The Hygienist

"Healthy Gums-The prerequisite to all successful dental treatement"

Tags: dentist, london dentist, nhs, whitening, inman aligner, cosmetic dentist, checkup, dental, anish, anish dentist, london hygienist, dental hygiene.

by Mr Anish Patel
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A fantastic ad campaign from Colgate. Not even an extra hand gets more attention than ones teeth!

Overview

Healthy gums are the foundations of all dental treament. We offer cleans with our dentist and hygiensit to remove heavy staining from coffee, tea, wine and smoking. We aim to restore gum health on the NHS when there is tar-tar preventing you from accessing the gums for cleaning and work with you to build stable foundations for long-term oral health.

During your checkup we would have spotted the signs of gum disease (gingivitis or periodontitis) and given you a score based on your gum health. The basic score is what we use to evaluate further treatment for your gums:

Basic Periodontal Examination Score and relevance to treatment we prescribe

  • 0 - No gum treatment, just reinforce oral health advice.
  • 1-Bleeding gums- Brushing technique advice and we may prescribe medicated mouthwash.(Gingivitis)
  • 2- A plaque retentive factor-Means anything that habours plaque and needs removing or refining. These include tar-tar (use an ultra-sonic/hand scaler to remove) or a poorly placed filling.
  • 3- Probable pockets 3.5mm-5.5mm. We would conduct all the above and a full periodontal 6-point pocket chart for that area. Then arrange for you to have a deep (below-gum) clean in that quadrant of your mouth repeated every 3 months and until the disease has resolved. (Moderate periodontitis)
  • 4- Probable depths of 5.5mm and above. If widepspread referring to a specialist (periodontist) will be indicated.(Severe periodontitis)
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What Caused This?

Poor oral hygiene (major cause),concurrent smoking, and diabeties( aggravating causes) are the main contributing factors to gum disease (periodontitis). Poor oral hygiene is the result of in-effective brushing and infrequent professional cleans, consequently allowing tar-tar and plaque to build up around the gum level.

Smoking is thought to restrict blood flow to your gums which can prevent your body from fighting off harmful bacteria in plaque. Uncontrolled diabeties is well know to alter the the lining of vessels and the immune status of an individual, which like smoking prevents the body from fighting back. Periodontal bacteria left unchecked will eventually lead to TOOTH LOSS caused by inflammation and destruction of the bone, ligaments, gums,and cementum (collectively known as the periodontium) if left untreated for long periods of time.

The Procedure

Non-Surgical Supra-Gingival General Scale And Polish

1.  Simply involves the ultra-sonic scaler to remove tar-tar from above the gums and if you have not had a clean in some time you may experience some sensitivity. This is completely normal.

2.  We follow this with a polish of your teeth. This leaves them feeling smooth and prevents plaque adherinng to any rough surfaces left after the clean.

Non-Surgical Sub-Gingival Scale With Local Anaesthesia

1.  If tar-tar far extends below your gums we start by placing a small amount of local anaesthetic. This removes all pain sensation in the area we are treating.

2.  Once suitably numb, we start by removing all tar-tar above and below the gums with the ultra-sonic and hand scalers. It is areas below your gums that no toothbrush or mouthwash can get to, and will need to be mechanically removed by us.

3.  We normally only do one quarter or half of your mouth at a time (2-4 appoitments), leave this to heal for 6 weeks and re-evaluate with our probe to check for healing. If we have a positive response we will often leave alone for another 6 weeks.

4.  After 3 months we will do a general clean and check, check for oral hygiene adherence, and make a follow-up appointment depending on disease regression or progression.

What To Expect After A Surgery

After a routine hygiene appointment, you may expercience some sensitivity on cold or hold. This is due to parts o your tooth being exposed that previously we covered with tar-tar. The pain will only last a couple of days, and if particulary bad can be treated with parcetamol.

Risks Of Having And Not Having Treatment

As a result of deep treatment you may have an aggrevated area of inflammation/infection. This area of infection is short-lived and easily treated with anti-biotics and good oral hygiene. The risks of not having treatment far out-strip those of having. These include progressive gum disease leading to gum and bone shrinkage, which eventually leads to tooth loss.

Alternatives

To reduce sensitivty during a clean an alternative is to use hand scalers instead of ultra-sonic scalers. You could also have the above treatment done with a periodontitst on referral if you are particularly resisitant to general treatment measures.

Surgical periodontal treatment with a specialist

Occasionally, despite our best efforts we fail to stop gum disease from progressing. This could be due to a number of factors including: continued poor hygiene, smoking, diabeties, or anything contributing to a lowered immune response. In these cases we will often refer you to a specialist or ask you to see our visiting specialist.
They will often attempt the same as above, and supplement with antibiotics only available on their expert prescription. Surgical treatment would also be considered as well as elective extractions (Sacrificing some teeth of very poor prognosis to allow cleaning of those teeth of better prognosis)
Often, we will work alongside the periodontist to stablise your gums before we carry out any further work

What To Think About

The repetitive cost of a routine check-up and hygiensit is far less that the one off treatment to have root canal treatment for example. It is in your interest both from a health and financial point of view to attend the dentist regularly. At this point you are at the first level of the "dental cycle", and with proper preventitive practice may never need to have complex expensive treatment done.

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