Dental Questions: Why Do I Need A Deep Cleaning?

According to recent estimates from the CDC, about half of all American adults have some form of periodontal disease. In these patients, gingivitis (inflammation of the gum tissue) has progressed to affect the bone and tissue levels around the teeth. The body's natural response to tarter (hardened plaque) is to lower the bone levels around the teeth, creating deep periodontal pockets.

In normal, healthy tissue, the pockets around the teeth have a depth of about 1-3 millimeters. With a toothbrush or floss, you can clean to a depth of about 4mm at home. Additionally, a toothbrush can remove soft, loose plaque but is ineffective at removing hardened tartar. Cleaning pockets deeper than 5mm or removing tartar from teeth requires the skills of a dental hygienist or a dentist. 

Patients with Severe periodontitis have pockets over 5mm on multiple sites throughout their mouths along with gum recession, bleeding and excessive tartar. For this group, a simple cleaning will not suffice. To manage their disease, a hygienist/dentist will provide a deep cleaning, also known as scaling and root planing.  Here, the gums are numbed so that the ulcerated tissue around the deep pockets is undisturbed by the cleaning process. The practitioner then proceeds to remove all tartar and plaque from the teeth, including the areas far below the gum line. This process is commonly performed over multiple appointments, so that your entire mouth is not numbed at once. 

The ultimate goal of a deep cleaning is to plane the roots of the teeth so that new tissue can heal around them, creating shallower pockets. However, the deep cleaning session is only a half treatment. We can get the teeth cleaned and ready to heal, but periodontal disease can only be managed long term with good oral hygiene- brushing twice a day for two minutes and flossing daily. 

Scaling and root planing is only one of many options in treating periodontitis. Depending on the location and severity of the disease, a general dentist or periodontist might recommend anything from a deep cleaning to gum surgery. As with everything in dentistry, a complete exam (including X-rays) is imperative in creating an appropriate treatment plan. If you would like to schedule an appointment today, please contact our office!

Examining the Anti-Flossing News

If you've been on the internet in the last month, chances are you've seen the AP article titled "Medical Benefits of Dental Floss Unproven." In this article, the author postulates that as the Department of Agriculture and Health and Human Services dropped flossing from its dietary recommendations, it comes to light that there is little to no scientific evidence that flossing is beneficial to oral health.

In dissecting this article, it is important to understand why dentists recommend flossing. The primary goal of flossing is to physically remove bacterial film (plaque) from the pockets between the gums and the teeth. As a secondary action, floss can dislodge food that gets stuck between teeth and help prevent decay. Floss cannot remove hard bacterial film (calculus/tartar) nor can it clean deep periodontal pockets. That being said, regular flossing will help prevent the development of these conditions to begin with. 

It becomes clear that the author of this story does not have a solid understanding of periodontal disease, oral health or scientific studies. One of the main points of the article is that there aren't any quality scientific papers that show the benefits of flossing. This fact more-so highlights the high costs and extreme difficulty in performing a study of this nature. Much of scientific research pivots on having reliable metrics and a large enough sample to get valuable data. Since flossing is so universally accepted in the dental community, securing the millions of dollars necessary to perform this study would be nearly impossible. 

Furthermore, the author argues that any evidence on flossing points to its benefits in reducing bleeding gums, removing plaque and stopping gingivitis. He seems to view these attributes in a vacuum, when in reality they are all part of the periodontal disease process. Plaque, when left undisturbed, eventually hardens into tartar. This then causes an inflammation of the gum tissue known as gingivitis. Gingivitis is responsible for the bloody, puffy and sensitive gums that many patients experience. With time, the inflammation spreads to the bone surrounding the teeth and causes it to recede creating deep pockets. At this point, the disease is called periodontitis. While it is true that floss will not reach the bottoms of these deep pockets, any reduction in bacterial load is beneficial and crucial to the treatment of periodontal disease.

The author is quick to note that "early gingivitis is a long way from severe periodontal disease" and that "severe periodontal disease may take five to 20 years to develop." What he fails to mention that slight or moderate periodontitis can develop much quicker (we usually see the first signs around age 30) and that the technical "severe" periodontal disease is a debilitating condition marked by loose teeth, chronic bad breath, pain and tooth loss. This is the exact same disease that started out as gingivitis. Why wouldn't you do everything in your power to mitigate this problem from the start? 

If you would like more reasons to keep flossing, just read any statements made by the ADA, the California Dental Association or the American Academy of Periodontology. The dental community shows unanimous support for the regular, daily use of dental floss. Furthermore, evidence shows that controlling periodontal disease is associated with less heart disease, better glucose control in diabetics and better outcomes in at-risk pregnancies. Flossing is an important part of your oral health home care! If you need any more information on the benefits of flossing or instructions on how to floss, feel free to contact our office!

