Why can’t I get a regular cleaning?

Becky Larson, RDH BS

Why can’t I get a regular cleaning?

One of the most common questions I am asked as a dental hygienist is, “why can’t I get a regular cleaning?”  This is always a tough one for me because I want what is best for my patients, but I also want them to be happy.  Many patients do not understand that there is a difference between the hygiene services that are available.  So I’d like to clarify.  There are 3 basic types of hygiene services or “cleanings” that your dentist/dental hygienist might recommend.  

Prophylaxis: 

A prophylaxis or “prophy” is a preventive cleaning where plaque, calculus, and stain are removed or cleaned off the teeth in order to prevent disease.  This type of cleaning is done when disease is not already present, but rather the mouth is in a current state of health.  There is minimal discomfort and little to no bleeding present.  

Scaling in the presence of inflammation (or gingivitis cleaning):

Scaling in the presence of inflammation (SPI or gingivitis cleaning) is different than a prophy in that there is disease present.  In this case, the mouth is in a state of gingivitis or inflammation of the gum tissue.  Gum inflammation includes swollen, red, tender, and bleeding gums.  This cleaning still includes the removal of plaque, calculus, and stain from the teeth.  Since the gums are already in a state of disease, this is not a preventive cleaning.  The gums generally bleed during the cleaning process and anesthetic may be administered for the patient’s comfort.  Since gingivitis can be reversed, there is often a good prognosis with healing of the gums after a gingivitis cleaning.  

Scaling and Root Planing (or a deep cleaning):

Gingivitis is the stage of disease that precedes periodontal disease.  Periodontal disease is an infection of the gum tissue that begins to destroy the supporting structures of the teeth including the gums themselves, periodontal ligaments, and jaw bone.  Once the supporting structures of the teeth are destroyed, they do not grow back.  Periodontal disease is not reversible, nor is there a cure, but it can be kept in an inactive state to prevent further destruction.  Patients with periodontal disease usually have generalized bleeding of the gums, bone loss, gum recession, and deep “pockets” or gum measurements that mean the gum is not attached on the tooth where it should be.  Scaling and root planning (or deep cleaning) involves removing the plaque, calculus, bacteria, and stain in these deep pockets where a toothbrush or floss can’t reach.  Anesthetic is usually always administered due to the need to clean below the normal gum tissue level (which can be very uncomfortable).  The gum tissue can heal as long as everything is removed from the pocket and no other further irritation is present. Thorough homecare is essential to keeping periodontal disease under control, as are more frequent hygiene appointments.  

Your dentist and/or dental hygienist can tell you which cleaning is necessary for you.  Just as we would never try to treat a disease that isn’t present, we can’t perform a prophylaxis cleaning when disease is present.  Doing so would be a great disservice to our patients.  Please talk with your dentist or dental hygienist if you have questions about the health of your teeth or gums.  

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Sources:

https://medical-dictionary.thefreedictionary.com/dental+prophylaxis

https://www.colgate.com/en-us/oral-health/conditions/gum-disease/what-does-gingivitis-treatment-entail-0513

https://www.mouthhealthy.org/en/az-topics/s/scaling-and-root-planing

https://www.colgateprofessional.com/education/patient-education/topics/plaque-and-gingivitis/what-is-periodontal-disease

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