Hygienist Treatment
My dentist used to clean my teeth, why do I have to see a hygienist now?
Back in the day the dentists used to do a quick scale and polish as part of the check up appointment. This was a quick way to remove the tartar build-up above the gums and from only a few teeth, followed by a polish with polishing paste to remove any surface staining. This treatment was a little more thorough than brushing and flossing at home.
Scaling and root planing, which is performed by the dental hygienist, is more comprehensive and therefore takes longer and can often be uncomfortable, especially if there is active inflammation and disease. The hygienist removes the tartar that is built up above and under the gumline, as well as removes any bacteria that is causing the gum disease by using a combination of ultrasonic and hand scalers. This is then followed by a polish with polishing paste to remove any surface staining. Scaling and root planing is the only way to remove bacteria that builds up under the gums causing gum disease and is considered preventative treatment.
What is a dental hygienist/ oral health therapist?
A Dental Hygienist or Oral Health Therapist is a registered health professional and has graduated from an accredited school of dental hygiene. In order to practice in New Zealand, dental hygienists need to be registered with the Dental Council of NZ and have an annual practicing certificate (APC). Dental Hygienists are trained specifically in the provision of oral health education and the prevention of oral disease to promote healthy oral behaviours. Their objective in the management of patients with gum disease is in prevention of gum diseases (Gingivitis and Periodontitis) and the non-surgical treatment of periodontal diseases. This includes scaling, root planning, tooth polishing aimed at removing plaque and calculus deposits and stain from the tooth and tooth root surfaces. Dental hygienists practise as part of a team with clinical guidance provided by a practising dentist or dental specialist (Periodontist). In some cases the dentist and dental hygienist will need to refer the patient to a specialist periodontist for further treatment.
What is hygiene treatment?
Scaling & Root Planing (a.k.a. Non surgical treatment/ Hygiene treatment)
Scaling refers to the professional removal of soft plaque and hard calculus (tartar) deposits from the teeth as well as around and below the gum line. This is a non-surgical treatment. It is undertaken using hand instruments (scalers or curettes) and/or sonic/ultrasonic instruments which use high frequency vibrations to help remove these deposits from the tooth surface.
Root planing is an extension of scaling which involves getting down further under the gum line to remove plaque and tartar from the tooth root surface. This is usually undertaken while the gum tissues are numb with dental anaesthetic so that the treatment can be performed painlessly. Scaling and root planing aim to provide a clean smooth tooth and root surface in order that the gum tissue/ attachment has a chance to heal around the tooth. Both scaling and root planing are non-surgical treatments. Scaling and root planing may sometimes be combined with antibiotic treatment to assist in the management of the gum infection.
Regular hygiene treatment performed by the dental hygienist can stabile gum disease as well as prevents it in the first place. How often you need to come and get the tartar removed will be assessed by your dental hygienist at your first visit.
What happens during a hygiene treatment?
Please allow an hour for your first appointment. The dental hygienist will check your medical history and ask you some questions about your oral care habits and previous dental experiences. This is so that the dental hygienist can assess any risk factors that may impact on your hygiene treatment or healing. It is really important to disclose your whole medical history as certain conditions and medication can hinder treatment and after care.
Then the dental hygienist will do a thorough periodontal assessment – this involves checking the oral tissues, probing of pocket depths and recession, checking for signs of oral cancers, checking for mobility and assessing your brushing, flossing or special cleaning techniques. At this point the dental hygienist will discuss with you about your gum condition, go over recommended home care (with demonstration if need) and then discuss the proposed treatment options.
Once consent has been obtained the dental hygienist will start the scaling (and root planning if needed) – this involves scaling with sonic/ultrasonic and hand scalers. Some people find hygiene treatment very uncomfortable, even painful – your dental hygienist will discuss options with you to make the treatment as pain free as possible. Remember the healthier the gums, the less painful the treatment. Regular hygiene treatment will help prevent further inflammation and infection that causes pain to gums.
