goal.  Your personal home care starts by eating balanced meals, reducing the number of snacks you eat, and correctly using the various dental aids that help control the plaque and bacteria that cause dental disease.

Tooth brushing – Brush your teeth at least twice a day (especially before going to bed at night) with an ADA approved soft bristle brush and toothpaste. Electric toothbrushes are also recommended.  They are easy to use and can remove plaque efficiently.  Simply place the bristles of the electric brush on your gums and teeth and allow the brush to do its job, several teeth at a time.

Flossing – Daily flossing is the best way to clean between the teeth and under the gumline.  Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone. Floss holders are recommended if you have difficulty using conventional floss.

Rinsing – It is important to rinse your mouth with water after brushing, and also after meals if you are unable to brush.  If you are using an over-the-counter product for rinsing, it’s a good idea to consult with your dentist or dental hygienist on its appropriateness for you.

Use other dental aids as recommended by your dentist or dental hygienist: Interdental brushes, rubber tip stimulators, tongue cleaners, irrigation devices, fluoride, medicated rinses, etc., can all play a role in good dental home care.