Dental Prophylaxis vs. Periodontal Maintenance. What's the Difference?

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.

The Link Between Oral Bacteria and Joint Failure

Joint Failures Potentially Linked to Oral Bacteria

 ScienceDaily (Apr. 18, 2012) — The culprit behind a failed hip or knee replacements might be found in the mouth. DNA testing of bacteria from the fluid that lubricates hip and knee joints had bacteria with the same DNA as the plaque from patients with gum disease and in need of a joint replacement.
This study is one of many that came from the Case Western Reserve University School of Dental Medicine that have linked oral bacteria to health problems when they escape from the mouth and enter the blood. Working with University Hospitals Case Medical Center researchers, the dental, orthopedic and arthritis researchers suggest it might be the reason why aseptic loosening or prosthetic wear of the artificial joints fail within 10 years when no infection appears to be present. The pilot study's findings were reported in the April issue of the Journal of Clinical Rheumatology.
Dr. Nabil Bissada, chair of the Department of Periodontics at the dental school, said the objective of the study, "Identification of Oral Bacterial DNA in Synovial Fluid of Patients with Arthritis with Native and Failed Prosthetic Joints," was to see if bacteria like Fusobacterium nucleatum and Serratia proteamaculans found in patients with gum disease were present in the fluid. "For a long time, we've suspected that these bacteria were causing problems in arthritis patients, but never had the scientific evidence to support it," Bissada says.

The researchers recruited and studied patients seeking care at the University Hospitals Case Medical Center for osteoarthritis (the wearing of the joints) and rheumatoid arthritis (an autoimmune disease). These study participants had both natural and artificial joints. Researcher extracted samples of their synovial fluid, which is much like oil that keeps a door from squeaking. These patients also had signs of periodontitis or gum disease and undergone exams where dental plaque was obtained for the study.

Plaque build-up from the bacteria, associated with gum disease, breaks down the walls of the pockets around the teeth. The inflammation process from the bacteria acts like a gate that gives bacteria access to the blood stream. Once in the blood, the oral bacteria can induce inflammation in remote sites. These oral bacteria have been linked to heart and kidney diseases, and premature births and fetal deaths. Because these bacteria cannot be found with routine lab tests, DNA sequencing analysis of the oral bacteria and the joint fluids are performed. 

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 has also been a founder in a biotech company called NovaBay Pharmaceuticals and was a member of their board of directors from 1997 -2014.

Periodontal Disease and Your General Health

Welcome to the first article of our new blog. Our dental office, Anthony Dailley DDS www.dailleydds.com regularly sends out similar electronic newsletters to our patients to keep them abreast of the lastest developments in dental health. We hope our blog will provide readers with additional knowledge about their dental health and what modern dentistry has to offer. Below is an article about how gum disease can effect much more than just one's oral health.

Anthony Dailley DDS

The relationship of periodontal disease to disorders elsewhere in the body has attracted a great deal of attention from the dental and medical professions, as well as from the public.  Numerous studies have emphasized that the oral cavity, and the periodontal tissues specifically, can affect other tissues and organs.  In essence, these studies have connected the mouth to the rest of the body and have resulted in physicians and nurses becoming more aware of diseases of the teeth, gums, and other structures in the oral cavity. Many studies recently published in medical and dental literature suggest that the mouth truly is a window to the body.  In fact many systemic diseases can manifest themselves orally well before any other signs or symptoms have become apparent medically.  The oral cavity is affected by inflammation (in particular periodontal disease).  The toxins produced by the oral bacteria that are responsible for periodontal disease can harm wherever they travel to in the body. Scientist have observed a connection between oral health and heart conditions.  In a study published in the International Journal of Cardiology found that patients who had suffered recent heart attacks had noticeably worse oral health compared to those patients with healthy hearts.  Multiple studies, including a recent report in the Journal of Clinical Periodontology show a startling correlation between patients with periodontal disease and those with heart disease.  The more severe the gum disease, the thicker and harder the walls of the arteries.  This is even true for young adults with no symptoms of heart problems.  There are increasing links between oral health and conditions such as diabetes, kidney disease, preterm labor, osteoporosis, and even Alzheimer's disease.  A 2007 report in the New England Journal of Medicine noted that patients who had their periodontal disease treated emerged not only with healthier gums but with healthier endothelial function which is a measure of health or the lining of the blood vessels.  The alarming fact is that more than 80% of adults aged 20-64 in the U.S. have some form of periodontal disease.  Maintaining good oral hygiene habits and regular visits to the dentist to prevent and manage periodontal disease are becoming more important as it relates to one's general health. “We all think that cholesterol is important to heart disease. The health of your gums is a more  important predictor of whether you will have a heart attack or not.” Mehmet C. Oz, M.D. F.A.C.S Director,Cardiovascular Institute Columbia University Medical Center, New York, NY   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 has also been a founder in a biotech company called NovaBay Pharmaceuticals and was a member of their board of directors from 1997 -2014.