If a patient comes to me for the first time and has not had a cleaning in quite some time, often I see a lot of plaque and tartar build up along the gums. This build up can irritate the gums and bone around the teeth and cause an infection. Depending on the severity of the infection, my patient might need periodontal treatment. The three parts of periodontal treatment are a generalized or whole mouth treatment, a localized or single tooth treatment, and maintenance. Each part is important and helps contribute to a healthy mouth.
When a patient comes to me with periodontal disease, one of the first things that I see is heavy plaque around the gums. On x-rays it is common for the plaque to be calcified and look like boney thorns coming off the individual teeth. These thorns not only harbor harmful bacteria but also irritate the soft tissue or gums as well as the bone, and the gums swell. This irritation causes the gums to bleed when brushed and flossed. When I see these signs around the gums, my recommendation to my patients is that we do initial periodontal therapy or a scaling and root planing. Some people know this as a deep cleaning because the hygienist or dentist are cleaning deep below the gums to remove the plaque that is not easily removed. In this procedure because the plaque is below the gums, we numb the mouth for comfort. This does not necessarily mean a shot but may just mean laughing gas or other topical anesthetics to keep a patient comfortable. After this, special tools are taken around the teeth and these tools are designed to efficiently remove heavy plaque from teeth while not harming the teeth themselves. Doing these effectively around all the teeth takes around one hour per quadrant and is either done in one 3 to 4 hour appointment or over two 2 hour appointments one week apart. If it is done in two separate appointments it is important to do them close together so that the plaque does not have a chance to reinfect the already cleaned areas. After the initial whole mouth treatment, I recommend the patient return in four to six weeks so that I can evaluate the healing.
At the re-evaluation appointment, my hygienist and I check around each individual tooth to see not only what inflammation is still present but also to see how clean the overall mouth is. Many of my patients view a deep cleaning as a wake up call to take better care of their teeth, and thankfully come back with minimal to non-existant levels of plaque. Occasionally though some people come back and the plaque is back. While it may not be at the same levels that it was before we did the whole mouth treatment, I can see that it is on its way to getting there again. For these patients, I discuss other options for cleaning such as an electric toothbrush or take home whitening trays to help keep the mouth clean. If the mouth is clean, but there are some individual areas of inflammation, I recommend that individual tooth periodontal treatment. Even though our initial therapy is comprehensive and does a great job removing the majority of plaque, sometimes small pieces of debris are left behind. When I go below the gums to do a deep cleaning, I am relying on the feel of the tooth not by sight. If I see areas of continued inflammation, I know that some plaque remains that is as smooth as the tooth and needs to be visually inspected. For these areas, I refer to my gum specialist or periodontist to do a minor surgery to visually access the teeth and remove the plaque from the teeth. Also during this surgery, reshaping of the bone may be needed so that everything is cleansable.
Regardless of whether individual tooth treatment is needed or not, after a whole mouth periodontal therapy appointment, maintenance is needed so that the infection does not recur. Even if my patient opts for no individual tooth treatment, it is still necessary to do regular maintenance visits so that problems do not worsen substantially. While many patients know these visits are regular cleanings, they are actually called periodontal maintenance. Maintenance visits should be done every three to four months until all the gums and bone are healthy. The frequency of these visits is a discussion between me and my patient. At periodontal maintenance visits, the focus is not only on making sure that the teeth look polished and clean, but also making sure that no infection has reappeared. If it has reappeared and it is minor, often times I will just clean the individual tooth up. If it has reappeared and it has come back everywhere, occasionally I need to redo the initial whole mouth treatment again. This usually only happens when a patient has put off their maintenance visit for an year or more as the plaque has had a lot of time to reaccumulate. For my patients that follow the recare and maintenance protocol, the teeth stay happy and healthy.
Taking care of the gums is an important part of having a healthy mouth. Plaque and tartar build up not only harbor infection but also irritate the foundation of all the teeth, and when the teeth have not had a professional cleaning in quite some time, periodontal treatment is needed to remove all the debris from the teeth. These treatments are important because the gums and bone are the foundation for the mouth and keeping them healthy makes sure that the teeth are strong. If you find that your gums are bleeding or irritated or if you think that you might need a deep cleaning, call us today at 504-392-5104 and we will help you out.