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 dental treatment question scaling and planing deep cleaning
pilot4x4  [Team Member]
4/20/2008 10:24:18 PM
Last Dec. I went to the dentist for an exam abd cleaning. I hadn't been for about 5 years, I know you should go more often but with moving and no insurance I didn't do it. Anyway they measured my pockets and few some that measured three and four so they recommended a deep cleaning (scaling and root planing). I got it done in Jan and they wanted me to come back in 3 months. I couldn't make that appointment because I got hurt so they've scheduled me for next week. They are telling me that I need to come in every 3 - 4 months for this procedure or until the pocket depth reduces back to 2 or less. Anyone that's had this treatment or if any of you work in the dental field do you think it's really necessary to go that often? If it's absoultely necessary I can come up with the money for it but they charge about $260.00 a quadrant each time so it adds up very quickly. When I talked to them about cost they told me not to worry because I can sign up for Care Credit and get 18 months to pay before there is interest charged, of course you still have to come up with the money to pay. What I'm really trying to figure out is if I really need to keep going back for this treatment or if the dentist is just doing it as a way to make money.
John
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Mackinaw  [Member]
4/20/2008 10:26:53 PM
Get a second opinion....go to another dentist and have a check-up. Don't tell any history from the other dentist. See what they say. My 2 cents.
Taxman  [Team Member]
4/20/2008 10:30:03 PM
I went to one in 2001 (1st time in 5-7 years) that wanted to push the "deep cleaning" which costs more when I made the appt, said it had been too long since my last cleaning. Refused to do a regular cleaning, so I didnt make an appt, left and havent been to a dentist since.

Like most medical things I think its a scam with the goal of taking your money and giving little in exchange.
Engineer5  [Team Member]
4/20/2008 10:33:45 PM
I had to have a deep cleaning after I forgot to go to the dentist for 10 years. No cavities or other problems other than I needed a deep cleaning. They knocked it out in one visit. It took a while and I was sore but wasn't too bad. When I went back 6 months later they did a little bit more. I go every 6 months now.

You might look at a different dentist and see what they say.
pilot4x4  [Team Member]
4/20/2008 10:41:21 PM
Enginer 5, When you go for your six month cleanings now do they just do a normal cleaning or do they do more than that? I plan on going every 6 months for a cleaning now that I've got insurance again but don't know if I really need the scaling and planing part of it 3 or 4 times a year.

This is the second dentist that's told me I need this treatment but it doesn't really count as a second opinion because he's a friend of the first dentist I went to. I only changed to this dentist beause the first one didn't take our insurance so they recommended this other dentist. I'm thinking of trying another dentist seperate from either of these two.
Engineer5  [Team Member]
4/20/2008 10:42:44 PM

Originally Posted By pilot4x4:
Enginer 5, When you go for your six month cleanings now do they just do a normal cleaning or do they do more than that? I plan on going every 6 months for a cleaning now that I've got insurance again but don't know if I really need the scaling and planing part of it 3 or 4 times a year.

This is the second dentist that's told me I need this treatment but it doesn't really count as a second opinion because he's a friend of the first dentist I went to. I only changed to this dentist beause the first one didn't take our insurance so they recommended this other dentist. I'm thinking of trying another dentist seperate from either of these two.



I just get the normal cleaning at my 6 month appointments.

Good Luck
MissileCop  [Team Member]
4/20/2008 10:43:02 PM
I hadn't gone to a dentist in 10 years (bad memories of the previous dentists), but I didn't want to end up losing my teeth like my father did. Went to a dentist that my friend recommended, and they did the deep scale in two sessions. Two quadrants the first visit, the other two the next. If they do their job right, you shouldn't need a repeat deep scaling. I had 3's and 4's as well. I've been fine for the past 7 years. The only thing I get harassed about is my inconsistent flossing, buy my hygienist is attractive, so I don't mind.

If they mean that they want to do the deep scale cleaning, and then have you in for regular cleanings every three to four months, and to keep an eye on your progress, then that's normal. They had me in every 3 months for awhile, and then I shifted to every 4 months afterwards.
K2QB3  [Team Member]
4/20/2008 10:43:58 PM
If you don't do it you'll end up with a detachment and crap will get stuck down in the pocket and you'll get an infection, or worse.

Those pockets get deep enough and you'll lose the tooth.

