Grand Dental Care Grand Rapids

Hygiene Corner

A regular cleaning, a root planing procedure and periodontal maintenance are not the same. This page can help explain the differences.

What is a regular or standard cleaning?
A regular cleaning is known as a prophylaxis in dental terms. The American Dental Association describes a prophylaxis as removal of plaque, calculus and stains from the tooth structures.

Removal of plaque, calculus and stains is accomplished by dental instruments that scrape away deposits from the teeth. An electric device, called an ultrasonic or sonic scaler may also be used. This deposit removal is performed on tooth structures that have not been affected by bone loss, typically the crowns of the teeth.

Calculus is also known as tartar and is a hard, mineralized deposit, somewhat like cement, that is formed from the plaque in the mouth and the minerals in a person's saliva.

Plaque is a soft, sticky substance that forms on teeth, regardless of what types of foods are eaten, which is composed of bacteria and bacterial byproducts.

A regular cleaning is recommended for persons who do not have any bone loss, periodontal disease, or infection around their teeth. There should also be no bleeding, mobility of teeth, receded area where the gums have pulled away from the teeth, or gaps where the spaces around the roots of the teeth are exposed. In other words, the mouth should be healthy, with no gum and bone problems.

What is a root planing procedure?

Root planning removes bacteria and their toxins, tartar, and diseased deposits from the surfaces of tooth roots. Scraping or scaling is required the full length of the root surface, down to where the root, gum and bone meet. Root planning is typically one of the first steps in treating gum and bone disease (periodontal disease).

Periodontal disease is very common, but does not always have distinct symptoms. It is an inflammation and infection of the supporting structures of the teeth (gums, bone, ligaments, root surfaces) that eventually results in the loss of teeth. You may notice that your gums bleed easily, that you have a bad taste in your mouth, that your gums appear longer or have shifted. Or you may not notice anything at all.

What is periodontal maintenance?

If you have periodontal disease, you may require root planning to remove disease deposits from the roots of your teeth. Other treatment, including surgery, may be required. After the disease process is under control, a regular cleaning is not appropriate anymore. Instead, you will require special ongoing gum and bone care procedures, also known as periodontal maintenance to keep your mouth healthy.

How often do I need to have my teeth cleaned?

The old system of everyone having their teeth cleaned only twice a year has fallen out of favor. In fact, many believe that the idea actually came from the recommendations of a 1940 toothpaste advertisement!

While some people may be able to maintain their dental health with semiannual cleanings, many patients find that their mouths and teeth stay in better shape when they have their teeth cleaned more frequently. Many dentists and hygienists are now setting up a patients cleaning schedule based on their personal needs. This may be as often as four times a year.

My insurance pays for teeth cleaning twice a year. Why should I have it done more often?

Dental insurance isn't really insurance (a payment to cover the cost of a loss) at all. It is actually a money benefit, typically provided by an employer, to help their employees pay for routine dental treatment. The employer usually buys a plan based on the amount of the benefit and how much the premium costs per month. Most benefit plans are only designed to cover a portion of the total cost of a person's necessary dental treatment. For example, a dentist may recommend a crown for a tooth that has extensive decay, however, the dental plan may only cover the cost of a filling. This does not mean that the patient does not need a crown, only that the benefit is limited to a filling

While a twice yearly insurance payment toward the cost of teeth cleaning is common, that type of payment arrangement actually has no relationship to what any patient might really need. Many patients need cleanings more frequently. People who have heavy plaque and tenacious calculus buildup are prime candidates. Also people who are generally healthy but have certain types of systematic conditions, such as diabetes, or those taking specific medications, may require more frequent cleanings. The good news is that with the help of dental benefits, the amount you have to pay is reduced!

I have been told that I have periodontal disease and need to have root planing and scaling. What is periodontal disease? What is root planing?

Periodontal disease can be described as an inflammation and/or infection of the gums and bone which support the teeth. Bacterial plaque, and it's toxic by-products, plus calculus and roughened root surfaces can overwhelm the mouth's defenses. Typically, unhealthy gum tissue covers eroded bone, resulting in abnormal pockets around the roots. Left untreated, periodontal disease can result in loss of teeth. It is a common, and sometime silent, condition in many adults.

