Cleaning

What are dental cleanings (“scale & polish”) and why have them?
Dental cleanings involve removing plaque (soft, sticky, bacteria infested film) and tartar (calculus) deposits that have built up on the teeth over time. Your teeth are continually bathed in saliva which contains calcium and other substances which help strengthen and protect the teeth. While this is a good thing, it also means that we tend to get a build-up of calcium deposits on the teeth. This chalky substance will eventually build up over time, like lime scale in a pipe or kettle. Usually it is tooth colored and can easily be mistaken as part of the teeth, but it also can vary from brown to black in color.

If the scale or calculus (tartar, as dentists like to call it) is allowed to accumulate on the teeth it will unfortunately provide the right conditions for bacteria to thrive next to the gums. The purpose of the cleaning and polishing is basically to leave the surfaces of the teeth clean and smooth so that bacteria are unable to stick to them and you have a better chance of keeping the teeth clean during your regular home care.

The professional cleaning of teeth is sometimes referred to as prophylaxis (or prophy for short). It’s a Greek word which means “to prevent beforehand” – in this case, it helps prevent gum disease.

How are dental cleanings done?
The dentist or dental hygienist uses specialized instruments to gently remove these deposits without harming the teeth. The instruments which may be used during your cleaning, and what they feel like, are described below.
Ultrasonic instrument
Commonly used first is an ultrasonic instrument which uses tickling vibrations to knock larger pieces of tartar loose. It also sprays a cooling mist of water while it works to wash away debris and keep the area at a proper temperature. The device typically emits a humming or high pitched whistling sound. This may seem louder than it actually is because the sound may get amplified inside your head, just like when you put an electric toothbrush into your mouth.
The ultrasonic instrument tips are curved and rounded and are always kept in motion around the teeth. They are by no means sharp since their purpose is to knock tartar loose and not to cut into the teeth. It is best to inform the operator if the sensations are too strong or ticklish so that they can adjust the setting appropriately on the device or modify the pressure applied.

With larger deposits that have hardened on, it can take some time to remove these, just like trying to remove baked-on grime on a stove that has been left over a long time. So your cleaning may take longer than future cleanings. Imagine not cleaning a house for six months versus cleaning it every week. The six-month job is going to take longer than doing smaller weekly jobs.

Fine hand tools
Once the larger pieces of tartar are gone, the dentist or dental hygienist will switch to finer hand tools (called scalers and curettes in dental-speak) to remove smaller deposits and smoothen the tooth surfaces. These tools are curved and shaped to match the curves of the teeth. They allow smaller tartar deposits to be removed by carefully scraping them off with a gentle to moderate amount of pressure. Just like taking a scrubbing brush to a soiled pot, the dentist or dental hygienist has to get the areas clean and smooth.

Root planning
This is the cleaning of the roots of teeth or cleaning of the teeth under the gum line.Root planning is used to treat periodontal conditions which are moderate to advanced gum diseases. When the gum is inflamed the pockets between the gum and teeth become deeper and they loose bone connections inside. The deeper these pockets are the easier it is for them to trap plaque deposits and make the gums worse.
Sometimes local anesthesia is needed to prevent any feeling of pain and depending on the degree of difficulties, root planning can take more than one dental visit.

Polishing
prophy angleOnce all the surfaces are smooth, the dental worker may polish your teeth. Polishing is done using a slow speed handpiece with a soft rubber cup that spins on the end. Prophylaxis (short for prophy) paste – a special gritty toothpaste-like material – is scooped up like ice cream into the cup and spun around on the teeth to make them shiny and smooth.

Fluoride

Your dentist may also apply fluoride. This is the final, and my favorite part of the dental cleaning! Fluoride comes in many different flavors such as mint, strawberry, cherry, watermelon, pina colada like ice cream at a parlor for a great taste sensation! Make no mistake though, this in-office fluoride treatment is meant for topical use only on the surfaces of the teeth and swallowing excessive amounts can give a person a tummy ache as it is not meant to be ingested.

Fluoride foam or gel is then placed into small, flexible foam trays and placed over the teeth for 30 seconds to a minute depending on the type used. Afterwards the patient is directed to spit as much out as possible into a saliva ejector. The fluoride helps to strengthen the teeth since the acids from bacteria in dental tartar and plaque will have weakened the surfaces. It is best not to eat, drink or rinse for 30 minutes after the fluoride has been applied.

Is it going to be painful?
Most people find that cleanings are painless, and find the sensations described above – tickling vibrations, the cooling mist of water, and the feeling of pressure during “scraping” – do not cause discomfort. A lot of people even report that they enjoy cleanings and the lovely smooth feel of their teeth afterwards! There may be odd zingy sensations, but many people don’t mind as they only last a nanosecond.

Be sure to let your dentist/hygienist know if you find things are getting too uncomfortable for your liking. They can recommend various options to make the cleaning more enjoyable.
Painful cleaning experiences can be caused by a number of things like exposed dentine (not dangerous, but can make cleanings unpleasant), or sore gum tissues.

In case you may have had painful cleaning experiences in the past, switching to a gentle hygienist/dentist and perhaps a spot of nitrous oxide (laughing gas) can often make all the difference. You could also choose to be numbed. If you opt for local anesthetic, you may want to break down the cleaning into 2 visits: dentists don’t like numbing both sides of the mouth at the same time, because people may accidentally bite their tongue until the numbness has worn off. If you find the scaling a bit uncomfortable because the gum tissues (rather than the teeth themselves) are sensitive, topical numbing gels can be used.

Pre-medications
If have a heart condition, or have undergone heart surgery, it is extremely important to let the dentist know prior to the day of the teeth cleaning. Those with heart problems or heart defects or patients following certain surgeries are at high risk for developing a condition called bacterial endocarditis, which can seriously affect the heart. The only treatment needed prior to a dental cleaning, unless otherwise instructed, is a dose of antibiotics an hour before the cleaning. Check with your family doctor or heart specialist before hand to find out if you need these antibiotics and what dosage.