The “dental prophylaxis” procedure is more commonly termed a “dental cleaning”. However, it is important to note that what your dental professional is accomplishing during this procedure is much more complex than “just a cleaning”. Try as we may, our at home methods (toothbrush and floss) are inadequate to completely debride our teeth of the plaque and tartar that accumulates over time. In order to complete these goals, we all require regular treatment using specialized instruments by individuals with specialized training to adequately maintain teeth and gums in optimal health. During these appointments, there are other diagnostic tasks completed. Your dental professional will also complete a once yearly full mouth periodontal charting so that any minute changes in your gingival health can be identified and the necessary intervention can be made.
The oral environment exists in a continuous battle between bacteria and plaque attempting to infiltrate the gingival system and the body attempting to keep them out. If the balance teeters in the direction of the bacteria and plaque for too long, there can be irreversible damage done to the gums and bone. This disease process is known as periodontitis, and the most important distinction of periodontitis is that it leads to the loss of supporting bone around the teeth.
Once there has been bone loss due to periodontitis, it cannot be regained. The most important consideration for the periodontitis patient is aimed towards prevention of progression of bone loss and maintenance of affected areas. The process by which we stop periodontitis is first through a treatment called “Scaling and Root Planing”. This treatment is usually completed in two separate appointments where one half of the mouth is treated at a time. During this treatment, the root and tooth surfaces are thoroughly debrided of bacteria and plaque, which will begin the process of halting the disease.
Once the Scaling and Root Planing treatments have been completed it is necessary that the patient be seen at increased intervals to ensure that the patients gum tissue and bone remain stable. These treatments are known as “Periodontal Maintenance” and are specifically used as a treatment for patients who have had periodontal disease. Once a patient requires this therapy, they will require it for the rest of their life due to the body’s inability to regain bone support once it has been lost.
Fluoride has had one of the greatest influences on public health with its ability to effectively and safely prevent dental decay. Fluoride itself is a naturally occurring mineral that is present in nature. Fluoride has been used in public water supplies for decades with astounding results in preventing decay in people of all ages. Fluoride is also the most important ingredient in toothpastes, which helps prevent against decay.
Another delivery method, which is particularly effective, is in office fluoride varnish application. This is a very safe, easy, and effective method for preventing dental decay and is applied to a patient’s teeth in approximately 30 seconds.
A cavity begins when acid, created by bacteria, is exposed to the tooth and begins a process of demineralization. Luckily, there is a natural process of remineralization which helps stop this process created by bacteria. If the remineralization process occurs in the presence of fluoride, the fluoride ions are integrated into the tooth structure. Once fluoride is imbedded in the tooth, it actually becomes more difficult for the tooth to demineralize and form a cavity. By applying fluoride by way of an in-office varnish, we can effectively strengthen the teeth and allow them to become more resistant to dental decay.
Sealants are a very effective preventative techniques to prevent dental decay, particularly in children. At the age of 6, children will experience the eruption of the first adult molars – commonly referred to as the “six-year molars”. These teeth are very important for developing this child’s bite and help guide the eruption of the child’s remaining adult teeth. The tops of these teeth often have natural pits, fissures, and grooves that are susceptible to food impaction and cavities. You can think of the tops of these teeth like the Grand Canyon – there are many curving nooks and crannies for food to get trapped within.
A dental sealant is a plastic material, much like a composite filling, which fills all of these “nooks and crannies” so that food will not become impacted. These are easily placed and can often be done during a child’s cleaning appointment by the dentist, dental hygienist, or dental assistant. No anesthetic or numbing is needed and simply applied, much like a fingernail polish.
Silver Diamine Fluoride (SDF)
A major struggle that we have had in dentistry has been the inability to stop and reverse dental decay after it has started. There have been several products and initiatives that have helped the battle against dental decay, such as fluoridated water and topical fluoride varnish, however these options are best used as a preventative measure and can’t be relied upon after a cavity has formed.
The most reliable and definitive measure to treat decay is still removal of the decay and replacement with a dental restoration. However, there is another material called Silver Diamine Fluoride (SDF), which can be used in situations where a dental restoration is not feasible. SDF is a blue liquid that when applied to an area of decay, infiltrates into the lesion and initiates a remineralization process that stops the decay from progressing. This is a very easy process that can be done in less than a minute without anesthetic. After application, the lesion is monitored over time and SDF can be reapplied as needed. The one drawback to this process is that when the remineralization process takes place, the silver in the solution precipitates and darkens the area. Because of this, we use this product exclusively on back teeth so that it does not cause any esthetic issues. This material is generally reserved for our patients who are too young or too old to reasonably and safely undergo dental treatment.