Root planing and scaling are therapeutic (healing), meticulous, and time consuming treatments are design to remove toxins and bacteria from the root surfaces of the teeth, thereby allowing the body's immune system to begin the healing process. Calculus (tartar), diseased cementum and/or dentin are scaled away. (Cementum is the hard tissue that covers the tooth root. Dentin is that part of the tooth that is underneath the cementum) These procedures are used as a complete treatment in some stages of periodontal disease, and as part of preparing the mouth for surgery in others. Several appointments, treating sections of the mouth, and local anesthesia may be required. Your dental hygienist or dentist may provide the service. The American Academy of Periodontology considers scaling the root surface to be a critical element in establishing periodontal health. In addition, recent studies are beginning to show a relationship between gum and bone health and certain heart conditions and other systemic diseases.

Q. What are warning signs of periodontal disease?
A. Gums that bleed when brushing or flossing.
Red, swollen or tender gums.
Persistent bad breath or bad taste.
Gums that have pulled away from teeth.
Pus between the teeth and gums when the gums are pressed.
Permanent teeth that are loose, shifting, or separating.
Any change in the way your teeth fit together when you bite.
Any changes in the fit of partial dentures.

Q. How is Periodontal (gum) disease treated?
A. Enzyme suppression treatment is a line of defense against periodontal (gum) disease. This kind of treatment includes oral medication that helps stop enzymes from attacking gums and bone. Antibacterial treatments include oral medication, topically applied antibiotics, and rinses that can help fight bacteria.

Q. Why do I need to come back in 3 - 4 months? My insurance only covers two cleanings a year.
A. The infected areas are not accessible by brushing and flossing and require your dentist or hygienist to manually remove the bacterial toxins with special instruments. The infection must be removed every 90-120 days to prevent further bone loss. Without adequate bone support tooth loss occurs.

Concerning your insurance benefits, it is true that most dental plans allow two cleanings a year for healthy patients. For patients with periodontal disease, however, you have separate benefits aimed at arresting the bacterial infection and preventing additional bone loss. Depending on premiums paid by you and/or your employer, periodontal benefits usually range from 30-80 percent. A deductible may also apply.

Once you have been diagnosed with periodontal disease, we are obligated to provide your dental plan with appropriate billing codes, a copy of your periodontal measurements, and sometimes x-rays. Legally and ethically, as your dental care team, we cannot ignore the infection in your mouth.

Q. Will my insurance cover my periodontal visits?
A. As a general rule, periodontal patients should expect to pay at least 30-50 percent of their treatment needs over the course of the year since most dental plans require a deductible and co-payment on periodontal services.

As you know, our goal is to provide excellent dental care to all our patients. In good conscience, we cannot ignore a bacterial infection simply because of insurance limitations. With periodontal disease, the risk is too great. If left untreated, periodontal disease not only leads to tooth loss, it may also place you at increased risk for heart disease, respiratory disease, diabetes, and, if pregnant, a preterm, low birth weight baby.

Q. Why haven't I been told about periodontal disease before?
A. This is an understandable question. Quite simply, or bodies change. When you come in for your cleaning and exam, the dentist evaluates both the health of your teeth and the health of your gums and bone support. Just as you may have developed a cavity since your last appointment, you may have also developed an infection in your gums which may be beginning stages of periodontal disease.

There are many risk factors affecting the onset of periodontal disease, including: smoking, diabetes, heart disease, respiratory disease, pregnancy, osteoporosis, stress, radiation, chemotherapy, medications, inadequate home care, hereditary predisposition, etc. Our goal is to protect your oral health which is essential to your overall physical health.

What is periodontal maintenance procedure?

The American Dental Association describes periodontal maintenance as a procedure..institued following periodontal therapy...(which) continues at varying intervals, determined by the clinical evaluation of the dentist, for the life of the dentition (for the life of the teeth) or any implant...(and) includes the removal of plaque and calculus from the supragingival and subgingival regions, site specific scaling and root planning.

