My dentist recommended I have this cleaning done, and since I am very anxious about dental work, I researched the procedure on the internet, and everywhere said that it is normally done in steps, sometimes 4 or 5, and takes about an hour, with craping under the gums. Well, I went today and all they did was scrape my teeth, like in a normal cleaning. No polish, no fluoride, no flossing.....and it took like a half hour. So it didn't hurt so bad, but the issue is this: My dental insurance pays 100% for regular cleaning, and only 25% for periodontal. I fell like I get more done in a regular cleaning!!! Should I ask the office what is going on? I work in the insurance field, so I am kind of wary that I am getting ripped off.
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I'm a dental hygienist and I do this procedure daily. (and I know it was just a typo but I laughed out loud when you typed "craping under the gums" instead of "scraping"!!!! Don't think I'll ever do that!!) You should definitely speak with the dentist about the procedure you had done and ask him to explain to you how it was different from a regular cleaning. I always fully explain what I'm doing and why I'm doing it; an educated patient is the best thing for me. In a regular prophy appointment (just a normal routine cleaning) the teeth are scaled ("scraped") both above and below the gumline (unlike what the other person who posted above said...the hygienist always cleans below the gumline). Then when all surfaces have been scaled, the hygienist will polish any residual stain off the teeth. A patient that requires a periodontal therapy needs this because over time, they haven't taken good care of their teeth and gums and because of this, tarter has built up heavily below the gumline (where a brush can't reach and if you haven't been flossing regularily, the gunk under there that started out as soft plaque you could have flossed out is now hardened to a concrete-like chunk you can't remove yourself) I tell my patients that the tarter is much like a splinter under your skin, it irritates the gum tissue both physically and chemically because it's decaying bacteria that gives off toxins. The gums do not like it being there and your body tries to defend itself by sending white blood cells to the area, thus increasing blood flow and swelling in that area. Gum disease usually does not cause any pain, but you may notice that the gums are red and/or swollen and almost always have bleeding when you do brush and floss. Healthy gums should never bleed. After the gums have been irritated awhile, they react by pulling away from the source of the irritation, they recede. And the gums don't just pull away and leave raw bone, when they recede, they trigger the bone underneath to start to dissolve too. The bone and the supporting soft tissue structure of the gums and ligaments are what hold you teeth in place so the loss of these structures is very significant....lose them and you will eventually lose your teeth! Your dentist and hygienist should show you the tarter build up and bone loss on your xrays. A patients xrays are the best teaching tools I have! Ask them to show you and explain. When you can see the cause and effect for yourself, it begins to make sense. So now, the treatment is to remove the source of infection/irritation and that requires a scaling or deep cleaning as some offices call it. If you go to a periodontist (a dentist who specializes in gum disease), the extreme method of doing this procedure is to do "flap surgery" where they do cut the gums into a flap, lay it down to expose the root surface which they clean thoroughly, then stitch the flap back in place. This is pretty extreme and it does work quite well but it's painful and expensive and many patients simply won't go through that. If you do this through your general dentist, they won't do the flap surgery, just deep clean and they will do the procedure in steps, as you noted. Usually they will do a quadrant of the mouth at a time (such as lower right, then lower left, upper right, then upper left) and then after about a 2 week period when that's all done, I have my patient come back in for one more appt. where I check how well the tissue is healing and go over any areas where it doesn't appear to be healing as well, evaluate how well the patient is doing at home with brushing and flossing (if I see new fresh plaque and tarter build up, they aren't doing a very good job and I go over it with them again) and then I polish the teeth. In my office, we break it down to 3 appts. because I do an entire arch at a time, the lowers on the first appt. and then the uppers on the next, then the follow up appt in 2 weeks. When I do a periodontal scaling and root planing, it differs from the regular cleaning on a patient without gum loss because I have to reach much further down onto the root surface below the gumline due to the bone loss. There is a gap, which we call a "pocket" between tooth and gum where all the bacteria and "crud" gets stuck. That pocket is deep in a perio-involved patient and we take our instruments (often using an ultrasonic cleaner that isn't sharp, no scraping, just uses sound waves to "jiggle" the tarter off) all the way to the bottom of that pocket and also smooth off the rough surfaces of the root of the teeth as we go (it's harder for new build up to attach to a smooth surface than it is to a rough one, that's why we smooth it out.) This is a very thorough, deep cleaning. It should not hurt, no more than mild discomfort. You may notice alot of bleeding as she is working, that's normal as the gums are swollen with extra blood and this is just releasing that inflamation. Yes, it's more involved than a regular cleaning and again, if you look at the xrays compared to the xrays of a healthy mouth, you can see why. It's important to remember that periodontal disease is not something we can CURE, it's something we can MANAGE. When bone is gone, it's gone, it will not grow back neither will the gums. BUT if the area is cleaned out well and kept clean by the patient at home and with regular 6 month cleaning appts. the perio problem can be slowed or halted at that point. You have valid questions and you should have been educated about this procedure, why you needed it and what to expect. Sounds like your dentist/hygienist dropped the ball on that. Go back and ask about it, ask to see the xrays, etc. Good luck!
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