Periodontists we work with

Properly managing your dental care can take a team of dentists, specialists and laboratories. For our patients that need the help of a periodontist, we are proud to work with Dr. Jeremy Wilgus of Camarillo Periodontics. His office combines the technology, expertise and compassion that our patients seek. 

If you have conditions such as deep pockets or periodontitis you may be referred to Dr. Wilgus. He specializes in a number of surgical and non-surgical techniques to improve gum health and repair damage. Beyond these services, his office offers various procedures to adjust and re-contour the gums. For some patients, a full cosmetic reconstruction will include visits to Dr. Wilgus for crown lengthening or grafting to create an ideal gumline. He is also an expert in placing implants in sensitive areas, such as the anterior teeth. If you would like to know more about periodontal services or why a patient might benefit from the services of a periodontist, please call our office! 

Dental Questions: What is Periodontal Disease?

Periodontal disease follows tooth decay as the most prevalent condition effecting the oral cavity. In fact, over half of all Americans have some type of problem with their periodontal tissues. It is important to understand the differences between the two main categories of periodontal disease- gingivitis and periodontitis.

The word "periodontal" identifies the tissues surrounding the teeth: the gums, bone, connective tissue and ligaments. These structures live in a delicate balance with the bacteria that exist naturally in our mouths. Over time, poor oral hygiene can allow the bacteria to colonize and grow around the teeth, leading to inflammation of the gum tissue. This first stage in periodontal disease is known as gingivitis. At this point, you might notice puffy, red gums that bleed during brushing or flossing. 

As the inflammation progresses and the bacterial colonies grow, the jaws start to undergo bony changes. Our bones will begin to grow away from the source of infection, leading to recession, pocket formation and loose teeth. These changes are associated with the more advanced form of periodontal disease known as periodontitis. 

Fortunately, there are a number or dental procedures aimed at stopping or reversing the effects of periodontal disease. It all starts with a dental exam to determine the extent of damage and assign an appropriate cleaning regimen. Patients with healthy tissue might just need a simple preventative cleaning, while others may benefit from a more intense procedure- such as scaling and root planing. If you would like to know more about periodontal disease, what causes it and how we can treat it, please contact our office!

Periodontitis in the United States

One of the main functions of the Centers for Disease Control (CDC) is to characterize the patterns and prevalence of diseases across the United States. Earlier this year, the CDC released a study that examined the gum tissue health of adults over the age of 30. They found that nearly of all subjects had some form of periodontitis (advanced state gum disease). That's nearly 65 million Americans!

Papers like these highlight both the importance of home care and the necessity of regular dental office visits. In most instances, periodontal disease is largely preventable. However, it requires a lifetime of proper oral hygiene and maintenance. This is one of the many reasons why we stress the importance of establishing good brushing and flossing habits starting at a very young age. Likewise, regular dental appointments allow a professional to monitor your progress and help keep you on the right track!

Like many things in life, maintaining proper oral hygiene is a collaboration between your efforts and the support of a dental healthcare team. Our office prides itself in not only treating our patient's problems, but also making sure they are equipped with the knowledge to prevent or manage further disease. If you would like to know more about gum disease, periodontitis or any other dental care topics, please give us a call. Our staff is always excited to teach the best practices in keeping your teeth and gums healthy!

Cleanings and Periodontal Maintenance

The most common and essential function of our office (and any dental office) is the administration of routine cleanings and exams. These are critical steps to your long term tooth preservation, decay prevention and gum care. However, many patients would likely be surprised to learn that there are an array of services offered under the “realm” of cleanings. In this article, we will uncover the different types of dental cleanings, who gets them, and their overall “goals” in terms of your oral health.

Before going into the different types of cleanings, it is important to understand a few key terms in diagnosing and treating gum disease. Please consider the following:

Plaque- A biofilm created by bacteria to allow it to better attach and anchor itself to the tooth.

Tartar/Calculus- The result of plaque hardening on tooth structure. This substance can cause rapid tooth decay and progression of gum disease. Additionally, it is very difficult to remove with home hygiene techniques.

Periodontal pockets- The depth of space between teeth and gums as measured by a “perio probe.” Pockets ranging between 1-3mm are considered healthy and maintainable with normal brushing. Anything deeper is the result of plaque/calculus irritating the gum tissue away from the tooth root.

Bone Loss- The loss of bone height around a tooth as a result of the body’s immune response to the long term presence of plaque and calculus.

