Often times, we get asked by patients, “What’s the difference between a normal cleaning a periodontal maintenance, and why does it cost more?” This is a great question and the answer has a few parts to it.
First, let's establish that a “normal” cleaning (prophylaxis) is for a healthy mouths. This includes procedures that address plaque, calculus and stains on the coronal portion of the tooth. “Coronal” means relating to the crown of the tooth, above the gumline. The typical patient who should receive prophylaxis comes to routine (every 6 months) hygiene appointments, exhibits excellent home care habits and has healthy tissues with no bleeding when probed or flossed. When they have a periodontal evaluation and charting session, probings are measured at 4mm or less.
Next, let’s cover periodontal maintenance and scaling. This is an ongoing therapeutic procedure to treat periodontitis, which is a chronic and incurable (but controllable) bacterial infection. The primary objective is below the gumline - removal of dentin that is rough and/or permeated by calculus and contaminated with toxins and microorganisms. Some soft tissue removal also occurs. This type of procedure requires more skill and expertise than a prophylaxis.
Periodontal disease overwhelms a patient’s defenses and spurs the immune system to initiate a breakdown of supporting tooth structures (bone loss). It is also episodic. These type of destructive episodes can be triggered by stress, disease or other problems unbeknownst to the patient. The three-month interval recommendation for perio maintenance is not arbitrary. It is based on the behavior of the bacteria. After periodontal maintenance therapy, periodontal pathogens aggregate on the biofilm and become the predominant species of bacteria again in three to 12 weeks. This means that by the 12th week, or 3 months, the periodontal “bugs” are flourishing again. That’s when we should reduce their numbers again. After discovery of periodontal disease, it is important to stay vigilant in controlling and monitoring through periodontal therapy.
To value a periodontal maintenance it is necessary to understand that it is different from a regular cleaning because you are controlling disease with therapy versus simply cleaning teeth.