You may think all dental cleanings are the same, but in reality, there are different cleaning types for different circumstances. The type of cleaning you need is determined by how much space there is between your tooth and gum (periodontal pocket) and how much plaque/tartar/calculus you have on your teeth. Your periodontal pockets are measured using a ruler type instrument called a periodontal probe.
The standard dental cleaning by your dentist or hygienist is meant to clean the enamel covered portions of your tooth and slightly below the gumline (usually the 1-3 mm pockets which are considered in the normal range). Surface stains, soft plaque, and hard calculus/tartar are removed. This can be done for adults or children. Your insurance company calls it a PROPHYLAXIS, sometimes abbreviated to pro or prophy. People often call them routine cleaning, regular cleaning or “just a cleaning”. It’s meant for people with good gum health or with slight or localized areas of gingivitis. (If you have widespread gingivitis, you may need scaling in the presence of gingivitis discussed below.)
Since the standard cleaning only cleans to about 3 mm below your gumline, it will not be any help if you have periodontal pockets that are 4 mm or higher. At that point you are considered to have gum disease or periodontal disease, and you need a different type of cleaning. Depending on your insurance, these may be covered at the same level as the prophylaxis or they may be considered under the periodontics section of your insurance. What are the other types of cleanings?
FULL MOUTH DEBRIDEMENT: If you haven’t been to the dentist in a while and if you have so much plaque and tartar/calculus that your dentist doesn’t think he or she can do a complete, full mouth examination because of it, this type of cleaning may be use to remove the bulk of the plaque and tartar/calculus. If you need this, you will need to return to your dentist at a separate visit for your dental exam and treatment plan. You may also need additional types of cleanings once your examination has determined your dental condition. Your teeth will probably not be polished after a full mouth debridement.
SCALING IN THE PRESENCE OF GENERALIZED MODERATE TO SEVERE GINGIVAL INFLAMMATION: For ease of reading, I’m going to abbreviate this long name to scaling with inflammation in this paragraph. Your dentist should perform your dental examination and find that your gums are swollen, inflamed, or bleeding, but you should not have periodontal pocketing that’s over 4 mm. This type of cleaning removes surface stains, plaque, and calculus/tartar from areas both above and below your gumline. (This is where it differs from the standard cleaning where going below the gumline is not as common.) Your teeth will probably be polished after a scaling with inflammation.
PERIODONTAL SCALING AND ROOT PLANING: I’m going to abbreviate this to SRP for this paragraph. SRP is done when your periodontal pockets are 4 mm and higher. It involves using instruments to clean plaque and tartar/calculus from both the enamel-covered portion of your tooth and the root of your tooth. During instrumentation, some soft tissue and bacteria may be dislodged as well. According to the definition, SRP is therapeutic treatment not preventive treatment which may be why many insurances consider it under the periodontics section of your insurance coverage rather than the preventive section of your insurance coverage. Some people will refer to this type of cleaning as a “deep cleaning”. Most times we will focus on half your mouth, or even a quarter of your mouth, at a time in order to make sure we are removing as much of the plaque and calculus/tartar as we can reach. In most cases, the side worked on that day will be polished. Sometimes, we may wait until both sides are done and polish all your teeth at the same time. At this point, you will need to return to your dentist more frequently than the average—usually 3 or 4 periodontal maintenance cleanings a year. (See below for Periodontal Maintenance). It differs from a standard cleaning because it: 1) goes below your gums and 2) is designed to treat your gum problem.
PERIODONTAL MAINTENANCE: This type of cleaning is begun after scaling and root planing or other gum treatment/therapy and continues usually at 3 or 4 month intervals for the remainder of the life of your teeth. It includes removing surface stains, plaque, and calculus/tartar from above and below your gumline as well as site specific scaling and root planing where needed. Periodontal Maintenance differs from a standard cleaning in that it does go deeper below your gumline and in some cases it is treating early recurrences of your gum disease before it can take firm hold, especially if you keep to the recommended time between your visits.
Unfortunately, if you do have gum disease or periodontal disease we cannot do “just a cleaning” on you as it is asking us to be negligent in our treatment—something we can’t ethically do. This doesn’t mean that you must have gum treatment. You can refuse the treatment, but most dentists shouldn’t go ahead with a standard cleaning when they know it is not addressing your problem.
*Note: Information in this article is not meant to replace the clinical judgement of your healthcare professionals.
Dr. Jennifer Robb is a general dentist who sees both adults and children in her dental practice.
1612 Cooper Foster Park Rd., Lorain, OH 44053
If you're the principal caregiver for an older person, you may have already faced age-related health challenges with them. Good preventive care, however, can ease the impact of health problems. This is especially true for their teeth and gums: with your support you're loved one can have fewer dental problems and enjoy better health overall.
