How often do you get a teeth cleaning?
You probably know that you should see a dentist every six months for a check-up and cleaning. At these appointments your teeth are cleaned and polished, maybe some x-ray films are taken, and a dentist does an exam. Then the dentist or hygienist usually gives a lecture saying that you should floss more often unless you lie and say that you floss every day. However, do these six-month cleanings actually do you much good? The popularity of the six-month visit is actually not from dentists but rather from dental toothpaste advertising agencies. Probably the most popular brand that created this belief was the Ipana Ads.
While I am appreciative to the Madison Ave advertising executives that promoted my profession and I love seeing my patients every six months, I believe that the number of check-ups and cleanings should be tailored specifically to each patient. Dental insurance companies do their clients a disservice as they approach dental treatment as a "one size fits all" and pigeon hole all patients into the same risk pool. Some patients get the same benefit from seeing a dentist once every twelve months as they would twice a year. Others should come see me every 3 months as cleanings every 6 months are not effective. I want to warn all my readers that this may get kinda boring and technical, but I feel that I need to go in-depth to explain this topic thoroughly.
In my opinion, there are four different risk pools for patients: low, medium, high, extreme. The risk category is how likely you are to develop dental diseases such as cavities or gum disease. To determine which risk pool you are in, I consider your previous dental treatment, your needed dental treatment, your age, and your medical history as well as your personal preference. I include patient preference in my risk assessment as I believe that input from my patients is necessary to determine what is the best treatment. I have some patients who might only need a cleaning once a year want two cleanings a year because they like the way that tooth cleaning makes them feel. Other patients whom I feel should see me once every 3 months believe that they can do well with a cleaning every 4 months.
Medium risk or cleaning every six months
I start with medium because dental insurance lumps everyone in a medium risk pool, and it is an easy place to start. If you have had moderate or severe gum disease (gingivitis) in the past five years or have had 1 to 3 fillings done in the past five years, I think seeing a dentist twice a year is the right. I see cavities and gum disease take around 6 months to develop in medium risk dental patients. I consider patients under the age of 22 who have not had cavities at medium risk as diets change significantly in this age group. I've seen many 12-year-olds do well in grade school and have no cavities, but when they enter high school it's much easier to buy soda other sugary drinks. I've seen some college students go from perfect teeth to 10 cavities in one semester. I also like to see patients who have retired every six months as again diets change and problems can develop quickly. My last general rule for medium-risk patients is for patients who take a prescription medication. Many prescription medications cause dry mouth which increases the risk of cavities.
Low Risk or Once a year cleanings
Low-risk patients have never had gum disease and haven't had a cavity for five years or longer. Also, these patients take no prescription medications on a regular basis and are between the ages of 23 to retirement. Thankfully with fluoridated water and better brushing, this group is growing among adults.
High Risk or cleanings once every 3 or 4 months
High-risk patients are those who every single time they visit the dentist, they have a new cavity. Also if a patient has had gum bone disease or periodontitis, then he is at high risk of it recurring and affecting teeth and gums again. This extra one or two cleanings a year helps find trouble spots with brushing and flossing but also removes any tough plaque that can only be removed by professional dental instruments. Finally, many patients who take a long list of prescription medications benefit from these frequent cleanings as the medications often affect not only the saliva but also other natural healing factors that the saliva has to help protect against tooth decay and gum disease.
I do find that some patients have a personal preference for more frequent cleanings. These patients fall into two types. The first is the avid coffee or wine drinker who hates having stained teeth. Teeth polishing can whiten teeth especially when coupled with routine whitening. The second is patients who have spent a lot of money on their mouths over the years. Patients with beautiful crowns and bridges that they want to make sure the work is in pristine condition. Patients who have had implants placed come to make sure the gums around the implants are healthy. They view regular cleanings the same way a car person might view frequent oil changes.
Extreme Risk or cleanings every month
Extreme risk patients are patients who have more than 10 cavities or active gum infection and they have not seen a dentist in quite some time (generally 2 or more years). Either they have a fear of the dentist or life has gotten in the way. With these patients, generally they required 2 or 3 cleanings in a short time period as plaque has built up so heavy that it cannot be removed all in one visit. During each visit, either the dentist or the hygienist will review brushing and flossing techniques. After a few monthly cleanings, I recommend that these patients see a dentist once every 3 months.
I hope that these explanations of each risk category can give you, the reader, an idea of what risk category you are in. Now I must admit that each dentist has different risk categories and look at different aspects of your mouth. While some groups are trying to standardize dental risk, many dentists will debate this topic. Many dental books have been written on this one subject, and dentistry as a profession is far from a firm agreement. Still though, I think many dentists will at least agree with me in principle that this is a good place to start when discussing routine maintenance. I think it's most important that you and your dentist discuss your risks so that you can better prevent any problems from occurring. Next time you see your dentist ask about how many cleanings a year they recommend and why.