What To Expect

If you are unfamiliar with what to expect during a typical oral exam, you may find it extremely helpful to get an idea of the step-by-step process before your visit.

The dental examination is a systematic process during which your dentist will investigate many facets of your oral and systemic health in order to identify pathologies or concerns and develop a uniquely customized treatment plan that is catered towards maximizing your oral health while meeting your goals and expectations.

That said, let’s explore all the facets related to the oral exam at your dentist’s office:

1. The Medical History Intake

During the medical history intake, your provider collects information about you, including:

List of medications you are currently taking.
List of vitamins and natural healing remedies you are currently taking.
Smoking and alcohol consumption.
Allergy list.
Previous experience with anesthesia.
Adverse reactions to anesthesia.
Family member reactions to anesthesia.
Any medical conditions you are currently being treated for.
Previous surgeries or hospitalizations.

This information allows your dental hygienist and dentist to identify necessary precautions for treatment. It is an integral first step in treatment planning.

2. The Examination

The second step of any oral health exam involves a thorough examination of your teeth and supporting structures. While this may seem like a straightforward objective, it is its own process that involves the incorporation of various techniques, technologies and therapies.

Your dental hygienist explores every surface of every tooth to uncover new cavities and examine the quality of existing fillings with a crown horn, a commonly used dental instrument. Over time, fillings can break down and require replacement. They may also be replaced for improved esthetics. In fact, many people today opt to remove their older silver amalgam fillings and replace them with natural-looking composite fillings.

The hygienist uses a pigtail tool to check for calculus deposits.
If X-rays are necessary, your hygienist takes full-mouth X-rays or bitewings (molars and premolars) to detect abnormalities not visible to the naked eye.
Healthy gums adhere tightly to the teeth. If they don’t, then periodontal disease may be present or bone loss may be occurring. The dental hygienist typically performs periodontal probing to measure the circumference of each tooth and the strength of the supporting bone structure. A calibrated probe is inserted between the teeth and gums to measure (in millimeters) the level of “gum adherence” to the teeth. The hygienist then records a millimeter number for every tooth. The goal is to record a number of one, two or three. A number of four or more indicates periodontal disease and potential bone loss. If the gums do not tighten after the cleaning, you will be scheduled for a scaling or root planing appointment. For more severe cases, you will be referred to a periodontist for additional treatment.
Using scalers, curets (scoop-shaped instruments) and sometimes additional high-frequency ultrasonic scalers, the hygienist cleans each tooth. Cleaning is performed below the gum and between the teeth as well.
Your hygienist gently polishes the teeth to ensure that the enamel is not disturbed. Toothpaste or a combination of baking soda and water may be used to complete the polishing.
Fluoride treatment is the last step.

3. The Education

Following the investigative stage of your oral exam, your dentist will spend some time with you talking about his findings, concerns and any problematic issues. You may be advised to consult with a specialist if more complicated or advanced work is required. A treatment plan is discussed at this point in the visit.

Professional cleaning is recommended every six months or as often as every two months should you be at risk for periodontal disease, are a smoker or a diabetic. Even those who require deep cleaning or scaling at the standard six-month interval might be better served by more frequent cleanings to avoid further damage, disease and the more invasive treatment necessities (such as scaling and root planing) that can produce tooth sensitivity.
It is important to brush and floss teeth after every meal, at least three times a day. Brushing is done in front of, behind, and on top of every tooth to clean and polish the surface. Improper brushing such as brushing too hard can lead to enamel loss and gum recession. Flossing between teeth is done to remove debris that can cause bacteria to form. Your hygienist reviews brushing and flossing habits to ensure that you know how to perform them properly.
Nutritional habits also play a role in dental hygiene. Your hygienist reviews nutritional habits that support the teeth, gums and bone structure in the mouth. Special attention is given to people who suffer from bad breath (halitosis), dry mouth, tooth sensitivity and the like.
Your dental hygienist provides advice based on your individual needs. For example, smokers are informed that they face an increased risk for periodontal disease, which leads to tooth loss. Nail biters can be risking injury to the enamel on their teeth. Teeth grinders are informed that the dentist will speak to them about a mouth guard. Dental hygienists also have special treatment considerations for babies, youths and senior citizens.

Regular dental cleaning

Prophylaxis is designed to preserve health and prevent the spread of disease. The purpose of polishing tooth surfaces is to make these surfaces smooth which makes it more difficult for plaque and debris to accumulate on your teeth to cause decay or gum disease.

Dental polishing, or prophy, is rarely done at the first appointment due to restrictions applied by patients dental plans and is only done after completing the clinical exam if there is no presence of gum disease.

It is professionally defined as a procedure that includes scaling and polishing procedures to remove coronal plaque, calculus and stains deposits that are coronal only (which rarely exist) and is a scaling and polishing procedure for patients in a healthy oral state.