Here are a number of things you should focus on to protect an older person's dental health.
Hygiene difficulties. With increased risk of arthritis and similar joint problems, older people may find brushing and flossing more difficult. You can help by modifying their toothbrush handles with a tennis ball or bicycle grip for an easier hold, or switch them to an electric toothbrush. A water flosser, a device that uses a pressurized water spray to remove plaque, may also be easier for them to use than thread flossing.
Dry mouth. Xerostomia, chronic dry mouth, is more prevalent among older populations. Dry mouth can cause more than discomfort—with less acid-neutralizing saliva available in the mouth, the risk for dental diseases like tooth decay or periodontal (gum) disease can soar. To improve their saliva flow, talk with their doctors about alternative medications that cause less dry mouth; and encourage your loved one to drink more water and use products that help boost saliva flow.
Dentures. If your older person wears dentures, be sure these appliances are being cleaned and maintained daily to maximize their function and reduce disease-causing bacteria. You should also have their dentures fit-tested regularly—chronic jawbone loss, something dentures can't prevent, can loosen denture fit over time. Their dentures may need to be relined or eventually replaced to ensure continuing proper fit and function.
Osteoporosis. This common disease in older people weakens bone structure. It's often treated with bisphosphonates, a class of drugs that while slowing the effects of osteoporosis can cause complications after certain dental procedures. It's a good idea, then, for an older person to undergo any needed dental work before they go on osteoporosis medication.
Keep alert also for any signs of dental disease like unusual spots on the teeth or swollen or bleeding gums. Visiting the dentist for these and regular dental cleanings, checkups and oral cancer screenings could prevent many teeth and gum problems.
If you would like more information on senior dental care, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Aging & Dental Health.”
Tooth-colored fillings fix dental decay, but unlike old-fashioned metal fillings, they leave your smile seamlessly restored. Dr. Jennifer Robb, your dentist in Lorain, OH, uses these cosmetic fillings in a variety of treatment situations. If you have a cavity, likely she'll place one in your tooth.
Materials used in tooth-colored fillings
There are a few different materials which are cosmetically pleasing, durable and long-lasting. They bond directly to enamel, are naturally-colored and may be used on the chewing surfaces or cheek-side (buccal) portions of a tooth. They work in interdental spaces as well. Your Lorain dentist will determine which material will work best for your cavity.
Restorative materials include:
- Composite resin, a flexible, yet strong, blend of plastic (acrylic) and glass particles which mimics natural tooth structure in sheen and color
- Glass ionomer, a blend of glass and sustained-released fluoride used to restore decay near the gum line, on tooth roots or other areas of the tooth which are not exposed to the strenuous pressures of biting and chewing
- Porcelain inlays and onlays, or partial crowns, which are formed in the dental lab to restore larger cavities involving the chewing surfaces and cusps, or corners, of larger teeth
All these materials feature a long-shelf life if you take care of your teeth with proper brushing and flossing, six-month cleanings and examinations with Dr. Robb. However, you should avoid hard foods, such as peanut brittle, because these can damage any filling or even dislodge it. Also, people who grind or clench their teeth usually experience excessive enamel wear. If this applies to you, ask Dr. Robb about a bite guard to cushion your teeth and your dental work.
When it's time for a filling...
The American Dental Association says that your dentist is your best ally in the fight against tooth decay. In addition to your diligent oral hygiene routine at home, and your tooth-friendly diet, Dr. Robb will provide you with careful six-month examinations which look for early signs of gum disease, decay, oral cancer and other issues. Your semi-annual cleanings remove the bacteria-filled plaque and tartar which begin cavities in the first place.
Find out more
Modern dentistry has much to offer in terms of preventive, restorative and cosmetic care. Tooth-colored fillings are just one item on a long list of services your family dentist provides so you have your best possible smile. If it's time for your routine check-up and professional cleaning, please call Dr. Robb's office in Lorain, OH, at (440) 960-1940.
Have you ever heard the term waiting with bated (or baited) breath? Most sources agree that bated, which is a shortened form of abated, is the correct spelling for the saying that means eagerly anticipating something. They also point out that baited is usually used in the sense of putting worms on a hook for fishing—and that got me thinking about bad breath.
Bad breath, which is sometimes called halitosis, occurs when sulfur compounds are released during break down of proteins in mucous and food by bacteria in your mouth. Voted most likely to have this effect: sweets and dairy products.
Other possible causes of bad breath are odors from foods like onions and garlic (which make their way to your lungs), tobacco use, and anything that dries out your mouth. This can include your medications since many have dry mouth as a side effect.
