“It’s Never JUST a Cleaning!”
By Dr. Max Zaslavsky
I was at LA Fitness one Friday night and I happen to run into a patient. “Sam,” as I would call him came up and said hello to me, with a great big smile on his face. He was working out his back, and so was I. In between lat pulldown sets, he said to me, “You know I love all of your staff!” He continued, “That Joanne….man, I have had a lot of cleanings, but never one so thorough as what she does.” Obviously I was proud. It takes a lot of work to assemble the perfect team, and make them a cohesive unit. I definitely took some pride in what he said about my star hygienist. Because of that incident, this blog is dedicated not to what I do, but what should be done in your initial visit to your recalls with your hygienist.
For some of you reading this who are my patients, you know Joanne, and how awesome she is. Joanne, my stellar hygienist, has been a blessing in my life for the past 10 years. She is one of the few people who has always kept in contact with me since I graduated dental school. We had worked together in another office in Deerfield Beach, and I said, “If I ever get my own office, I want her.” Sure enough, almost 5 years ago, she came into my office and began my small startup.
Let’s get into the role of what a hygienist should do. Obviously if you know how we do things in our office, this is the criteria you have been accustomed to. If you are in a different office, perhaps you should look to see if these procedures are indeed occurring. Initially, we begin with a full mouth series of x-rays. I know some offices do only 4 bitewings, but not us. It’s not comprehensive, and you are only cheating yourself with only 4. The reason is 4 bitewings (which usually come along with those $39 Groupon offers) can not diagnose infection. Although they can diagnose dental cavities in between the teeth, they will never, ever detect an infection. Different angles of x-ray radiographs detect different facets of a tooth and its surrounding bone structures. We always want to be as complete and comprehensive as possible to see every angle.
Some may argue that we are over exposing a patient to radiation, but with today’s digital x-rays (which is what we have in our office), you are exposing yourself to up to 70% less radiation.
There had been some literature in the news as of late in regards to brain tumors and dental x-rays. The documentation is honestly untrue and the reality is your cell phone usage is probably going to give you cancer before we ever do.
Next up, the hygienist along with your dentist will determine what kind of dental cleaning you will need. If you are a smoker, chances are you will need a more detailed cleaning than the regular prophylaxis. If you do not floss, more than likely you will need more than just a regular 1-hour cleaning. If you have not had a dental cleaning in over 2 years, more than likely you will need more than just a regular cleaning.
How do we determine gum disease?
Bone loss can be determined not only visually, but also via the x-rays we have taken, and periodontal probings. Joanne uses a small measuring stick called a periodontal probe and measures the architecture of the bone structure around each and every tooth you possess. Each tooth has 6 surfaces- 3 in the front and 3 in the back. Normal probing depths are sort of like golf scores- the lower the number the better the prognosis of a tooth. Generally 1-3 millimeters is normal. It means you are flossing and doing what you’re supposed to be doing. It could also mean you aren’t flossing and you just have awesome genetics. Whatever it is, to pseudo quote the Dos Equis man, stay periodontally strong my friends…stay strong.
Anything above 3mm is when things become a red flag that we need to address with more scrutiny. If a probing depth of 6 millimeters or greater is measured, we would obviously need to treat things more aggressively than if it was a 4 millimeter pocket. Our hygienist may even suggest a medication to be placed in the gum pocket (called Arrestin) in conjunction with the cleaning in order to clean out the bacteria invading the tooth. The key thing in all this is that a deep pocket needs to be cleaned by a hygienist. Floss and a Waterpik can only go so far into a tooth. If we are addressing a pocket that is 6 or greater, there is no way at all that you can do this on your own. Don’t think you as a patient can fix a periodontally diseased pocket. This is when you need a hygienist like Joanne to get in there and “get ‘er done.” Don’t be that guy who thinks you can do it on your own, and it only becomes worse.
See it’s all about bacteria. It’s all about keeping it clean. If we remove the bacteria, we can remove the plaque that acts like a splinter that hurts the bone surrounding the tooth. Furthermore, removing the bacteria and plaque surrounding the teeth will only help you and your heart. The same bacteria in gums is the bacteria that you swallow that goes through your system and can create heart issues. Gum disease has been linked to pancreatic cancer, esophageal cancer, and a whole bunch of other things. It’s all connected, and when the primary source of nutrition is your mouth, you need to fix the dental problems before they impose upon everything else.