"I want to have my teeth cleaned"

This is a frequent request from a new patient calling for a dental appointment.  It is a fair request in that most people who desire this service are in need of it to one degree or another.  Cleaning teeth on the first appointment, however, presents a problem in that the extent of procedures needed to get the teeth clean and gums healthy cannot be determined from a phone conversation, only from an in-office periodontal (gum) assessment that is part of a comprehensive oral examination.  The approach to this request differentiates the health-centered, wellness based dental practice from a traditional one which will be explained in this article.

The hygiene arm of most traditional dental practices is where patients are seen on a regular cycle to have their teeth cleaned, and offers an opportunity to discover dental treatment for the dentist to perform.  In a health-centered practice the primary purpose of its hygiene arm is to support the fundamental mission of the practice – patient health and education. 

Having clean teeth embodies a lot more than a sparkling smile and feeling “spiffy” from the gums up, as true teeth cleanliness also has to do with what’s “down under” where bacterial action, inflammation and infection can reside, most often without the patient being aware of it.  Teeth surfaces extend well below gum levels and here is where it becomes a matter of systemic as well as oral health.  It is a sad fact that people with teeth that have periodontal disease to the point of looseness never experience pain from it.  Given this, the question becomes whether one wants to have smooth feeling teeth for a day, or have oral health for life, which could very well be extended through having it.

Facts that support the rationale of a periodontal assessment prior to cleaning teeth:

• Cleaning teeth on a healthy patient with no gum pockets or bleeding on measuring them is a one appointment procedure.
• 90% of our new patients have bleeding gums that require more than one appointment for the necessary learning and treatment(s) required to halt the bleeding.
• Many people who brush and floss improperly say that their gums don’t bleed.  This is because their efforts skirt the areas below the gum level where the “skin” is missing and inflamed, which bleed easily upon measuring.
• There is no way to determine how to program the correct amount of time and care required to develop healthy gums without a complete oral evaluation including x-rays, dental examination, health history and gum measuring, and in our office, plaque analysis using a phase microscope. 
• Gums can bleed for several reasons and there are many potential local causes: bacterial plaque; stress on teeth from an uneven bite; teeth grinding; improper nutrition; tobacco usage.
• There is a systemic component to gum disease, as the blood that goes through the gums goes through the heart and all other organs.  Bleeding gums can cause elevated blood glucose, cholesterol and C Reactive Protein (CRP) levels.  In fact, persons with diabetes cannot afford to have gum disease as it makes the diabetes worse and having diabetes aggravates the gum condition – a real “closed loop.”  (See Dentistry and Diabetes)
• Gum disease, besides being associated with prediabetes and diabetes, compromises the immune system and is also associated with obesity, heart and arterial disease, strokes, dementia, Alzheimer’s Disease, pre-term and low birth weight babies.  Therefore, those with bleeding gums are measured for blood glucose, cholesterol, C Reactive Protein and GST (Genetic Susceptibility Testing)  (See The Scottsdale Project Report and Getting to the Heart of Dental Disease)   
• As indicated, unhealthy, inflamed and infected gums are never painful.  This is one of the primary reasons that periodontal disease is the major cause of tooth loss – it occurs “silently” without the person being aware of it
• Stain and hard tartar (calculus) on teeth under the gums are not the cause of gum disease, but a result of it.
• American Dental Association statistics report 85 to 90% of all adults and 35% of all children will have some form of gum disease within their lifetime. 
• It is a shock for many of our new patients who have had periodic “cleanings” to discover that they have active periodontal disease with pockets and bone loss around their teeth.
• Unhealthy dental plaque is soft and is composed of bacteria, decaying food (their nutrients), dead gum tissue cells, toxic immune products and white blood cells.
• Once teeth are thoroughly cleaned, bacterial plaque will start re-forming within 24 hours, so it is important that the patient be thoroughly trained to remove this substance efficiently on a daily basis.  In a health-centered practice the dentist and hygienist not only take the time to assess the new patient’s periodontal health status, but also evaluate their manual dexterity to remove plaque and supply the proper tools best suited for their particular needs. 
• Unawareness of the above.  A major aspect of any form of health development is what actions one takes towards developing it.  Prior to that, one needs to learn the “why’s” (cause and diagnosis) so that the “what’s” (self and in-office care) are made significant.  True health is not so much what is done to a patient, but also what they do for themselves based on sound education and skill learning, coupled with proper in-office treatment based on an individual evaluation - it’s what you know translated to daily action that constitutes health.

We have discovered that spending enough time in the beginning avoids wasting it in the future, so we take the time to individually assess and diagnose each new patient prior to prescribing an appropriate plan for their teeth cleaning/periodontal health development needs.  A thorough periodontal program in our office consists of: 

It being outlined and monitored by the doctor based on a thorough periodontal evaluation and diagnosis consisting of pocket measuring and phase microscopic assessment.

1. Oral cancer examination.
2. Dental examination.
3. Report of present oral situation.
4. Oral hygiene assessment, dexterity evaluation and instruction.
5. Initial and follow up microscopic bacterial evaluation. 
6. Thorough scaling and polishing of all tooth surfaces.
7. Manual Dexterity assessment and training.
8. Safe, bacterial-killer rinses.
9. Continuing "Report Card," especially of troublesome areas to guide you during the time between maintenance appointments.
10. Essentially, treatment by a hygienist who is interested in your continued oral health and is genuinely committed to this goal.
    
    If Warranted:
11. Pre and post program blood testing, if indicated (CRP, Blood Glucose, Hb1Ac, cholesterol and simple, non-invasive tests to determine genetic susceptibility to periodontal disease.)    
12. Neutraceutical supplementation.
      
    We have discovered several things through not limiting our periodontal treatment to just cleaning teeth.  Besides developing healthy mouths, we are in a position to not only improve the state of our patients’ general health, but actually save lives.