What can you do if you have bad breath?
First, see your dentist to make sure your mouth is healthy. Persistent bad breath is one sign of gum disease. Pockets between your teeth and gums trap food and bacteria and those pesky sulfur compounds. Cavities in your teeth can also catch food and plaque and have the same effect. Treating your gum disease or cavities will often reduce bad breath. If you smoke or chew tobacco, quitting will not only help your breath, it will help reduce your risk of other diseases. Your dentist will also ask for a health history that may highlight medical conditions that contribute to bad breath. If this is the case, you will be referred to a medical doctor for follow up.
Once your mouth is healthy, anything that increases your saliva will help your bad breath. Try to stay hydrated. Plain water (rather than the flavored varieties) is the best for counteracting bad breath. Green tea contains polyphenols that have been shown to reduce sulfur compounds; however, adding milk or sugar to the tea increases bacterial activity in your mouth and decreases its effectiveness. Mint tea has been shown to be quite effective at neutralizing garlic oils.
Fibrous vegetables or fruits are also helpful for increasing your saliva, and their firmness will scrape some plaque off your teeth. Fruits have natural sugars in them so vegetables, such as cucumbers or celery, are slightly better choices. Parsley, which is often used as a garnish, also seems to have some anti-bad-breath properties when it is chewed.
Chewing sugar-free gum or using sugar-free mints are also good ways to increase your saliva. Look for ones that contain xylitol or sorbitol. As a plus, recent studies have indicated that xylitol might also reduce your cavity rate. Be careful not to overuse them, however, since these sugar alcohols can upset some people’s digestive systems.
You may be tempted to turn to mouthwashes to help with your bad breath. Some mouthwashes merely mask the problem and do not do anything to help it. Choose one with antibacterial properties to help temporarily reduce the number of bacteria in your mouth or choose one specially formulated for relief of dry mouth.
You should also make sure you are brushing and flossing correctly. You should brush at least twice a day for at least 2 minutes each time. Floss once a day, making sure you are keeping the floss tight against your tooth and taking the floss below the gum. You may also want to clean your tongue with your toothbrush, a tongue brush or tongue scraper. Tea tree oil has antibacterial properties and some experts recommend placing a drop at the back of your tongue. (Tea tree oil is not recommended if you are pregnant or breast-feeding since it has not been tested for safety in these situations.) If you are not sure how to brush or floss, ask your dentist or hygienist.
*Note: The information in this article is not intended to replace the clinical judgement of your healthcare professionals.
If you do not have a dentist, please contact my office at 440-960-1940 or by using the contact form on my website www.drjrobb.com You can also interact with Dr. Robb on facebook at https://www.facebook.com/drjenniferrobb
Human beings have known for millennia the importance of keeping teeth clean. Although we've only come to more fully understand dental plaque's role in dental disease in the last century, our ancestors seemed to know instinctively this gritty biofilm on teeth had to go.
People from the past once used a variety of substances like ground oyster shells or leftover fire ashes to remove plaque from their teeth. Today, most of the world has replaced these substances with toothpaste, a mainstay of daily oral hygiene.
So, why is toothpaste better than other substances used in the ancient past? Besides the many other ingredients found in the typical tube of toothpaste, here are the top 3 that make it the ultimate tooth cleaner.
Abrasives. While your toothbrush does most of the mechanical work loosening plaque, toothpaste has ingredients called abrasives that give an added boost to your brushing action. The ideal abrasive is strong enough to remove plaque, but not enough to damage tooth enamel. If you look at your toothpaste's ingredient list, you'll probably see an abrasive like hydrated silica (made from sand), hydrated alumina, calcium carbonate or dicalcium phosphates.
Detergents. Your toothpaste's foaming action is a sign of a detergent, which helps loosen and break down non-soluble (not dissolvable with plain water) food substances. While similar to what you may use to wash your clothes or dishes, toothpaste detergents are much milder, the most common being sodium lauryl sulfate found in many cosmetic items. If you have frequent canker sores, though, sodium lauryl sulfate can cause irritation, so look for a toothpaste with a different detergent.
Fluoride. The enamel strengthening power of fluoride was one of the greatest discoveries in dental care history. Although not all toothpastes contain it, choosing one with fluoride can improve your enamel health and help protect you from tooth decay.
These and other ingredients like binders, preservatives and flavorings, all go in to make toothpaste the teeth-cleaning, disease-fighting product we've all come to depend upon. Used as part of daily oral hygiene, toothpaste can help brighten and freshen your smile, and keep your teeth and gums healthy.
If you would like more information on using the right toothpaste, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Toothpaste: What's in It?”
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