Teeth Cleanings

Know Before You Go: Teeth Cleanings

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Everything you need to know to make the most of your hygiene visits: when to get a second opinion, what the hygienist actually does, and what to ask your dentist.

by Dr. Burhenne

Teeth Cleanings

Teeth cleanings are essential not just for clean teeth, but a healthy mind and body as well. But for such a routine visit, there’s lots that people don’t know about. Here’s what you should know and what you should expect out of your next teeth cleaning.

Before You Go

Many people see the mouth as separate from the rest of their body. But the reality is that it’s all connected — and problems in your mouth can cause or even act as an indicator of disease in other parts of your body — including dementia and heart disease.

Teeth cleanings are an essential part of keeping your mouth, and the rest of your body, disease-free. I’ve designed this guide to give you everything you need to know to get a quality teeth cleaning, get your money’s worth, and what to expect.

After you finish this guide, I’ll expect you to eliminate “whatever you say, Doc” from your vocabulary. Yes, teeth cleanings are routine, but there are some things you need to know.

Find Out Your Family History

You might know if there is cancer or heart disease in your family in case your doctor asks — and gum disease family history is just as important. Find out what type of gum disease and how severe.

I know it’s not exactly dinner time conversation but it doesn’t hurt to ask. There’s a strong genetic predilection for gum disease and this information can help your dentist with your teeth cleanings and overall care.

Find Out If You’ll Need an Antibiotic

We all have bacteria in our mouths and certain dental treatments can allow that bacteria to enter the bloodstream (called bacteremia). For most of us, this isn’t a problem. A healthy immune system prevents these bacteria from causing any harm.

When you have a teeth cleaning, the bacteria that are in your mouth can get into the bloodstream after the proceure. This is very common, well-known, and safe — if you’re healthy.

For certain groups of people, there is concern that this bacteremia could cause an infection elsewhere in the body. An antibiotic makes sure you cover all your bases.

If you fall into that category, click here to read my recommendations.

Understand Why Teeth Cleanings Are Necessary

We need teeth cleanings for two reasons:

  • To prevent diseases in the rest of the body like heart disease, dementia, and complications of diabetes
  • To prevent tooth loss

The mouth is an area that’s completely different from the entire body, and it takes quite a beating from the food we eat and the talking we do all day long. And this unique environment requires special care.

Teeth cleanings remove the buildup of plaque and tartar. This buildup is for the most part natural — kind of like how a boat picks up barnacles just by being in the ocean. But too much buildup leads to gum disease.

The reason tartar needs to be removed is because your body sees it as a foreign invader. As with any other foreign invader, like a flu bug or an infection, your body “sends in the troops” using the immune system to fight off the infection. There is a battle in your mouth at all times, and the war is never over. Teeth cleanings level the playing field by keeping things in check.

Gum disease is when your body’s immune system is responding to this tartar buildup with inflamed and bleeding gums. The immune system response is successful at killing off invaders like infection and flu bugs, but at a cost: like a war, there are innocent bystanders that get slaughtered. As gum disease progresses, so does the destruction to your bone and tissues in your mouth.

Your immune system is meant only to fight off infection for a short period of time — chronic activation of the immune system means it can get worn out and it won’t be as strong to fight off an illness. Chronic activation of the immune system can lead to diseases in the rest of your body.

That’s why preventing gum disease reduces risk of stroke, heart disease, and dementia.

At a certain stage, this damage is irreversible, so prevention is the best way to maintain overall health and keep beautiful teeth for a lifetime — and teeth cleanings are a critical piece of this prevention.

What Is a Teeth Cleaning?

A professional teeth cleaning is done by the hygienist at a dentist’s office. The hygienist uses tools to remove tartar from your teeth — both above and below where the gum meets the tooth.

During the Appointment

What You Should Expect

Your hygienist should explain what work is being done, why it’s being done, and why your teeth may be sensitive or why your gums are bleeding.

You can ask for a mirror or an intra-oral camera (a more hi-tech version of the mirror) which will allow you to watch your hygienist working and understand what’s being done to your teeth.

It’s one thing to hear your hygienist say, “You really need to pay more attention to your back molars.” But it’s quite another thing to actually see your hygienist scraping tartar from your back molars so you can following up with proper brushing and flossing at home.

Your dentist or hygienist should give you an updated primer on proper brushing and flossing technique. Follow through after a teeth cleaning is everything, so use this opportunity to get a full demo of what you should be doing at home to keep your mouth disease-free and healthy.

What to Ask For

While you’re there for your teeth cleaning, ask your dentist for a diagnosis for stage of gum disease. This will give you some idea of where to go from here. You can have direction until you know where you’re starting from.

You can ask: “Am I type I, II, III, IV, or V for gum disease?”

