So, what is the difference between a "Regular" cleaning called a Prophylaxis and a Deep cleaning (Scaling and Root Planing or Gingivitis therapy)? Here are the facts. As a dental hygienist for over 25 years I have seen just about everything. The most frustrating part of being a dental professional is the lack of understanding regarding the importance of oral health and lack of follow through with the needed treatment based on the findings of the hygienist/dentist.
If you go to the dentist and get a prophy (code 1110), then that means you have a HEALTHY mouth. The probing depths (spaces between your tooth and gum), are 1, 2 or 3 and there is NO bleeding when touching your gums with our ruler (probe). Your gum tissue is pink, firm, and looks like the texture of an orange peel with "stippling." All this requires is for your dental hygienist to work above your gums because there are no "barnacles" of tartar under the tissue creating a colony of BUGS that are eating your bone away. A cavitron is really not even required because there just aren't any hardened deposits on your teeth that are needing to be chiseled off. So your hygienist may use the cavitron but should use hand instruments that are made for "above the gum" scaling and then lastly polish the teeth with either a rubber cup and paste or use the prophy jet (think of a pressure washer for teeth using baking soda).
However, if your gums are bleeding when either we floss them or use a probe and get measurements of 3 and 4 but your xrays are showing your bone is healthy, then you will require a Gingivitis cleaning. BLEEDING IS NEVER NORMAL! The difference between gingivitis and periodontal disease is whether or not you have started to lose the bone that is holding your teeth in place. Your jaw bone is the foundation of your teeth so if you lose your bone...you lose your teeth. Depending on how SEVERE the gingivitis is, a bacteria culture may be recommended. It's called a HAIN test and it's the only way to know if you have any of the microbes present that cause periodontal disease. If you test positive for even 1 out of the 11 bugs that cause this problem, you will need systemic antibiotics. If you do not treat the root cause, you will never get rid of gum disease despite how many times you brush or floss daily. However, ruling out a MTHFR mutation may also be helpful (I will discuss this another time as it's a lot of info).
Your mouth is THE most vascular part of your whole body so if you have disease in your mouth, you have SYSTEMIC disease. There are no fences in your body so these bugs are going to affect your organs. Your brain and carotid artery are not exactly far from the breeding ground in your mouth so it's super important to know what you're dealing with. The HAIN test will show if you have the genetic markers for pancreatic cancer, colo-rectal cancer, Alzheimer's, heart attacks, strokes, diabetes and oral disease in general. Your teeth are alive and linked to your entire body so please do not get mad at your dental professional when you are told that you need treatment for the DISEASE in your mouth. I just love it when a patient has not been to the dentist for YEARS and then flips out when they see the cost of treating gum disease. It's like not getting an oil change for years and being mad at your mechanic because you blew the engine. We are not trying to SCAM you, please take responsibility for your own actions as it's not our fault you are now hosting a bug fest in your mouth. Neglect has a high price so prevention is key!
A gingivitis cleaning (code 4346) should use the hospital grade antiseptic called Chlorhexidine gluconate while cavitroning to prevent the bacteria from getting into your bloodstream and will require some sort of topical anesthetic so you will be numb and not jumping out of the chair in pain. I use Oraqix or Cetacaine, both are wonderful for patient comfort. Hand instruments for under the gum will be used, depending on the severity of the gingivitis, polishing may be completed at this visit or you may need a separate visit to do a second irrigation and polish just to make sure all of the infection is removed. If a HAIN test was performed and came back positive, your second visit should be 2 weeks after the initial gingivitis cleaning and antibiotics would be given at that time, along with medicaments to put into a waterpik to administer at home daily. The right tools are essential in having a healthy mouth so invest in an ultrasonic toothbrush (I like the BURST), and a good waterpik (either the Aquarius or Hydrofloss are best).