They're your teeth, only you can decide how much it's worth to still have them in twenty years.
engineer2001  [Member]
4/20/2008 10:45:18 PM
My father-in-law is a dentist, and we talk about this sort of thing all the time, as I have a little pocketing as well. My understanding is that it comes, basically, from not brushing and flossing your teeth well enough. The bacteria that normally live in your gums get out of control because you feed them what you eat and don't whack them with floss to cut down on their population. Those bacteria give you bad breath and cause that pocketing as well. If left unchecked, you will get gingivitis, and that will lead to periodontal disease, and your teeth will all fall out.

If you don't want to have dentures and hideous breath that smells like 50's Russian ammo SPAM cans when you first open them, I would recommend both getting the deep cleanings to help now and then brushing and flossing twice daily to keep it from getting worse.

My FIL recommends it to people who need it (bleeding when cleaning their teeth and measurable pocketing), and if they don't get it done, he just recommends it again and again until their gums bleed all the time and their teeth fall out. It's most likely not a scam. They just don't want your gums to get all bloody and unhealthy. If you bleed when you brush or even when they clean your teeth, you are not brushing/flossing right or enough. Healthy gums don't bleed, even if scraped by an explorer or scaler (the metal picks they use). Mine bleed almost none at all now that I am actually taking care of my teeth right, and I just got my 6-month cleaning done last weekend. He says I'm almost 100% better now.
cmjohnson  [Team Member]
4/20/2008 10:46:20 PM
I tend to think the whole thing is a scam, frankly.


I'm a lousy dental patient anyway. I'd rather go through lithotripsy again than get my teeth cleaned. Really.

If I go for a deep scaling, root planing, whatever they call it, odds are that I'll opt for sedation because I have this slight tendency to react aggressively to people causing pain in my mouth.


CJ
ApacheScout  [Team Member]
4/20/2008 10:46:39 PM
Not attacking the OP,but why does everyone use the "no insurance"excuse for not going to the dentist?Do you avoid the doctor because no insurance?
Anyway,I had the deep cleaning done after a 20 or so year hiatus from the dentist.
I also got about 10 grand worth of "repairs".Jump ahead about a year later.
The dentist got a new hygentist (sp) and sure enough she recommends deep cleaning!!
I just had it done about a year before.The dentist walks by while I'm having this done and says"didn't you just have that done?".Its like $1000.00 for the whole mouth.
I wonder if its a scam,after all,who's going to argue with a doctor?
nightstalker  [Team Member]
4/20/2008 10:47:33 PM
My dentist said I need root planing and scheduled me for two appointments. The first took a little over an hour, the second, less than an hour. $1000. He hadn't given me the treatment cost and I was a bit shocked. They used exactly the same instruments, the only difference being the topical anesthetic for working below the gum line. I thought the price was high but found that actually the $200 to $250 a quadrant was typical. However, they charge as if you will get this done in 4 separate appointments and if you tolerate the cleaning well like I do, it goes pretty quickly, not unlike a regular cleaning. I'm OK with him charging what he wants but he should have let me know ahead of time that this was going to be A LOT more expensive than a regular cleaning. I questioned him on the charge and he said it took much more expertise on the part of the hygienist. I think this is marginally true but when a 1 hour cleaning cost $100 and 2 hours of root planing cost $1000, it's time to shop around a bit. I think you can get it done cheaper and anyway should get a second opinion about how often to have it done. Having 2's and 3's ain't that bad. I had a few 5's in the back. They have a laser version of this that you might look into. It might be as expensive but it might have some advantages over the traditional root planing.

Good luck.

I've seen this treatment for much less but hesitate to recommend the LOWEST BIDDER for medical type services. It doesn't really make sense to go that way. Get friends to tell you about their dentists.
Taxman  [Team Member]
4/20/2008 10:51:37 PM

Originally Posted By ApacheScout:
Not attacking the OP,but why does everyone use the "no insurance"excuse for not going to the dentist?Do you avoid the doctor because no insurance?



I dont carry insurance because I avoid the doctor.



Insurance normally covers cleanings so it probaly doesnt pay well.

I guess the deepcleaning is an upsell they use on 5-10% of people
nightstalker  [Team Member]
4/20/2008 10:57:05 PM
I googled this up. This person claims to be a dental hygienist and offers this information. 4 mm pockets seem to be the point of reference.





Speaking as a dental hygienist, scaling and root planing is recommended for patients who have a lot of bleeding and periodontal pockets that are deeper than 4mm. Depending on the depth of the pockets and the patients pain tolerance freezing is usually recommended.