Understand What Gum Disease Is

Imagine when you’ve cut your hand — it swells up. The same thing happens to gums that are inflamed by the buildup of tartar, even more so than swelling in other parts of the body because gums have an incredibly rich blood supply.

Discuss this with your dentist and make sure to talk about your own status when it comes to gum disease.

Know Why a Pocket Reading Is So Important For Overall Health

gum disease progression

Where the gum and the tooth meet isn’t actually where they attach — they are attached further down. This creates a small pocket, which you can picture like a moat all the way around your tooth.

The size of this little pocket can change in two ways:

  1. At the bottom of the pocket are ligaments that hold the gum and tooth together. These ligaments are eaten away by the enzyme produced by the body produces when the body feels it’s under attack (collagenase). This makes the pocket deeper.
  2. The top flap of the pocket can grow in size due to inflammation.

Pockets can get deeper from the top or the bottom — but however it happens, it’s not good for your health.

That’s why a “pocket reading” is an important indicator of your health. A pocket reading is a measurement of the size of your pockets.

Deeper pockets are indicators of disease. Ideally, you’re preventing your pockets from deepening with proper oral hygiene at home and regular teeth cleanings, which will prevent your gums from being inflamed.

Ask For Your Pocket Reading

Ask to hold a mirror so you can watch your dentist measure your pocket — you’ll see a little probe with ruler lines on it being inserted into your pocket.

periodontal probe
Photo via healthsnap.ca

Ask your dentist for your pocket reading. Again, this is good to know. Just as you want to know what your blood pressure is, you want to know what your pocket reading is and be aware of how it’s changing.

Know the Different Types of Teeth Cleanings

There are different types of teeth cleanings, depending on how healthy your gums are. Make sure you’re not over-treated or under-treated.

No Gum Disease

This is the best and what you should aim for at each teeth cleaning. There’s no bleeding when the dentist flosses your gums or puts the probe inside your pockets to measure them.

Treatment: Maintain, maintain, maintain. It is infinitely easier (and healthier) to maintain good health and prevent disease than it is to become unhealthy and to have to seek treatment. Ask your dentist how to maintain this good health. You will still need regular teeth cleanings, but in exceptional cases, you might be able to get a cleaning once per year, and this is perfectly fine.

Having no gum disease for a lifetime will reduce your risk of heart disease, dementia. If you have diabetes, it will reduce complications. The reduced inflammation in your body will make you better at fighting infection and maybe even make it easier to lose weight. Keep up the good work!

Type I: Gingivitis

Gingivitis is very common. Around 80% of people in the United States have gingivitis.

If you have gingivitis, your gums bleed when you floss them or when the dentist measures your pockets. There might be some redness along the edge of the gum where it meets the tooth.

Gingivitis means your gums are reacting to an infection and they’re diseased. Healthy gums don’t bleed when touched.

Treatment: you’ll need to be doing better at home with flossing and brushing and you might need to increase your frequency. Ask your dentist or hygienist for a demo of proper brushing and flossing technique. You might also need different instruments — gum disease can be aggravated by a toothbrush that is too old.

Type II: Early Periodontitis

At this stage, you’ve had gingivitis for some time and it has progressed to something more serious. Your dentist might tell you that you have deep pockets. Your gums are bleeding when flossed or probed. It’s possible you may even have some ligament damage to the place where your gums attach to your teeth.

Gum recession is also common at this stage. Gum recession is when gums pull down, away from the tooth, after healing from inflammation. Receding gums aren’t pretty and they lead to tooth sensitivity because the root of the tooth starts to become exposed as the gum pulls down. Gum recession is 100% irreversible. It’s permanent and no surgery can fix it.

Treatment: Early periodontitis is the beginning of a very dangerous path. If you’re at this stage, I would recommend a deep cleaning, called a scale and root planing.

A root planing is required at this stage because there’s so much tartar buildup that brushing and flossing on your own will be inadequate now. With this much tartar buildup, it’s impossible to clean down to the surface of the tooth — until it’s removed by a professional in a deep cleaning.

Ask your dentist which sections of your mouth are affected because you might not need the deep cleaning everywhere. Scale and root planings are done in quarters — upper right, upper left, lower right, and lower left. You will need a deep cleaning in one, two, three, or all four of these quadrants.

A scale and root planing gives you the chance to prevent the tartar from building up and taking hold again. This is why follow through is critical after the deep cleaning. Ask your dentist for a demo of the proper flossing and brushing technique you’ll need to use at home.

Type III, IV, and V: Moderate to Severe Periodontitis

At this stage, you also have deeper pockets and bleeding gums. As the severity increases, it gets more and more difficult to get healthy again. In these severe stages of periodontitis, you begin to tempt your fate with a point of no return — as in, the point where your gums will no longer respond to treatment. Surgery is frequently required in these stages.