Following periodontal therapy means that a patient has received surgery or root planning in the past.
Removal of plaque and calculus from the supra and subgingival regions means that any deposits and/or bacteria that are in place either above or below the gum lines are scaled away.
Root planing means that the root surfaces, both above and below the gun line are scaled and smoothened to remove calculus, and diseased cementum and/or dentin.

A periodontal maintenance procedure is not the same treatment as a regular cleaning even though a hygienist may perform both services. A periodontal maintenance procedure, also known as supportive periodontal treatment (SPT), includes, but may not be limited to:

An update of your medical and dental history;
X-ray review;
Mouth/face exam-inside and outside including cheeks, lips, tongue, gums and throat;
Tooth examination-by the dentist: (The dentist;s exam is usually separate from the periodontal maintenance and billed separately as well);
Gum and bone examination (periodontal proving around each tooth to check for bone loss);
Review of home care;
Scaling and root planing, as need;
Polishing of teeth as needed; and
Gums and pocket irrigation with medicine as needed.

Typically, an interval of three months between appointments is effective, but more frequent appointments may be needed. As in many other chronic conditions, successful long-term control of the disease and prevention of tooth loss depends on continual, and possibly lifetime maintenance.

I understand that I need to come frequently for periodontal maintenance. How often will my insurance pay?

Many insurance plans pay for periodontal maintenance twice a tear, even though most patients require appointments four times a year, Remember that insurance plans limit the number of exams, cleanings, and periodontal maintenance appointments that they will cover because these are the type of treatments that many people need to have frequently. The good news is that any amount paid reduces what you have to pay out of your own pocket. It helps!

If my insurance plan will only pay for periodontal maintenance twice a year, why should I have it done more often?

Your insurance plan can help you pay for the treatments that you need, however it was never designed to pay for everything. Most plans typically pay a minimum regardless of what you might need as an individual. It is a mistake to let benefits be your sole consideration when you make decisions about your dental health. People who have lost their teeth often say that they would pay any amount of money to get them back. Your teeth, smile, attractiveness, ability to chew and enjoy food, and general sense of well being are dependent on your dental health. It is worth the extra time and expense to keep your teeth for a lifetime.


