Routine dental appointment involves more than just a cleaning

By Michele Steif CONTRIBUTOR

Most patients’ perception of a routine dental cleaning appointment is taking X-rays and cleaning teeth. However, hygienists are doing so much more.

It is critical that we first review each patient’s current medical conditions and medications, as well as dental health. In my 30-plus years as a hygienist, I have often been asked, “What does that have to do with my teeth?” My response is “everything!”

We want to know what systemic conditions may be affecting your oral health. Medical conditions help us assess the immune response to the bacteria present in the oral cavity. Certain medical conditions lower the immune response, even in dentally healthy patients.

Next, assessment of current X-rays is necessary to determine if the supporting hard tissues of the teeth have been compromised. We look to see if there is horizontal or vertical bone loss between the teeth, the degree of loss, and whether it involves the area between the roots.

Finally, we assess the soft tissue before we remove hard deposits above or below the gumline. We take measurements around the teeth at six sites per tooth to determine if there is any tissue breakdown and progressive bone loss. Then we make a visible assessment of tissue health and, from all of the collected data, rate the tissue in one of four ways: healthy, gingivitis, periodontitis, or refractory periodontitis. Healthy tissue does not bleed – ever. It is pink in color, firm in consistency, and tight around teeth. There is no bone loss.

Gingivitis is gum inflammation caused by bacterial plaque (now called periodontal microbiome.) If left untreated, this inflammation can spread to the supporting tissues of the teeth and lead to bone loss. Once this occurs, this new disease is called periodontitis.

The mechanism of tissue breakdown and progressive bone loss is immuno-inflammatory, meaning a patient’s medical history influences whether the disease progresses.

Refractory periodontitis refers to destructive periodontal disease in patients who, despite adequate treatment and proper oral hygiene, demonstrate additional bone loss.

As you can see, a routine hygiene appointment is much more than taking annual X-rays, removing tartar, polishing, and flossing. Treatment should be individualized based on all these factors, resulting in therapeutic benefits of disease prevention and maintenance.

As a dental hygienist, I know that the rewards of a professional dental cleaning go beyond a beautiful smile. I impact my patients by educating them about disease prevention, preventing serious issues with treatment at their routine visit, and recommending a plan to improve or maintain their oral health.