Patients often ask why they are having “Periodontal Maintenance” when all they want is to have their teeth cleaned. If your Periodontist or Dentist has recommended that you be scheduled for Periodontal Maintenance, or if you have noticed that there is a difference in billing for these procedures, here is a brief explanation:
Prophylaxis, or Regular Cleaning:
A regular cleaning is recommended for patients who do not have bone loss, periodontal disease, or infection around the teeth. There should be no bleeding, mobility of the teeth, receded areas or gaps where the spaces around the roots of the teeth are exposed. In other words, the mouth should be healthy with no bone or gum problems. A regular cleaning, or prophylaxis, removes soft plaque, tartar, and stains from the teeth above the gumline, and only slightly below. A regular cleaning is usually done 2 to 3 times a year, depending on how quickly stain, plaque, and tartar accumulate. It is considered a preventive procedure by your insurance carrier, since regular cleanings will help prevent periodontal disease.
If you have periodontal disease which has resulted in bone loss, gum “pockets” deeper than 4 millimeters, bleeding gums, exposed root surfaces, or if you have had periodontal surgery or root planning to treat periodontal surgery or root planning to treat periodontal disease, a regular cleaning is not appropriate. Periodontal Maintenance Scaling is needed to maintain gum and bone health. This procedure includes removal of plaque and tartar from above and below the gumline, all the way down the length of each tooth to where the root, gum and bone meet. Rough areas of the roots are smoothed if needed, pocket depths are carefully monitored, and inflamed pockets may be irrigated with antibacterial medicines if necessary. Periodontal Maintenance is usually performed 3 to 4 times a year, depending on several factors: how quickly the plaque and tartar accumulate, how much bleeding or inflammation is present, how stable the present condition is, how well you are able to maintain your teeth at home on a daily basis, any health risk factors you may have.
We know that there is a relationship between chronic inflammation in the gums and overall health, especially heart disease and diabetes. Keeping the gums and the bone surrounding your teeth as healthy as possible is an important part of your regular dental visits or hygienist.
Depending on the depth of the pocket and severity of the root surface irregularity, the periodontist may wish to make the area numb so that the process is comfortable for you. Don’t hesitate to discuss with your periodontist or hygienist how to best manage any discomfort.
Sometimes if the pockets are not too deep, there may be little or no discomfort during the procedure – even without numbing. The only sensation may be the physical scraping feeling along the teeth as the area is cleaned and smoothed. A root planed root surface free of tartar has a better chance of allowing the gum tissues to heal and reattach to it. As a result, some deep gum pockets can be reduced after a deep cleaning.
Typically with deeper pockets and extensive rough root surfaces, the deep scaling and root planing procedure might be broken down into quadrants of work per appointment. For example, the upper right side of the mouth might be worked on one day, and the three other parts worked on at separate appointments. Or alternatively, one half of the mouth (right or left, upper or lower) might be cleaned per appointment. This also allows for only a part of the mouth being frozen at a time and makes for more manageable, shorter appointments.
The periodontist may use antibiotic gels within the periodontal pocket, again to remove any nasty bugs, or may rinse out the pocket with various medications such as chlorhexidine.
Discomfort can vary after root planing, but one can expect it to be more sore afterwards since it’s usually in a deeper region under the gums.
The teeth themselves can become a bit more sensitive to temperature, and bleeding might occur for a little while. Over-the-counter painkillers such as ibuprofen work very well to alleviate discomfort, but stronger painkillers can be given should you need them.
Brushing and flossing can be delayed or done more gently to avoid aggravating any bruised or tender gum areas. Your periodontist or hygienist may recommend salt water or chlorhexidine rinses.