Professional polishing removes plaque, tartar, and stain from the teeth. It is a cosmetic procedure that removes surface stains on the crown part of the tooth or above the gumline so they will look and feel cleaner. However, this procedure is not a procedure that cleans infected, diseased gum tissue and root surfaces. This is only a superficial cleaning and will not eliminate disease or get it under control.

It’s main purpose is to improve the appearance of your teeth by making them look cleaner and brighter.

Since this polishing is a preventive procedure, it is completed only if the teeth are free from calcified plaque buildup and the gum tissue is healthy.

It’s “just a cleaning”…

Many people think of a dental polishing as the dental equivalent of car waxing. Actually, the combination of a prophy and a routine examination is the first-line defense against catastrophic dental problems. Years of experience has shown that the best way to prevent dental pain and expense is to prevent the problem in the first place… by brushing and flossing. At least half a dozen studies have shown that people with poor oral health tend to be at risk for heart disease.

When a bacterial strain commonly found in dental plaque was infused into the blood stream of rabbits by University of Minnesota researchers, they found the microbe quickly induced the same type of clotting that often leads to heart attacks. The bacterial infusion was also associated with increased blood pressure and a faster heart rate.

So whatever is making you want to delay your prophy and exam doesn’t matter to the harmful bacteria in your mouth; they will still multiply at their usual rate, and your risks will escalate. The easiest and least-costly thing you can do to protect yourself is to schedule your dental exam today.

Remember you not purchasing only a dental procedure you are making an investment, an investment in your future dental and overall health.

Debridement

Debridement is the removal of excessive amounts of plaque and tartar from your teeth. Debridement is done on people who have heavy plaque and tartar (calculus) build-up, usually because they haven’t visited a dentist in several years. The plaque and tartar accumulation on the teeth is so heavy that your dentist can’t see the teeth to examine them. Before he or she can do an exam, the plaque and tartar must be removed through debridement.

Preparation:
Some people who are very sensitive to pain might need local anesthesia for this procedure. Others might require some form of sedation, such as nitrous oxide. Often, people who avoid the dentist have some form of dental phobia, so anesthesia or sedation may be necessary to make them comfortable.

How It’s Done:
Debridement is done with a combination of hand instruments and an ultrasonic device. This device uses water and high-frequency vibrations to dislodge plaque and tartar from the teeth.

Follow-Up
Debridement is usually the first phase of comprehensive periodontal treatment. After completing the debridement, your dentist will re-evaluate your teeth to determine the appropriate course of therapy, which may involve scaling and root planing or periodontal surgery.

Risks
If your gums are inflamed they can bleed during the procedure. In some cases, you may notice that your teeth are sensitive to temperature (hot and/or cold) after debridement. This occurs when the roots of the teeth are exposed following the removal of plaque and tartar.

Infection is possible after debridement, but it is very rare.

Scaling and Root Planing

Scaling and root planing is the most common and conservative form of treatment for periodontal (gum) disease. Scaling is the removal of calculus (commonly called tartar) and plaque that attach to the tooth surfaces. The process especially targets the area below the gum line, along the root. Plaque is more likely to stick to rough surfaces. For this reason, the root surface is smoothed down in a process called root planing. Root planing removes any remaining calculus and smoothes irregular areas of the root surface.

Plaque is a sticky substance, full of bacteria, that forms on teeth. When plaque hardens over time, it is called calculus.

What It’s Used For:
Bacteria cause periodontal disease. Plaque and calculus provide an irregular surface that allows these bacteria to attach easily. Scaling and root planing are done to remove them. For early stages of the disease, this treatment may be all that is needed to get the condition under control. This is especially effective with gingivitis. With more advanced gum disease, scaling and root planing may be the first step before surgery.

Preparation:
For some patients, scaling and root planing can cause discomfort. A local anesthetic may be used to numb the portion of your mouth that is being worked on.

How It’s Done:
Scaling and root planing are done with a combination of ultrasonic scalers and hand instruments. Ultrasonic instruments are electric or air-powered. They have two components:

A relatively dull metal tip that vibrates at a very high frequency and “knocks” plaque and calculus off the tooth
A water irrigation system that cools the tip and helps to flush out debris from around the teeth

Hand instruments are not powered. They have cutting edges that your dentist or hygienist uses to chip away plaque and calculus. These instruments come in various shapes and sizes. Different instruments are used for different teeth, and even for different surfaces of the same tooth.

Typically, ultrasonic instruments are used first to remove large deposits of plaque and calculus from the crowns and roots of the teeth. Hand instruments called scalers and curettes are then used to remove any remaining material and make sure that the tooth surface is clean and smooth. When working under the gum line, your dentist or hygienist cannot see the plaque or calculus. He or she will rely on the sense of touch to feel for roughness on the root surface.

Sometimes, scaling and root planing can be completed in one visit. This usually is possible if you have gingivitis, the earliest stage of gum disease. However, if you have periodontitis, multiple visits are usually needed. The periodontist typically will do a quarter of your mouth (a quadrant) at each visit.