Did the hygienist do a full mouth "probing" where she took measurements around ALL of your teeth (usually 10 readings per molar and 6 on all other teeth)? Nothing can be diagnosed or recommended without that being done first. She should have recorded all numbers (or at least those that are 4mm or greater) on a chart.

Irrigation is helpful for pockets that are deeper than 4mm.

Pain does not necessarily have to accompany a thorough dental cleaning. A lot of it depends on the hygienists' training, technique and experience.

If you are concerned about the treatment your hygienist recommended speak to your dentist and ask him why this was recommended now. There should be past periododontal charts in your file for comparison if you've been a patient there for some time. This charting is usually a legal document and is needed by all adults who see hygienists for any dental cleaning.
bigez  [Team Member]
4/20/2008 10:57:59 PM
I should have been a dentist. I don't know any that aren't filthy rich and don't have a least one Porsche. At least in my area.

I brush and floss more than anybody I know. I even bring a freakin' toothbrush to work and brush there after lunch. I never see anybody else doing this.

STILL, everytime I go, they say my "pockets" are kinda deep, blah blah. I haven't had a cavity since I was 12 or 13. I think what they meant to say was "You're a sucker, and I hope you have Deep Pockets" (as in LOTS of money).
pilot4x4  [Team Member]
4/20/2008 10:58:22 PM
I got the treatment done in Jan. They said I needed the scaling, planing and all in three quadrants so I had them done all at once. I was pretty sore the next day, had some pain and bleeding for a couple of days but I'm glad I got it all done in one shot rathern than going back and going though that for each quadrant. They gave me he impression that they do this scaling on each visit but maybe that's not the case, maybe it's more of a normal cleaning each time. I'll find out more info from the dentist on it. Since I went in Jan I've been using a sonicare brush and making sure I floss every day so that should hopefully help impove my teeth.
bobcat50  [Team Member]
4/20/2008 10:59:42 PM
Same with me, had been years since I went. Thought all you needed to do was brush your teeth once or twice a day. Had a cavity that need to be worked on and they wanted to do the deep cleaning before the filling.

Showed me pictures of the different stages of gum disease. From looking in a mirror I could see I was at about stage 3. Had some deep pockets.

If you don't get it taken care of the pockets will get bigger. The bone will also decay and the teeth will loosen and fall out. Also causes a low grade infection that can affect your heart.

I currently go 3 times a year for the cleanings, looking forward to when I can get it down to two a year.

It's your choice and I agree to get a second opinion but if you have gum disease the diagnoses is not rocket science.

pilot4x4  [Team Member]
4/20/2008 11:01:10 PM
Yes they did the measuring and recorded them. Also when they did the treatment they treated the worst of the pockets with a product called Arestin.
pilot4x4  [Team Member]
4/20/2008 11:08:48 PM
Did your dentists tell you that after progress is made you can reduce it back to 2 - 3 cleanings a day? The first dentist told me once you are diagnosed with deep pockets it's something you have forever and that you have to go 4 times a year for the rest of your life. It seems from what I've read though and what some of you say is that it does impove over time and you can get back to normal cleanings or close to it eventually.
ds3_09  [Member]
4/20/2008 11:10:15 PM
I am in dental school in my Junior year. According to the current literature 1-3 mm is considered healthy, 3-5 is mild periodontitis, 5-7 moderate, 7+ severe. There is a big difference if it is a few spots of 4mm vs generalized perio issues. I personally think that 4mm pockets can be reduced with good brushing and flossing and regular prophylaxis's at the dentist. Once you get lots of 4's and 5's liek more than 20% of all the depths you need a scaling and root planing.

The method you brush can make a huge difference. The most accepted method currently is called the "Modified Bass" technique (cut and pasted from some dentist website)
:
Modified Bass Method
(only currently recommended technique)how to brush

This is widely excepted as the most effective measure for the removal of plaque around the gumline, this area being the most significant in the control of early and advanced gum disease.

Direct the brush towards the roots of the teeth at a 45ยบ angle. Press lightly but not enough to bend the bristles and then gently, with short movements, brush back and forth in a vibratory type action.