A perio probe- The indentations show 1mm and 5mm intervals for measuring pocket depths. 

The majority of patients that come to our office receive what is called a prophylactic cleaning (or “prophy”). This is typically considered a standard cleaning that you would receive twice a year on a 6 month recall. The word “prophylactic” indicates that this type of cleaning is strictly preventative care. Here, the patient’s gum tissue is considered to be within the healthy spectrum- mild plaque and calculus, shallow periodontal pockets and no bone loss. Our hygienists will remove any buildup you have incurred since your last visit and make sure there is no progression of gum disease. The purpose of this appointment is to “prevent” your healthy gum tissue from progressing into the spectrum of periodontal disease.

Some patients fall within an in-between state of periodontal disease. While they do not have aggressive bone loss, their levels of calculus, gum recession and periodontal pockets are not within a healthy spectrum. For these patients, we usually recommend a periodontal recall cleaning. This service, usually administered in three month intervals, is a more aggressive maintenance of the teeth and gums. We are no longer preventing periodontal disease; widespread calculus inflammation and tissue detachment marks the clinical presence of disease. These patients are receiving dental scaling for multiple pockets over 4mm- much deeper than a toothbrush can clean. The ultimate goal of this appointment is to prevent moderate disease from progressing further, with the hopes that you will soon be back to normal “prophy” cleanings.

A diagram visualizing the difference between healthy and diseased gum tissue and bone. 

A final category of cleanings exist for individuals who typically have not seen a dentist in a number of years. These patients have excessive calculus, periodontal pockets greater than 4mm on almost every tooth and excessive bone loss over the entire mouth. Not only will home hygiene be insufficient to keep up with the progression of disease, but standard cleaning techniques will fall short as well. Here, we provide scaling and root planing for the the most invasive levels of calculus and plaque removal. The entire mouth is cleaned over two or four appointments, usually with an anesthetic. This type of procedure is usually recommended once to give your mouth a complete, thorough evaluation and cleaning. The goal is to set a healthier baseline for your mouth, so that it can be better managed by regular scheduled cleanings and your personal home care routine.

We recommend all of these periodontal services to a number of our patients for a number of reasons. Sometimes, unique situations will require a combination of approaches, the expertise of specialist or even surgical intervention. Only a thorough evaluation by Dr. Kari or one of our skilled hygienists will give us a true picture of your gum health. If you would like schedule an exam or cleaning, please contact our office. We are here to listen to your concerns and guide you every step of the way!

Dentistry in the News- Oil Pulling

If you turn on the news tonight, chances are you will see at least one article on harmful food additives, dangerous diets or other health scares. With so many alarming stories on the average american diet and wellness, many of our patients are trying alternative and holistic medical solutions. Today, we would like to cover one of these treatments that directly relates to dentistry and dental science; Oil Pulling. 

Oil Pulling is an ancient South-Asian practice of swishing or holding oil in the mouth. It arises from traditional Hindu medicine and is said to have incredible benefits for the entire body. In modern times, oil pulling is thought to aid in eliminating bacteria from the teeth and gums. The practice has been popularized by TV shows such as Dr. Oz and holistic medicine websites and blogs. Some believe that the oil can emulsify and trap bacteria, allowing it to be removed as the oil is expelled. Others argue that the action of swishing oil can push bacteria out of the gum tissue and hard to reach areas. No matter what proposed mechanism, the promise is a healthier mouth with lower bacterial counts.

The American Dental Association’s stance on oil pulling is that there isn’t enough conclusive scientific evidence to recommend it as a treatment for any oral condition. With papers suggesting both benefits and drawbacks, it is hard to reach a hard decision on if, how or why oil pulling works. At Thousand Oaks Family Dentistry, we feel that while oil pulling may not have any concrete medicinal benefits, there is relatively little harm in it’s practice. If you believe it can make your mouth healthier and cleaner, then feel free to try oil pulling. Our only advice is to use a quality (cold pressed) oil and to discard the oil into your trash (it can quickly harden and clog up bathroom sinks). Additionally, make sure you rinsing thoroughly after each pulling session and do not let the oil sit on your teeth for extended periods.

In short, we recognize oil pulling as a treatment many of our patients are utilizing. While you may see some health benefits, we want you to realize that there is no substitution for brushing twice a day, flossing and receiving regular dental cleanings. We know of no way to better maximize your oral health and minimize chances for disease and decay. As with any habit, if you notice oil pulling is having negative effects, stop treatment immediately. We want all of our patients to be happy and healthy. If you feel oil pulling can help get you reach that state, then feel free to add it to your existing home care regimen in a safe and controlled manner!