Submitted by Edilia Glenski, DMD, FAGD, owner of Definitive Dental Care

There are different types of cleanings depending on whether the patient has a healthy mouth, gingivitis or periodontal disease.

A healthy mouth

A healthy mouth consists of coral pink (depending on ethnicity, there are natural pigments that change the color of gums to darker shades of brown) gums that are stippled like an orange peel. The gums are not red, purple or puffy. The gums do not bleed when the patient brushes his teeth. The gums are comfortable when the doctor or hygienist use a metal instrument called a probe to measure for pockets around the teeth. Pockets are the “turtle neck sweater” shaped spaces between the gum and the tooth.

In a healthy mouth, pockets measure 3 millimeters or less. The level of the gums meets the crown of the tooth at the enamel, and there is gum tissue covering the space between the teeth. No dark triangles visible between the teeth.

Gingivitis

Gums with gingivitis are usually red, purple, swollen, puffy and easily bleed. The surface of the gums appears smooth and shiny instead of like an orange peel. This disease is caused by bacterial plaque and by irritation from hard deposits called calculus.

Bacterial plaque is a sticky substance that contains bacteria, bacterial glue, bacterial waste products and toxins. It gives teeth a “furry” feel and can be brushed or flossed away.

Calculus can form in as little as 24 hours and is caused by calcium and other minerals in the saliva being trapped by any plaque that was not removed by brushing or flossing. Calculus is mainly found on the tongue side of the lower front teeth and on the cheek side of upper molars. Calculus must be removed by special instruments at the dental office as they are now “stuck” to the teeth so tightly (like barnacles on the hull of a ship) that brushing or flossing cannot remove it.

Gingivitis can be localized to specific areas of the mouth or generalized throughout the entire mouth.

Periodontal disease

The cause of periodontal disease was poorly understood until recently. It is not a severe form of gingivitis. In fact, the two diseases are caused by completely different bacteria. The bone loss that accompanies periodontal disease is actually an exaggerated immune system response. Your immune system will attack your bone in an effort to remove the bacteria and toxins. This auto-immune reaction is an inherited response, so if your parents had it, you probably do too.

Gingivitis and periodontal disease can occur together or separately. If you have periodontal disease without gingivitis, you will have bone loss and not necessarily experience sensitive or bleeding gums.

Periodontal disease can only be diagnosed using a full mouth series of X-rays and a full probing of each individual tooth. The disease can be localized to specific areas of the mouth or generalized throughout the entire mouth.

Severe bad breath, loose teeth, teeth that fall out by themselves and pus exuding from the gums can all be found in advanced periodontal disease. Periodontal disease is treatable, but it is not curable because it is genetic. In order to keep this disease under control, a person must be seen for follow-up treatment every three months or more frequently as needed.

The different types of cleanings

A prophylaxis is a preventative cleaning reserved for people who have healthy mouths. They may have a localized area of gingivitis, but no signs of periodontal disease (as determined by probing around the tooth) and no heavy bleeding during probing or cleaning.

A gross debridement is a cleaning that consists of a generalized removal of plaque and calculus in people with gingivitis or periodontal disease. This is usually done to allow better access and visibility for diagnosis and probing and to allow the gum inflammation to settle down prior to further treatment.

A scale and polish is usually done after a gross debridement on people with moderate to severe gingivitis or early periodontal disease. It is basically a fine-tuning to ensure removal of calculus under the gums and to get the patient on the road to health.

Root planing is treatment for mild to moderate generalized or advanced localized periodontal disease. It is usually preceded by a gross debridement. This is sometimes referred to as a “deep cleaning.” Antibiotic gels are used in conjunction with root planing to treat periodontal disease and may be placed at the same appointment as the root planing.

Periodontal cleaning is the treatment given to people with periodontal disease at a frequency of at least every three months to prevent further bone loss.

Your dentist will recommend the cleaning that is appropriate for you after a thorough examination with X-rays is done.

Glenski is owner of Definitive Dental Care in Palm Harbor, Fla. She has been practicing general and cosmetic dentistry since 1980 and is one of only eight dentists in the state of Florida accredited by the American Academy of Cosmetic Dentistry. Glenski is also a professor of anatomy and physiology at St. Petersburg College in St. Petersburg, Fla.

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