Treatment: You’ll need multiple scale and root planings (read the section about Type II: Early Periodontitis above for information on the scale and root planing procedure). I would recommend considering a second opinion from a periodontist as well, who specializes in these more advanced and serious stages of gum disease.

After your root planing procedures, your follow through at home with proper brushing and flossing is imperative to be able to reverse the disease. Everything done at the dentist will be reversed without your taking care of your teeth every day and after every meal.

Ask your dentist: “How am I brushing and flossing?” By asking this, you are verifying the efficacy of how you take care of your teeth at home.

Gum disease is a very complicated, multi-factor disease, and no matter what stage you’re at, and even if you don’t have gum disease, you have to monitor it your whole life — kind of like blood pressure. The mouth is never static — it is always changing depending on the foods we eat, how we brush and floss, and the chemicals we expose it to.

The treatment guidelines above are for gum disease that is caused by plaque. But gum disease can also occur due to hormonal changes from a pregnancy, medications you’re taking, grinding your teeth, poor dentistry, or root canals, you could get gum disease that way.

Summary of Questions to Ask During the Appointment

  • What classification of gum disease do I have?
  • How deep are my pockets?
  • Do you notice any gum recession?
  • Am I over-brushing?
  • Am I grinding my teeth?
  • May I have a demo of how I should floss and brush my teeth?

After the Teeth Cleaning

No matter whether you have gum disease or not, or what stage gum disease you have, your oral hygiene at home is critical. Follow through after your teeth cleaning is everything.

Make sure you are:

  • Brushing and flossing after meals, or at least twice per day.
  • Eating a diet rich in vegetables
  • Making an appointment for every three months if you have gum disease, or every six months if you don’t have gum disease and are just maintaining good health.

Gum disease is easy to prevent, but a hard disease to get rid of. Home care is essential — your dentist and hygienist can’t do it all for you at these appointments.

Glossary

Bleeding upon provocation: Your gums bleed when flossed or measured by the dentist

Pockets: The “moat” all around each of your teeth that is naturally present. It’s the space between the gum line (where you see your gums and teeth meet when you look in the mirror) and where the tooth and gum attach a little further down

Deep pockets: Pockets that are damaged

Morphology changes: Early changes to the shape, color, and texture to the gums that make it readily evident to the trained eye that there is gum disease present

Gum disease: An infection of the tissues that surround and support the teeth, which causes tooth loss and inflammation throughout the body that is linked to diseases like dementia and heart disease

Periodontitis: A more serious infection which, like gum disease, leads to tooth loss and inflammation throughout the body which is linked to other diseases

Bone loss: The loss of the bone that surrounds the tooth, hence the loss of supporting tissue of the tooth, and the eventual loss of the tooth itself

Periodontist: A dentist who specializes in the prevention, diagnosis, and treatment of periodontal disease

FAQ

Q:

You're cutting me with that sharp instrument! Of course my gums bleed!

A: This is a common myth!

Where the gum and the tooth meet isn’t actually where they attach — they are attached further down. This creates a small pocket, which you can picture like a moat all the way around your tooth.

It might feel like you’re getting pricked, but what’s actually happening is a small probe is being inserted into that pocket. Sticking this probe in between the gum and tooth lets the dentist see if the gum bleeds and oozes on its own if touched or flossed.

Q:

Can Gum Disease Be Cured?

A: Gum disease is easy to prevent, but once you have it, it’s a complex, multi-factor disease that is different for everyone.

This is why treatment of gum disease has to be individualized for each person.

You can usually reverse gum disease in the earlier stages, but at the later stages you can only arrest it — meaning, you won’t be able to reverse it, but you’ll be able to at least keep it where it is and stop progressing to further stages of gum disease.

By the time you get bone loss at stage III, it becomes a disease that is not curable. At this stage, the best you can hope to do is stop the disease from progressing further, but there’s no reversing disease and getting back to where you once were. You can get rid of inflammation at this point, but you’ll potentially require surgery or implants. There’s no getting rid of bone loss. At stage III, you’ve potentially changed the architecture of your jaw.

Q:

Why would my hygienist recommend a teeth cleaning every two months?

A: Ask your hygienist: How deep are my pockets? How well am I flossing? Have your hygienist or dentist justify it.If you require a teeth cleaning every two months, it could be that you have tartar that builds up below the gumline quickly, deep pockets, and poor oral hygiene on your part.
Q:

When should I seek out a second opinion?

A: If you are diagnosed with type III, IV, or V, get a second opinion from another dentist.

Mark Burhenne DDS

Sources

Antibiotic Prophylaxis
Do I Need Antibiotics Before Dental Care (ADA)
Associations between salivary calcium and oral health

read next: How to Make Teeth Cleanings Less Painful

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