Over many years of practice we have frequently found patients getting confused over the difference between a dental prophylaxis and periodontal maintenance. If you have never had periodontal disease before then this article may not be very relevant to you, but if you have then hopefully it will clarify any confusion you may have had.
It is important to understand that a dental prophylaxis (prophy) is intended for a health mouth. The American Dental Association (ADA) defines a prophy as a dental prophylaxis performed on the dentition that includes scaling and polishing procedures designed to remove plaque, calculus, and stain from those surfaces of the tooth above the gum line.
In the strictest sense of the definition a prophy is a procedure performed on a patient that does not have subgingival (below the gumline) deposits or periodontal pocketing. The typical prophy patient gets their teeth cleaned every 6 months, exhibits good home-care habits, has healthy gingival tissues, and has no pockets over 4mm.
Periodontal Scaling, also referred to as Root Planing, or Deep Cleaning is a procedure designed to remove bacteria, calculus, and their accompanying toxins from areas below the gum line. It is indicated for patients with periodontal disease. Periodontal procedures are for the most part subgingival in nature. Periodontal scaling requires more skill, time and expertise than a prophylaxis, and typically requires local anesthetic. Patients with periodontal disease will exhibit bone loss and pocketing around the affected teeth. It is a bacterial proliferation of pathogens that overwhelm the host defenses and spurs the host's own immune system to initiate a breakdown of the supporting tooth structures. We also know that periodontal disease is not a "curable" disease, but it is controllable in most patients. Therefore when a patient has experienced periodontal disease in the past, we must be ever-vigilent to monitor them for signs of active disease long after the disease has been brought under control.
The Periodontal Maintenance procedure is designed to follow active periodontal therapy. This procedure is intended for patients who have completed periodontal treatment whether it be surgical and/or nonsurgical (root planing). It includes the removal of the bacteria from deep pocket areas, scaling and polishing of the teeth, periodontal evaluation, and a review of the patient's ability to control their plaque. Typically an interval of three months between appointments results in an effective treatment schedule. Periodontal maintenance treatment following periodontal therapy is not synonymous with a prophylaxis or regular cleaning.
Periodontal Maintenance is quite different from a regular prophy because it is controlling the disease process, whereas a prophylaxis is preventive in nature and not therapeutic.
About the author: Dr. Anthony Dailley is a practicing general dentist in Berkeley California. He has been practicing since 1981 and graduated from San Francisco State University with a degree in Cell & Molecular Biology, and obtained his dental degree from the Pacific School of Dentistry. Dr. Dailley also holds a fellowship position with the International Congress of Oral Implantologist (ICOI). Dr. Dailley has also been a founder in a biotech company called NovaBay Pharmaceuticals and was a member of their board of directors from 1997 -2014.