		Hygiene Corner A regular cleaning, a root planing procedure and periodontal maintenance are not the same. This page can help explain the differences. *What is a regular or standard cleaning?* A regular cleaning is known as a prophylaxis in dental terms. The American Dental Association describes a prophylaxis as removal of plaque, calculus and stains from the tooth structures. Removal of plaque, calculus and stains is accomplished by dental instruments that scrape away deposits from the teeth. An electric device, called an ultrasonic or sonic scaler may also be used. This deposit removal is performed on tooth structures that have not been affected by bone loss, typically the crowns of the teeth. Calculus is also known as tartar and is a hard, mineralized deposit, somewhat like cement, that is formed from the plaque in the mouth and the minerals in a person's saliva. Plaque is a soft, sticky substance that forms on teeth, regardless of what types of foods are eaten, which is composed of bacteria and bacterial byproducts. A regular cleaning is recommended for persons who do not have any bone loss, periodontal disease, or infection around their teeth. There should also be no bleeding, mobility of teeth, receded area where the gums have pulled away from the teeth, or gaps where the spaces around the roots of the teeth are exposed. In other words, the mouth should be healthy, with no gum and bone problems. *What is a root planing procedure?* Root planning removes bacteria and their toxins, tartar, and diseased deposits from the surfaces of tooth roots. Scraping or scaling is required the full length of the root surface, down to where the root, gum and bone meet. Root planning is typically one of the first steps in treating gum and bone disease (periodontal disease). Periodontal disease is very common, but does not always have distinct symptoms. It is an inflammation and infection of the supporting structures of the teeth (gums, bone, ligaments, root surfaces) that eventually results in the loss of teeth. You may notice that your gums bleed easily, that you have a bad taste in your mouth, that your gums appear longer or have shifted. Or you may not notice anything at all. *What is periodontal maintenance?* If you have periodontal disease, you may require root planning to remove disease deposits from the roots of your teeth. Other treatment, including surgery, may be required. After the disease process is under control, a regular cleaning is not appropriate anymore. Instead, you will require special ongoing gum and bone care procedures, also known as periodontal maintenance to keep your mouth healthy. *How often do I need to have my teeth cleaned?* The old system of everyone having their teeth cleaned only twice a year has fallen out of favor. In fact, many believe that the idea actually came from the recommendations of a 1940 toothpaste advertisement! While some people may be able to maintain their dental health with semiannual cleanings, many patients find that their mouths and teeth stay in better shape when they have their teeth cleaned more frequently. Many dentists and hygienists are now setting up a patients cleaning schedule based on their personal needs. This may be as often as four times a year. *My insurance pays for teeth cleaning twice a year. Why should I have it done more often?* Dental insurance isn't really insurance (a payment to cover the cost of a loss) at all. It is actually a money benefit, typically provided by an employer, to help their employees pay for routine dental treatment. The employer usually buys a plan based on the amount of the benefit and how much the premium costs per month. Most benefit plans are only designed to cover a portion of the total cost of a person's necessary dental treatment. For example, a dentist may recommend a crown for a tooth that has extensive decay, however, the dental plan may only cover the cost of a filling. This does not mean that the patient does not need a crown, only that the benefit is limited to a filling While a twice yearly insurance payment toward the cost of teeth cleaning is common, that type of payment arrangement actually has no relationship to what any patient might really need. Many patients need cleanings more frequently. People who have heavy plaque and tenacious calculus buildup are prime candidates. Also people who are generally healthy but have certain types of systematic conditions, such as diabetes, or those taking specific medications, may require more frequent cleanings. The good news is that with the help of dental benefits, the amount you have to pay is reduced! *I have been told that I have periodontal disease and need to have root planing and scaling. What is periodontal disease? What is root planing?* Periodontal disease can be described as an inflammation and/or infection of the gums and bone which support the teeth. Bacterial plaque, and it's toxic by-products, plus calculus and roughened root surfaces can overwhelm the mouth's defenses. Typically, unhealthy gum tissue covers eroded bone, resulting in abnormal pockets around the roots. Left untreated, periodontal disease can result in loss of teeth. It is a common, and sometime silent, condition in many adults. Root planing and scaling are therapeutic (healing), meticulous, and time consuming treatments are design to remove toxins and bacteria from the root surfaces of the teeth, thereby allowing the body's immune system to begin the healing process. Calculus (tartar), diseased cementum and/or dentin are scaled away. (Cementum is the hard tissue that covers the tooth root. Dentin is that part of the tooth that is underneath the cementum) These procedures are used as a complete treatment in some stages of periodontal disease, and as part of preparing the mouth for surgery in others. Several appointments, treating sections of the mouth, and local anesthesia may be required. Your dental hygienist or dentist may provide the service. The American Academy of Periodontology considers scaling the root surface to be a critical element in establishing periodontal health. In addition, recent studies are beginning to show a relationship between gum and bone health and certain heart conditions and other systemic diseases. *Q. What are warning signs of periodontal disease?