Follow-Up:
For two to three days after the treatment, you may have some soreness and be sensitive to hot and cold temperatures. Over-the-counter pain relievers can help.

You may be asked to use an antiseptic mouth rinse after scaling and root planing. This is especially likely when soreness of the gums prevents effective oral hygiene measures. However, you should continue brushing and flossing as usual. You can expect some minor bleeding in the first days after scaling and root planing. This usually stops within a week.

Risks:
Treating periodontitis decreases gum inflammation. It also eliminates periodontal pockets, which can trap plaque. Therefore, if treatment is successful, the swelling will be gone and your gums will shrink or recede.

The extent of shrinkage depends on the initial depth of the pocket and the severity of periodontitis. The more severe the disease, the more your gums will recede after successful therapy. As a result, some part of the root is exposed. This makes the tooth look longer. It also will be more sensitive to heat and cold. To prevent root cavities, your dentist may prescribe a fluoride-containing gel. It’s also important to control plaque.

If your medical doctor has told you that you need to take antibiotics before certain dental procedures, tell your dentist or hygienist about this before you undergo scaling and root planing.

Fluoride

Enamel, the outer layer of the crown of a tooth, is made of closely packed mineral crystals. Every day, minerals are lost and gained from inside the enamel crystals. These processes are called demineralization and remineralization.

Demineralization is when acids in the mouth dissolve the enamel crystals that make up the outer layer of the tooth. These acids are formed by the combination of plaque bacteria and sugar in your mouth. The loss of enamel is balanced by remineralization. In this process, minerals such as fluoride, calcium and phosphate are deposited inside the enamel. Too much loss of minerals without enough replacement leads to tooth decay.

Fluoride helps teeth in two ways. When children eat or drink fluoride in small doses, it enters the bloodstream and becomes part of their developing permanent teeth. This also makes it harder for acids to cause demineralization. In addition, fluoride works directly on teeth in the mouths of children and adults. It helps to speed remineralization and disrupt the production of acids by bacteria.

Fluoride Treatments:
Fluoride in foods, supplements and water enter the bloodstream through the stomach. From there, it is absorbed into the body. In children, the fluoride then becomes available to the teeth that are developing in the jaw.

Topical fluoride products are applied directly to the teeth. They include toothpaste, mouth rinses and professionally applied fluoride treatments. Topical fluoride treatments are in the mouth for only a short time. However, fluoride levels in the mouth remain higher for several hours afterward. Fluoride found in the water and in food products also works this way because the water washes over the teeth and some fluoride remains in the saliva.

Fluoride treatments are given in a dental office. They are applied as a gel, foam or varnish. The fluoride used for these treatments is at much higher strength than mouthwashes or toothpastes.

Fluoride supplements also are available by prescription. They usually are reserved for children who live in areas where the water supply does not contain enough fluoride. Children who need supplements receive them from ages 6 months to 16 years.

Fluoride Supplements: Who Needs Them?
Children between 6 months and 16 years old who do not drink fluoridated water should take fluoride supplements . They are available as liquids for younger children and tablets for older children. Either your pediatrician or your dentist can prescribe them.

All children should use fluoridated toothpaste. If your children are younger than 6, be cautious about how they use it, however. Young children are more likely to swallow toothpaste after brushing instead of spitting it out. Use only a pea-sized amount of toothpaste when they brush. Encourage them to spit out as much as possible. Avoid flavored toothpastes that might encourage swallowing.

If your child has a history of cavities or is at high risk of decay, he or she should use additional fluoride. This will promote remineralization. Fluoride mouth rinses are recommended for children over the age of 6. They are found in the mouthwash section of most stores.

Your dentist can prescribe fluoride rinses and gels if your child needs a higher level of fluoride. Carefully supervise your children when they use any fluoride product. Keep fluoride out of reach of young children.

Can Fluoride Cause Harm?
As with other compounds, fluoride is safe and effective when used properly. It can be hazardous at high doses, however. All water-fluoridation systems are checked daily to maintain safe fluoride levels. Parents should supervise the use of all fluoride products in the home.

Fluoride-supplement tablets should be stored safely away from young children. These supplements are taken each day in small quantities. The dose can range from 0.25 to 1 milligram per day based on the child’s age and the amount of fluoride in the water.

Dentists limit the amount of tablets they prescribe at one time to reduce the risk of overdose. To avoid any chance of overdose, do not stock up on fluoride tablets. If you have any questions regarding fluoride risks, talk to your dentist or physician.

Toxic fluoride doses are based on weight. For example, the toxic dose of fluoride for a 2-year-old child weighing 22 pounds is 320 milligrams. For an 8-year-old child weighing 45 pounds, the toxic dose is 655 milligrams.

In comparison, an 8-ounce glass of water fluoridated to 1 part per million contains 0.25 milligrams of fluoride. Since these fluoride products are used in such small amounts, it is very difficult to receive toxic doses when using fluoride products at home.