I do have a Gingivitis Protocol on my website https://simplysilvermouthwash.com/pages/mask-mouth-gingivitis-protocol and also offer the bacterial culture/genetic marker test https://simplysilvermouthwash.com/products/personal-dental-consultant?variant=33018016464976 so please feel free to check it out.
A Scaling and Root Planing is required (codes 4342or 4341 depending on how many teeth are involved) when the pocket depths are greater than 4 mm with bleeding on probing. If you have 5 mm pockets, this is a red flashing light to do something now! Periodontal disease can be transmissible folks, most people don't know this fact. If the thought of kissing a mouth full of bugs doesn't turn your stomach I honestly don't know what to say. Before I started dating my husband I offered to clean his teeth because I wanted to make sure I wasn't going to end up with someone in dentures...call me crazy! Anyhoo, once these microbes have penetrated the sulcus (the space between your tooth and your gum that we measure with our probe) and have invaded your blood stream, you now have a systemic bacterial infection. That's why getting the right diagnosis is so crucial. I know for a fact that there are very few dental offices that even offer the HAIN test or use the correct therapies to treat gum disease (ask your dentist if they follow the No More Hygiene program or the BaleDoneen method). This is a tragedy in my opinion and is why I'm so passionate about educating the patient on proper protocols. Please refer to my book Dentistry for Dummies for a complete handbook on what good versus bad dentistry looks like https://simplysilvermouthwash.com/products/dentistry-for-dummies
Depending on the severity of disease present will determine how many visits are necessary to treat the periodontal disease. If it's early periodontal disease, usually only 2 visits are required. However, if your pockets are greater than 6 and you have calculus (tartar) showing up on your xrays, you need 3 appointments with the Chlorhexidine gluconate being used at each visit to get the hospital grade antiseptic deep into the sulcus and flush out the bugs. The whole goal is to get the pocket to close up. You simply can't keep 5, 6, 7 mm plus pockets clean. Manual floss only goes down to 4 mm's in depth so getting the tissue to tighten back to the tooth is essential for long term health and is why a waterpik is absolutely essential. Vertical bone loss can re-grow, horizontal bone loss doesn't. I have many patients that will do the HAIN test multiple times to make sure the bacterial infection is completely gone. The 2 most difficult bugs to treat are Aa (Aggregatibacter actinomycetemcomitans) and Pg (Porphyromonas gingivalis) so more than 1 round of antibiotics may be necessary. There comes a time when the periodontal disease is too severe for conservative and non-surgical methods. That's when it's time to see the specialist and if you think spending close to $2,000 for non-surgical gum therapy is expensive, what till you see the bill for periodontal flap surgery.
After you go through a deep cleaning and if your insurance was billed for 2 quadrants or more, you will now be needing a Periodontal maintenance cleaning (code 4910) for at least 2 years following the procedure. After remaining stable for at least 2 years and depending on the depth of pockets, it is possible you can go back to a "regular" cleaning (prophy code 1110). This will be determined by your dental professional and how healthy your gums remain. Chances are you will still need to get your teeth cleaned every 3-4 months for life if you are prone to periodontal disease. Healthy mouths only require cleanings twice a year.
Over 85% of Americans have some form of gum disease and is it any wonder that almost half of all Americans have cardiovascular disease? When is the AMA going to start asking questions regarding oral health to their patients...I'd really like to know.
Don't be a statistic...there are options if you're a dental phobe or can't afford to get a cleaning. In my book, Dentistry for Dummies, I give you suggestions and recommendations to make your dental experience a cost effective and happy one. Keep in mind that a healthy diet and optimized immune system are essential. Providing your body with the right supplements to help fight off the bacteria that's causing the problem to begin with is important as well. I also offer consultation services https://simplysilvermouthwash.com/products/personal-dental-consultant?variant=33014348447824, so if you have questions and would like help navigating your dental treatment I'm happy to help. Please feel free to contact me firstname.lastname@example.org. Oh and remember....only floss the teeth you want to keep!
Blessings to you and yours,
Heather the Hygienist
Comments will be approved before showing up.