A dentist (or a dental assistant) performs cleaning of a patient’s teeth and gums as treatment. This cleaning may be preventative treatment (prophylaxis) to avert gingivitis, or it may be a therapeutic procedure performed on a patient who already has gum disease in varying stages.

When a patient comes into a dental office, the dentist will conduct a comprehensive examination on the patient in order to arrive at a specific, individual treatment plan. The treatment plan is based on a diagnosis made after a thorough examination performed using the available relevant diagnostic aids. When a dentist looks at the patient’s gums, he or she notes the gum’s colour, shape, and size. The practitioner records areas of the patient’s mouth that bleed on probing, pocket depth (between the tooth and gum), and gum recession. Based on a determination of whether the patient’s gums are healthy or unhealthy, the dentist will classify the cleaning as either preventive or therapeutic.
Preventive cleaning is what most patients think of as regular cleaning. Now, every dentist does regular cleaning differently. At my office, for instance, when a patient comes in for his or her first visit, I look at everything related to the patient’s teeth, including the jaws, the head and the neck. After that I make a diagnosis, facilitate relevant tests, followed by the treatment plan. Quite often, that examination reveals much more than is expected and the simple request for a cleaning may be a small part of oral health and rehabilitation. The worst case scenario could be a life threatening discovery.
Therapeutic cleaning often requires local anaesthetic. This is because calculus, which is calcified plaque that increases constantly, usually penetrates beneath the gum line, destroying bone and ligaments, and it has to be removed with an ultrasonic scaler. The gums in those areas become tender, painful, sometimes abscessed, and bleed easily. In such cases, it would be bad news for the patient if the disease process (chronic periodontitis) was allowed to perpetuate until the teeth involved begin to shake. This would signify that the support structure is no longer viable and depending on the degree of mobility, extraction remains the only option.
These types of cleaning, believe it or not, can be more important than even fillings because they represent the only professional procedure capable of preventing the widespread loss of teeth we humans now endure. While a tooth can be restored with filling, root canal therapy or crown, once its support structure is debilitated or destroyed by chronic bacterial infection, there cannot be any recovery and that irreparable damage results in the inevitable loss of the tooth implicated. Unfortunately, chronic periodontitis is generally insidious.
Many times, patients do not know that they have chronic periodontitis. They come to the dental office saying: “Doc, I spit blood when I am brushing my teeth”, or “Doc, I have these hard crusts on my teeth that the toothbrush cannot remove,” or worst: “Doc, most of my teeth are shaking badly but they do not hurt.” That is why it is so important to prevent all these from happening in the first place. Consult your dentist today. Do not wait until it is too late.
Written by Dr. BERTRAND R. STUART D.D.S