Cleanings, Root Planing, Maintenance...Oh My!

We are asked often about the differences in treatment and cost for getting teeth cleaned. Since it has become such a common question, I thought we'd answer it simply in a blog post.

Dental Cleanings
According to the American Dental Association, this is the definition of an adult dental cleaning (technically a prophylaxis): "A dental prophylaxis performed on transitional or permanent dentition, which includes scaling and polishing procedures to remove coronal plaque, calculus, and stains. Some patients may require more than one appointment or one extended appointment to complete a prophylaxis. Document need for additional time or appointments." 

Dr. Fletcher's No-Nonsense Explanation: I realize that is a lot of words, so let me break it down. A dental cleaning is done for people with healthy gums. It removes plaque and calculus (also known as tartar) from above the gum line. This is typically completed by a hygienist in one visit. The hygienist may use a scaler/curette (patients refer to them as metal picks) or an ultrasonic scaler (commonly referred to as the tool that "vibrates, buzzes and shoots water"). Lastly, the hygienist will polish your teeth with an air-driven slow-speed prophy cup filled with flavored pumice.

The key: the patient has healthy gums (meaning no bone loss, no periodontal disease) and the teeth are simply cleaned in one visit.

Root Planing
According to the American Dental Association, root planing (deep cleaning) is defined as follows: "This procedure involves instrumentation of the crown and root surfaces of the teeth to remove plaque and calculus from these surfaces. It is indicated for patients with periodontal disease and is therapeutic, not prophylactic, in nature. Root planing is the definitive procedure designed for the removal of cementum and dentin that is rough and/or permeated by calculus or contaminated with toxins or microorganisms. Some soft tissue removal occurs. This procedure may be used as a definitive treatment in some stages of periodontal disease and/or as a part of pre-surgical procedures in others."

Dr. Fletcher's No-Nonsense Explanation: Let me simplify it for this blog post. This is not a cleaning. The patient getting root planing does not have healthy gums. It is therapy or treatment for diseased gums. Your teeth are probed/measured for the purpose of diagnosis. Patients with good oral hygiene can manage pocket depths at 3-4mm. Probing depths 5mm and above with evidence of plaque, calculus, inflammation or infection require treatment of the tooth and root surfaces. This is done typically one corner of the mouth at a time with dental anesthetic. It is always followed up with a reevaluation, to make sure the treatment was successful.

The key: the patient has been diagnosed with periodontal disease (bone loss has occured and acute or chronic gingival inflammation is present). This treatment is completed 1/4 of the mouth at a time with dental anesthetic. The patient may leave with an antibiotic or an antimicrobial rinse. 

Periodontal Maintenance
This is the most confusing part of periodontal therapy. Periodontal Maintenance is defined by the ADA as follows: "This procedure is for patients who have previously been treated for periodontal disease. Typically, maintenance starts after completion of active (surgical or nonsurgical) periodontal therapy and continues at varying intervals, determined by the clinical diagnosis of the dentist, for the life of the dentition. It includes removal of supra and subgingival microbial flora and calculus, site specific scaling and root planing where indicated, and/or polishing teeth. When new or recurring periodontal disease appears, additional diagnostic and treatment procedures must be considered."

 Dr. Fletcher's No-Nonsense Explanation: This seems like a cleaning, except it's for patients who have previously had gum surgery or root planing...aka they do not have a healthy mouth. The hygienist will go after troubled spots, numb if necessary, and constantly evaluate the "state of disease." The name explains a lot: Periodontal Maintenance, in other words the dentist/staff are maintaining the current conditions and trying to prevent them from getting worse. They may be more frequent than dental cleanings too.

The key: Not a cleaning, but it sure feels like one, because the whole mouth is treated in one visit. It is more active, more thorough and more involved.

The comments are open on this post, so feel free to ask questions that you may have.

Keep smiling!
ARFDDS 

FAQ - Dental Implants

Question: What can you tell me about dental implants?

Answer: I’ve been involved with the restorative end of the process for the past ten years or so and I’ve been a member of the Modesto Study Club which is a group of local dentists and specialists who meet monthly to diagnose and treatment plan different cases.

Dental implants are made out of titanium and placed into the top or bottom jaw bone and then used to replace one tooth, many teeth or to anchor a denture. Most dental implants are created with three parts: the implant itself is placed into the bone, the abutment is screwed into the implant and sticks out of the gums and then the crown is cemented or screwed into the abutment. In this three part system, I refer patients to a surgeon for the implant and I am responsible for restoring the abutment and the crown.

There are several things to consider when thinking about implants. First, do I have enough bone to hold the implanted tooth/teeth in place? If not, you may need to consider a bone graft procedure. Secondly, will I take care of my new implant. Implants need as much, if not more, care than your original teeth. Third, am I prepared for the three month healing process? Implants take three months or more to integrate into a healthy patient’s bone. Although there are dentists placing implants for immediate use, I still recommend that implants heal without any use until they integrate with the bone.

The California Dental Association has a terrific article that explains everything about dental implants. You can link to it here.

If you have any questions, please drop a comment.

Keep smiling! – Dr. Fletcher

FAQ - Does the office take Stanislaus Dental Foundation insurance?

One other insurance plan question is: “Does your office take Stanislaus Dental Foundation coverage?”

Our insurance coordinator Trudi responds: “Dr. Fletcher is a member of the Stanislaus Dental Society and the California Dental Association, therefore we treat patients who have insurance through the Stanislaus Dental Foundation.”

FAQ - How much will my dental care cost?

Question: How will I know how much my dental care will cost?
Answer: No one likes surprises. Therefore, prior to any treatment, Dr. Fletcher will explain the risks, benefits and alternatives of any and all treatment.  Part of that discussion with his patients is informing them of the cost. The financial coordinator will provide you with a written estimate for any dental work that is planned and you will need to sign that estimate prior to any dental work.

FAQ: Do you take my insurance?

A common question we get in our office has to do with insurance plans. Patient’s often want to know: “Do you take my insurance?”

Our insurance coordinator Trudi responds: “The best answer is ‘maybe.’ If the patient can provide our office with accurate insurance benefit information, as a courtesy, we will bill any insurance company. Unfortunately there is one small requirement: It must be a PPO dental plan.
Dr. Fletcher is not a provider for any HMO dental plans, so those plans will not cover any treatment he provides. He also no longer accepts Healthy Families plans and is not a provider for MediCal or DentiCal coverage.