* A. Gums that bleed when brushing or flossing. Red, swollen or tender gums. Persistent bad breath or bad taste. Gums that have pulled away from teeth. Pus between the teeth and gums when the gums are pressed. Permanent teeth that are loose, shifting, or separating. Any change in the way your teeth fit together when you bite. Any changes in the fit of partial dentures. *Q. How is Periodontal (gum) disease treated?* A. Enzyme suppression treatment is a line of defense against periodontal (gum) disease. This kind of treatment includes oral medication that helps stop enzymes from attacking gums and bone. Antibacterial treatments include oral medication, topically applied antibiotics, and rinses that can help fight bacteria. *Q. Why do I need to come back in 3 - 4 months? My insurance only covers two cleanings a year.* A. The infected areas are not accessible by brushing and flossing and require your dentist or hygienist to manually remove the bacterial toxins with special instruments. The infection must be removed every 90-120 days to prevent further bone loss. Without adequate bone support tooth loss occurs. Concerning your insurance benefits, it is true that most dental plans allow two cleanings a year for healthy patients. For patients with periodontal disease, however, you have separate benefits aimed at arresting the bacterial infection and preventing additional bone loss. Depending on premiums paid by you and/or your employer, periodontal benefits usually range from 30-80 percent. A deductible may also apply. Once you have been diagnosed with periodontal disease, we are obligated to provide your dental plan with appropriate billing codes, a copy of your periodontal measurements, and sometimes x-rays. Legally and ethically, as your dental care team, we cannot ignore the infection in your mouth. *Q. Will my insurance cover my periodontal visits?* A. As a general rule, periodontal patients should expect to pay at least 30-50 percent of their treatment needs over the course of the year since most dental plans require a deductible and co-payment on periodontal services. As you know, our goal is to provide excellent dental care to all our patients. In good conscience, we cannot ignore a bacterial infection simply because of insurance limitations. With periodontal disease, the risk is too great. If left untreated, periodontal disease not only leads to tooth loss, it may also place you at increased risk for heart disease, respiratory disease, diabetes, and, if pregnant, a preterm, low birth weight baby. *Q. Why haven't I been told about periodontal disease before?* A. This is an understandable question. Quite simply, or bodies change. When you come in for your cleaning and exam, the dentist evaluates both the health of your teeth and the health of your gums and bone support. Just as you may have developed a cavity since your last appointment, you may have also developed an infection in your gums which may be beginning stages of periodontal disease. There are many risk factors affecting the onset of periodontal disease, including: smoking, diabetes, heart disease, respiratory disease, pregnancy, osteoporosis, stress, radiation, chemotherapy, medications, inadequate home care, hereditary predisposition, etc. Our goal is to protect your oral health which is essential to your overall physical health. *What is periodontal maintenance procedure?* The American Dental Association describes periodontal maintenance as a procedure..institued following periodontal therapy...(which) continues at varying intervals, determined by the clinical evaluation of the dentist, for the life of the dentition (for the life of the teeth) or any implant...(and) includes the removal of plaque and calculus from the supragingival and subgingival regions, site specific scaling and root planning. Following periodontal therapy means that a patient has received surgery or root planning in the past. Removal of plaque and calculus from the supra and subgingival regions means that any deposits and/or bacteria that are in place either above or below the gum lines are scaled away. Root planing means that the root surfaces, both above and below the gun line are scaled and smoothened to remove calculus, and diseased cementum and/or dentin. A periodontal maintenance procedure is not the same treatment as a regular cleaning even though a hygienist may perform both services. A periodontal maintenance procedure, also known as supportive periodontal treatment (SPT), includes, but may not be limited to: An update of your medical and dental history; X-ray review; Mouth/face exam-inside and outside including cheeks, lips, tongue, gums and throat; Tooth examination-by the dentist: (The dentist;s exam is usually separate from the periodontal maintenance and billed separately as well); Gum and bone examination (periodontal proving around each tooth to check for bone loss); Review of home care; Scaling and root planing, as need; Polishing of teeth as needed; and Gums and pocket irrigation with medicine as needed. Typically, an interval of three months between appointments is effective, but more frequent appointments may be needed. As in many other chronic conditions, successful long-term control of the disease and prevention of tooth loss depends on continual, and possibly lifetime maintenance. *I understand that I need to come frequently for periodontal maintenance. How often will my insurance pay?* Many insurance plans pay for periodontal maintenance twice a tear, even though most patients require appointments four times a year, Remember that insurance plans limit the number of exams, cleanings, and periodontal maintenance appointments that they will cover because these are the type of treatments that many people need to have frequently. The good news is that any amount paid reduces what you have to pay out of your own pocket. It helps! *If my insurance plan will only pay for periodontal maintenance twice a year, why should I have it done more often?* Your insurance plan can help you pay for the treatments that you need, however it was never designed to pay for everything. Most plans typically pay a minimum regardless of what you might need as an individual. It is a mistake to let benefits be your sole consideration when you make decisions about your dental health. People who have lost their teeth often say that they would pay any amount of money to get them back. Your teeth, smile, attractiveness, ability to chew and enjoy food, and general sense of well being are dependent on your dental health. It is worth the extra time and expense to keep your teeth for a lifetime. back to top