A common question that I get is, "My insurance doesn't pay well for periodontal maintenance can't you just send it in as a routine cleaning?" The answer to that is a big NO! Stating that a routine cleaning is being performed when it's not is actually insurance fraud.
Another question then may be, "Since I only get two cleanings a year can't you just do that." The answer is, a good dental office will provide you with the services you need and will not allow an insurance company to determine what's best. After all, insurance companies do not have your best interest in mind! They pay the best for individuals who have a healthy mouth. And let's face it, that's not most of us!
I completely understand why many people misunderstand the concept of periodontal maintenance vs. a "cleaning." I know I have accidentally called the periodontal maintenance appointment a "cleaning" when talking to patients.
FYI: While many of the components are the same, a periodontal maintenance appointment has specific guidelines set by the ADA and is performed on patients who have at some point undergone periodontal therapy and thus have a history of periodontal disease. The ADA further mandates that this be performed for the lifetime of your teeth.
Keep in mind, the ADA has set these standards based on the value to your total health not just your dental health.
We routinely take blood pressure, update medical histories and take x-rays as needed during both periodontal maintenance appointments and routine cleanings. The main differences between the two include:
- For periodontal maintenance, the ADA mandates that periodontal probing be completed at every visit (every 6 weeks to every 4 months) to monitor the disease process so intervention can be done in the earliest stages. For routine cleanings, periodontal measurements are taken either at 6 month or 12 month intervals.
- Checking and documenting mobility levels during all periodontal maintenance appointments. During a routine cleaning this is not performed because the gums and bone are healthy so mobility is not an issue.
- Scaling to remove plaque, calculus and bacteria from below and above the gum line is completed in both types of hygiene appointments. However, below the gum line can differ dramatically between the two types of appointments. During a routine cleaning, the pockets are 1-3mm so scaling would not be at any depth greater than 3mm. During periodontal maintenance, pockets may be much deeper (I have seen up to 12mm) so much more surface area is being scaled.
- During periodontal maintenance appointments, scaling and root planing is performed on any areas not healed from the previous appointment. This means that if an area does not respond to scaling and root planing initially, we will keep retreating with scaling and root planing until it either heals or Dr. Alexander feels it's necessary to refer for surgery. In comparison, a routine cleaning is just that, routine.
- If needed, below the gum antibacterial irrigation is applied during the periodontal maintenance appointment.
- Bone levels are also looked at and noted any time x-rays are taken. When they are taken though as part of periodontal maintenance, bone levels are closely monitored and any variations are noted between the sets of films. Tracking bone levels is one of the best methods for determining if the disease is progressing.
FYI: After being diagnosed with periodontal disease, bacteria, plaque and tarter (especially below the gum line) needs to be professionally removed to help control the disease process. The standard length of time between periodontal maintenance appointments is 3 months. That is the length of time it takes bacteria in the pockets to become destructive to the bone and supporting tissue. That's 4 cleanings per year.
While PerioProtect does amazing things, it does not take the place of a dental hygiene visit where bacteria, plaque and tarter are removed above and below the gum line. For some, the health of the periodontal tissue may be so improved with PerioProtect that periodontal maintenance can be performed every 4 months instead.
Now, there are also the infrequent cases of patients with extreme dental phobia. For those patients that are only going to come in once or twice a year because of the anxiety, PerioProtect definitely helps long-term. PerioProtect will not take the place of those missed visits, but it will slow down the effects of the missed appointments.
Next up: what the periodontal maintenance appointment entails and how it differs from a routine prophylaxis/cleaning.
There are a number of reasons why I would recommend PerioProtect:
1. It works!
2. It's pain free.
3. It's easy to use.
4. You can use it from work or home.
At first, I was a little skeptical as to how effective this treatment would be. I read all the published research. I talked first hand to dentists who had used it. I even looked into the studies they did that enabled the PerioProtect system to get FDA clearance. It really sounded just too good to be true. Then we tried it.
We first tried it on a few patients as a last resort before surgery with a periodontist. What I found was, the patients who used it, it worked remarkably well. Now, I would recommend it to anyone who has a history of gum disease! I have even prescribed PerioProtect for my wife.
Most people think of periodontal (gum disease) treatment as being painful and involving surgery. Actually, there are many effective and pain free options for the majority of patients that do not involve surgery. Here are the non-surgical periodontal treatment options we offer:
- PerioProtect, the FDA cleared, pain free way of treating gum disease. For more info on this, read my blog tomorrow and Friday.
- Laser periodontal therapy. This treatment offers me additional ways of treating gum disease without surgery!
- Scaling and root planing. This name actually sounds worse than it is! My hygienists use topical numbing gel for this. For most patients, that works great. On occasion, we have patients that request or even need local anesthesia to ensure their continued comfort. If you are just nervous about the procedure I can additionally provide you with nitrous oxide (laughing gas). And, for more severe cases of anxiety, oral sedation can eliminate your dental anxiety.
Our website has even more information on these periodontal disease treatments. Also, I will discuss PerioProtect specifically in the next few days. It is one of the most amazing things I have seen in dentistry in my 30+ years experience.
Since gum disease is a bacterial infection of the bone and tissue surrounding the teeth, leaving the disease untreated can lead to:
- Bone loss around the teeth
- Loose teeth
- Eventual loss of teeth
Here are some other reasons to treat your gum condition. Periodontal (gum) disease has been linked to the following:
- Heart disease and stroke
- Diabetes
- COPD
- Preterm, low birth weight babies in mothers with gum disease
All these health problems are linked to periodontal disease. By treating gum disease, you may see an improvement in your overall health as well, especially if you have a history of diabetes or heart disease.
Bleeding gums are not normal even during pregnancy. In fact, a sign of gum disease is bleeding gums!
FYI: During pregnancy the gums do bleed more because of the body's increased inflammatory response to the bacteria found in plaque. This is caused from an increase in certain hormones.
Why is this important? This early bleeding can be a sign of gum disease or pregnancy associated gingivitis. And, research has proven that gum disease during pregnancy increases the risk for a preterm low birth weight baby!
Years of research have proven that seeing your dentist and having your teeth cleaned during pregnancy are safe. In fact, regular dental care may help prevent complications such as preterm delivery or low birth weight resulting from the bacteria found in gum disease.
Dental exams are often neglected during pregnancy. If you or someone you know are pregnant, make sure to put your baby's health first by seeing your dental heath professional regularly. Routine dental care can easily help to prevent complications associated with gum disease and pregnancy.
Myth #1: Gum disease and having longer looking teeth are a natural part of the aging process.
Nothing could be further from the truth!
Fact: Gum disease is a result of a bacterial infection in the bone and tissue surrounding the teeth.
In fact, with good homecare and following your dentists recommendations, most everyone can live a lifetime without loosing a single tooth to gum disease.
FYI: Gum disease can effect anyone at any time.
Bacterial plaque is the main cause of gum disease. There are many other contributing factors that can affect even those with immaculate home care.
- Stress
- Smoking/tobacco use
- Genetics
- Diabetes
- Clenching or grinding your teeth
- Puberty, pregnancy and menopause in women
- Medications
Take the
Gum Disease Risk Assessment Quiz from the American Academy of Periodontology and find out quickly what your risk level is for gum disease. Keep in mind though even if you rate at low risk, only a licensed dentist can tell you for sure if you have gum disease.
