You show up for your dental appointment expecting your free cleaning and your dental providers explain that you will instead need a deep cleaning that will cost you hundreds of dollars. If this sounds familiar, you are not alone! This scenario plays out in dental offices around the country thousands of times every day. Gum disease is one of the least understood diseases in our body and we as a profession have not done a good job of explaining it to our patients. Some studies estimate that over half of all Americans have gum disease so there is clearly a huge disconnect. Let’s take a dive into this issue.
“What in the world is gum disease anyway?”
Since our mouth is part of our digestive system, it’s filled with many types of bacteria. I simplify them as “teeth bacteria” or “gum bacteria”. Gum bacteria love to hide in dark spaces, usually underneath your gums. They have a very unique feature in that they love to call their friends and form a web of colonies called biofilm. Biofilm starts off soft and whitish. In fact, if you wake up in the morning and scrape your teeth and gums you will see the white film on your nails. The only way of removing these bacterial colonies is to physically scrape them off by brushing and flossing. Here is the frustrating part, no matter how good we are at brushing and flossing, studies show that every 3-4 months these bacteria colonies get so strong they start to harden up like rocks. We call these bacterial “rock formations” calculus.
“Who cares if I have bacteria, it doesn’t bother me at all”
The bacteria living in these colonies now start to cause gum inflammation, redness and bleeding, we call this gingivitis. If you let months and years go by then the bacteria start to eat away at your bone and the foundation around your teeth, this is what we call periodontitis or gum disease. Once bacteria eat away at your bone, that bone is gone forever, it is nearly impossible to regain that bone. You can imagine with years of bone loss the foundation around your teeth will become weak, you will eventually get loose teeth, develop pus and bad breath in your mouth. Unfortunately this is often when a lot of patients come to see the dentist for help. When gum disease gets to that level of severity, we have very few options to help our patients and oftentimes patients may end up losing teeth.
“So I need to get cleanings twice a year?”
This is why we recommend having your gums and bone evaluated by your dentist or hygienist at least twice a year, that’s the bare minimum. Getting preventative cleanings when your gums are healthy is the best way to PREVENT gum disease. We use special tools to blast away these bacteria homes before they can become too big. Getting a healthy mouth cleaning twice a year is an arbitrary precedent set by dental insurance companies. Though twice a year is fine for most patients, there are many patients in our office who get cleanings 3-4 times a year to prevent gum disease or maintain their gum health.
“Why can’t you just do the free cleaning if I have gum disease?”
The free cleaning that is covered by most insurance plans is called a healthy mouth preventative cleaning. It involves cleaning above and around the gums, it’s meant for patients who don’t have gum disease. When we start to see signs of gum disease we now have to do gum therapy to get rid of that disease that’s below your gums. A free healthy mouth cleaning is typically an hour, a gum therapy appointment can often be 2-3 hours and involve multiple visits. We typically will numb your gums to get you comfy and use specialized tools to get to bacteria that have made homes deep below your gums. This procedure needs to be done meticulously to make sure we remove as much of the bacteria as possible. Since this procedure requires so much time and specialized equipment, it has to be billed out as a separate treatment code.
“Well my dentist did the free cleanings for years, he never mentioned any gum disease?”
As medical technology is improving so is our ability to catch disease that was once missed. Everything from heart disease to cancers are now screened and caught earlier than we were able to 20 or 30 years ago. As dental technology improves with the advent of digital x-rays, we are now able to analyze and catch gum disease that might have been missed in the past. In fact, in our office we are rolling out a machine-learning computer software that analyzes x-rays to catch cavities and gum disease that might have once been missed by the human eye. In fact, if a dentist or a hygienist does a healthy mouth cleaning on a patient and leaves behind active gum disease below the gums, they risk losing their dental license from supervised neglect. It was very common in the past for patients to lose their teeth from gum disease but because of our improved treatments, this is becoming more and more rare. We now routinely see patients in their 80s and 90s with all their natural teeth.
“I did this gum therapy/deep cleaning just a few years ago, how come I have to do it again?”
If we have a professional cleaning service do a deep clean in our homes, then never do any routine cleanings or hire the professionals again then very soon our house will be pretty dirty again. Our mouths are the same way, every 3-4 months the bacteria in our mouths will return to large numbers and they will need to be cleaned to maintain your gum health. We recommend all patients with gum disease see the hygienists every 3-4 months for their gum maintenance after their initial gum therapy treatment. You can’t cure gum disease and you can’t reverse gum disease but you sure can stabilize it for years and decades.
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