Once the tartar is removed the dental hygienist will polish the teeth with polishing paste to remove residual staining. Once the scaling, root planning and polish are done the dental hygienist will discuss with you about your recall – this is the recommended time you should be coming back to get the hygiene treatment so we can prevent further disease.
If you are taking warfarin, we will need to know your latest INR count on the morning of your appointment – this is to prevent uncontrolled bleeding during your hygiene appointment. The reception staff will ask for the INR count when they confirm your appointment.
Your hygienist cannot do a general check-up. If you have problems with your teeth you will have to see a dentist for consult and treatment. Please note that if you have not been for a dental check for many years or if there is a problem with your teeth or oral tissues your hygienist may refer you to the dentist before any hygiene work is undertaken.
What is gum disease?
There are two main types of gum disease (periodontal disease) – gingivitis and periodontitis.
Gingivitis - an inflammation of the gums - is the initial stage of gum disease and the easiest to treat. The direct cause of gingivitis is plaque - the soft, sticky, colourless film of bacteria that forms constantly on the teeth and gums.
If the plaque is not removed by daily brushing and flossing (or interdental cleaning), it produces toxins (poisons) that can irritate the gum tissue, causing gingivitis. Eventually this soft plaque will calcify into tartar (calculus) that can only be removed by a dental professional. At this early stage in gum disease, damage can be reversed since the bone and connective tissue that hold the teeth in place are not yet affected. Left untreated, however, gingivitis can become periodontitis.
Periodontitis is caused by bacteria that attach to the teeth at the gum line and result in an infection. Your body tries to fight the infection. Some of the substances that your body produces can be harmful. They damage the jaw bone and the ligament around the teeth. If this process continues, the teeth become loose. Pockets form between the teeth and gums. These pockets are places where more bacteria grow and more tartar can build up. If your periodontitis is not treated it can cause permanent damage by destroying the jaw bone which holds the teeth in place. The bone deterioration is permanent and this causes the teeth to become loose and even fall out.
An increasing amount of research also suggests that there is evidence linking chronic periodontal disease to conditions such as coronary heart disease, diabetes and respiratory disease. Moreover, current research suggests that if you have periodontal disease during pregnancy you may be significantly more likely to have a baby born prematurely or with a low birth weight. Keeping your gums healthy will ensure a better chance of good general health.
Risk factors for gum disease
Lack of plaque removal is not the only thing that can contribute to gum disease. There are many risk factors that may make a patient more prone to getting gum infection.
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Smoking and tobacco use
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Genetic factors
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Diabetes
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Other systemic diseases
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Poor nutrition and deficiencies
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Stress
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Hormones, pregnancy and puberty
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Medications
Your dentist and dental hygienist will assess any risks you may have and provide you with advice and work with you to achieve a healthy mouth. For more in depth information about the listed risk factors please visit http://www.perionz.org/what-is-periodontal-disease/#risk-factors-for-gum-disease.
How do I Know if I have gingivitis?
Classic signs and symptoms of gingivitis include red, swollen, tender gums that may bleed when you brush. Another sign of gum disease is gums that have receded or pulled away from your teeth, giving your teeth an elongated appearance. Gum disease can cause pockets to form between the teeth and gums, where plaque and food debris collect. Some people may experience recurring bad breath or a bad taste in their mouth, even if the disease is not advanced.
What can I do to prevent gum disease?
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Make sure that you are removing the plaque bacteria daily though twice daily brushing and once a day cleaning in-between the teeth. Mouth wash can help reduce the bacteria in the mouth but it will not physically remove plaque so you still need to brush and clean in-between the teeth daily.
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Get regular dental checks and radiographs to help monitor for any signs of bone loss, gum disease and infection.
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Get regular hygiene treatment with the dental hygienist to keep on top of the tartar and bacteria, which can cause the gum disease.
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Make sure you eat a balanced diet so that your body can get the vitamins and nutrients it needs to have a healthy functioning immune system for healing.
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Keep hydrated with water throughout the day in order to keep the mouth clean and moisturised.