Why are there different types of dental cleanings?
There are different types of cleanings depending on whether the patient has
1) a healthy mouth,
2) gingivitis,
3) periodontal disease.
a healthy mouth
A healthy mouth consists of coral-pink gums (depending on ethnicity, there are natural pigments that change the color of the gums to darker shades of brown) that are stippled like orange peel. Gums are not red, purple, or swollen. The gums do not bleed when the patient brushes their teeth. The gums are comfortable when the doctor or hygienist uses a metal instrument called a probe to measure the pockets around the teeth. (Pockets are the “turtleneck sweater” shaped spaces between the gum and the tooth.)
In a healthy mouth, the bags measure 3 millimeters or less. The level of the gums meets the crown of the tooth in the enamel and there is gum tissue covering the space between the teeth (no dark triangles visible between the teeth).
Gingivitis
Gums with gingivitis are often red, purple, puffy, swollen, and bleed easily. The gum surface appears smooth and shiny rather than orange peel. This disease is caused by bacterial plaque and irritation of hard deposits called stones.
Plaque is a sticky substance that contains bacteria, bacterial glue, bacterial waste products, and toxins. Gives teeth a “furry” feel and can be brushed or flossed.
Calculus can form in as little as 24 hours and is caused by calcium and other minerals in the saliva becoming trapped by any plaque that was not removed by brushing or flossing. The calculus is found mainly on the tongue side of the lower front teeth and on the cheek side of the upper molars. Calculus must be removed with special instruments in the dental office, as they are now “stuck” to the teeth so tightly (like barnacles on a ship’s hull) that brushing or flossing cannot remove them.
Gingivitis can be localized to specific areas of the mouth or generalized throughout the mouth.
Periodontal disease
The cause of periodontal disease was poorly understood until recently. It is not a serious form of gingivitis. In fact, the two diseases, gingivitis and periodontal disease, are caused by completely different bacteria. The bone loss that accompanies periodontal disease is actually an exaggerated response of the immune system. Your immune system will attack your bone in an effort to remove bacteria and toxins. This autoimmune reaction is an inherited response, so if your parents had it, you probably have it too.
Gingivitis and periodontal disease can occur together or separately. If you have periodontal disease without gingivitis, you will have bone loss and you will not necessarily experience tender or bleeding gums.
Periodontal disease can only be diagnosed by a series of full-mouth X-rays and a thorough probing of each individual tooth. The disease may be localized to specific areas of the mouth or generalized throughout the mouth.
Severe bad breath, loose teeth, teeth that fall out on their own, and pus coming from the gums can all be found in advanced periodontal disease. Periodontal disease is treatable, but it is not curable because it is genetic. To keep this disease under control, a person should be seen for follow-up treatment every 3 months or less.
The different types of cleaning
A PROPHYLAXIS is a preventive cleaning reserved for people who have a healthy mouth. They may have a localized area of gingivitis but no signs of periodontal disease (as determined by probing around the tooth) and no profuse bleeding during probing or cleaning.
A COARSE DEBRIDEMENT is a cleaning that consists of a general removal of plaque and calculus in people with gingivitis or periodontal disease. This is usually done to allow better access and visibility for diagnosis and probing and to allow the gum swelling to stabilize before proceeding with treatment.
A ESCAPE AND POLISH is usually performed after gross debridement in people with moderate to severe gingivitis or early periodontal disease. It’s basically a fine-tuning to ensure removal of calculus under the gums and put the patient on the path to health.
Root planing is a treatment for mild to moderate localized advanced or generalized periodontal disease. It is usually preceded by macroscopic debridement. This is sometimes called “deep cleaning.” Antibiotic gels are used in conjunction with root planing to treat periodontal disease and can be placed at the same appointment as root planing.
PERIODONTAL CLEANING is the treatment given to people with periodontal disease at least every 3 months to prevent further bone loss.
Your dentist will recommend the right cleaning for you after a complete x-ray exam.