This may seem a little more difficult behind (tongue/palate) the front teeth. If you use a pencil grip, it is easy to brush side-to-side in these areas.
ds3_09  [Member]
4/20/2008 11:11:00 PM

Originally Posted By pilot4x4:
Did your dentists tell you that after progress is made you can reduce it back to 2 - 3 cleanings a day? The first dentist told me once you are diagnosed with deep pockets it's something you have forever and that you have to go 4 times a year for the rest of your life. It seems from what I've read though and what some of you say is that it does impove over time and you can get back to normal cleanings or close to it eventually.


That depends on how deep the pockets are.
engineer2001  [Member]
4/20/2008 11:20:29 PM

Originally Posted By bigez:
I brush and floss more than anybody I know. I even bring a freakin' toothbrush to work and brush there after lunch. I never see anybody else doing this.

STILL, everytime I go, they say my "pockets" are kinda deep, blah blah.


I was doing the same thing too. What I didn't know was that I was brushing wrong and flossing wrong too. I thought I knew what I was doing. Man, what a difference it makes when you do it right. See the technique the dental student posted above for brushing. For flossing, you need to get below the gumline (as in pull the floss as low as you possibly can and then pull it down some more along both sides of each tooth). I thought I was pulling my teeth out when I first did it right, I was flossing so low down. I though just popping the floss in between the teeth down to the gum line and out was good enough for my whole life. Nope. You're really not just getting gunk from between your teeth - you're actually cleaning out from under the gumline along each tooth. I think this is an issue that dentists should bring up more often (how to brush and floss correctly). I honestly thought I was doing everything right.

If you have any questions, you should ask your dentist next time you are in for a cleaning. He will be glad to tell you how to do it properly, I'm sure. They just don't tell anyone except kids how to brush and floss because they don't want you thinking that they are treating you like an idiot. They answer if asked, though.
Nick29  [Member]
4/20/2008 11:45:14 PM

Originally Posted By engineer2001:
My father-in-law is a dentist, and we talk about this sort of thing all the time, as I have a little pocketing as well. My understanding is that it comes, basically, from not brushing and flossing your teeth well enough. The bacteria that normally live in your gums get out of control because you feed them what you eat and don't whack them with floss to cut down on their population. Those bacteria give you bad breath and cause that pocketing as well. If left unchecked, you will get gingivitis, and that will lead to periodontal disease, and your teeth will all fall out.

If you don't want to have dentures and hideous breath that smells like 50's Russian ammo SPAM cans when you first open them, I would recommend both getting the deep cleanings to help now and then brushing and flossing twice daily to keep it from getting worse.

My FIL recommends it to people who need it (bleeding when cleaning their teeth and measurable pocketing), and if they don't get it done, he just recommends it again and again until their gums bleed all the time and their teeth fall out. It's most likely not a scam. They just don't want your gums to get all bloody and unhealthy. If you bleed when you brush or even when they clean your teeth, you are not brushing/flossing right or enough. Healthy gums don't bleed, even if scraped by an explorer or scaler (the metal picks they use). Mine bleed almost none at all now that I am actually taking care of my teeth right, and I just got my 6-month cleaning done last weekend. He says I'm almost 100% better now.


I'm a dental student. This is actually a very good explanation. Probing depths of 4mm or greater are what you should be concerned about (3mm or less is normal), and multiple 4mm+ pockets (a pocket is an area with a probing depth of 4mm or greater) is indicative of periodontal disease. Some people have a tendency to get periodontal disease despite perfect home care, while others can brush their teeth once a month and still have healthy gums, and most are somewhere in the middle. A 3 month recall is normal for periodontitis patients, but you shouldn't necessarily need scaling and root planing that often.

When you have pockets, the bacteria that causes plaque, and is normally present on the crowns of your teeth, becomes embedded on the roots of the teeth. The purpose of root planing is to remove this bacteria and bacterial toxins, as well as calculus (calcified plaque) from the root surface, and to smooth out the root surface in order to help the soft tissues reattach to the tooth. It costs more because it's more difficult and usually more time consuming than a regular cleaning. Like any medical or dental procedure, you're paying to have the procedure done; not by the hour. It's also very important to do your part by brushing and flossing. If you need scaling and root planing every 3 months, you're either unlucky and have high susceptibility to periodontal disease, or you're not brushing and flossing well/often enough.

Periodontitis isn't curable in the sense that you'll never have to worry about it again once it's been treated, but it can be controlled and the process can be reversed (probing depths can go back to normal if they aren't too deep, bleeding can be stopped, etc.). Once it's under control

Google found this site that seems to have a good explanation and images: www.apfelbaum-perio.com/periodon.htm
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