What is teeth cleaning at the Dr. Nikhil's Dental Clinic, panipat?

Teeth cleaning at Dr. Nikhil's Dental, panipat, is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities (dental caries), gingivitis, and periodontal disease.



What is a deep cleaning at the dentist?

A regular cleaning focuses on the surfaces of the teeth and between teeth above the gum line. During a regular cleaning, the teeth are also polished. A dental deep cleaning, or scaling and root planing, is needed in order to remove bacteria, calculus (tartar), and debris that has collected under the gum line.


Do deep teeth cleaning hurt?
The only sensation may be the physical scraping feeling along the teeth as the area is cleaned and smoothened. A root planed root surface free of tartar has a better chance of allowing the gum tissues to heal and reattach to it. As a result, some deep gum pockets can be reduced after a deep cleaning.



What causes tartar buildup on teeth?
Plaque contains bacteria that cause cavities and gum disease. As plaque forms and is not removed by proper brushing and flossing, it can harden into tartar — sometimes called calculus — which is calcified (or hardened) plaque that attaches to the enamel on your teeth, as well as below the gum line.


What is a scale and polish?
A scale and polish is a quick cleaning of the teeth carried out by a dentist. Usually using something called an Ultrasonic, the dentist will clean around the gum line on the back and front of your teeth to remove any plaque and tartar.


Can a dentist remove tartar?
Plaque that is not removed can harden into tartar, a hard mineral deposit that forms on teeth and can only be removed through professional cleaning by a dental professional. When this happens, brushing and cleaning between teeth become more difficult, and gum tissue can become swollen or may bleed.


Periodontics

Periodontics is the dental specialty focusing exclusively in the inflammatory disease that destroys the gums and other supporting structures around the teeth. A periodontist is a dentist who specializes in the prevention, diagnosis, and treatment of periodontal, or disease, and in the placement of dental implants. Periodontists receive extensive training in these areas, including three additional years of education beyond dental school. As specialists in periodontal disease, they are experts in the latest techniques for diagnosing and treating periodontal disease. They are also trained in cosmetic periodontal procedures.

Periodontists treat cases ranging from mild gingivitis to more severe periodontitis. Periodontists offer a wide range of treatments, such as scaling and root planing (the cleaning of infected root surfaces), root surface debridement (the removal of damaged tissue), and regenerative procedures (the reversal of lost bone and tissue). When necessary, periodontists can also perform surgical procedures for patients with severe gum disease. Additionally, periodontists are trained in the placement, maintenance and repair of dental implants.

Periodontology is an emerging specialty in the field of dentistry which deals with the diseases of the tooth supporting structures. In our clinic set up we have the skills to carry out various treatment modalities to manage the patients suffering from periodontal diseases, including scaling and prophy, root planning, and crown lengthening.

Proper tooth brushing technique and flossing are key to avoid periodontal problems. We communicate with the patient, ask them their hygiene measures, and teach them the correct way of brushing and flossing, this is called patient education.

What causes gum disease?

Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.

Gingivitis

The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.


Periodontitis

When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth”). In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.

Risk Factors:

Smoking. 

Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.

Hormonal changes in girls/women. 

These changes can make gums more sensitive and make it easier for gingivitis to develop.

Diabetes. 

People with diabetes are at higher risk for developing infections, including gum disease.

Other illnesses and their treatments. 

Diseases such as AIDS and its treatments can also negatively affect the health of gums, as can treatments for cancer.

Medications. 

There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medicines can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth and gums clean.
Genetic susceptibility. Some people are more prone to severe gum disease than others

Scaling-Polishing

Scaling and root planing, otherwise known as conventional periodontal therapy, non-surgical periodontal therapy, or deep cleaning, is the process of removing or eliminating the etiologic agents – dental plaque, its products, and calculus – which cause inflammation, thus helping to establish a periodontium that is free of disease. Periodontal scalers and periodontal curettes are some of the tools involved.

Periodontal Intervention:
Treatment of periodontitis may include several steps, the first of which often requires the removal of the local causative factors in order to create a biologically compatible environment between the tooth and the surrounding periodontal tissues, the gums and underlying bone. Left untreated, chronic inflammation of the gums and supporting tissue can raise a person’s risk of heart disease.

Prior to beginning these procedures, the patient is generally numbed in the area intended for instrumentation. Because of the deeper nature of periodontal scaling and root planing, either one half or one quarter of the mouth is generally cleaned during one appointment. This allows the patient to be entirely numbed in the necessary area during treatment. It is typically not recommended to have the entire mouth scaled at one appointment because of the potential inconveniences and complications of numbing the entire mouth- i.e., inability to eat or drink, likelihood of self injury by biting, etc.

Generally, the first step is the removal of dental plaque, microbial biofilm, from the tooth, a procedure called scaling. Root planing involves scaling the tooth’s root. These procedures may be referred to as scaling and root planing, periodontal cleaning, or deep cleaning. These names all refer to the same procedure. The term “deep cleaning” originates from the fact that pockets in patients with periodontal disease are literally deeper than those found in individuals with healthy periodontia. Such scaling and root planing may be performed using a number of dental tools, including ultrasonic instruments and hand instruments, such as periodontal scalers and curettes.

The objective for periodontal scaling and root planing is to remove dental plaque and calculus (tartar), which house bacteria that release toxins which cause inflammation to the gum tissue and surrounding bone.

Removal of adherent plaque and calculus with hand instruments can also be performed prophylactically on patients without periodontal disease. A prophylaxis refers to scaling and polishing of the teeth in order to prevent oral diseases. Polishing does not remove calculus, but only some plaque and stains, and should therefore be done only in conjunction with scaling.

Often, an electric device, known as an ultrasonic, sonic scaler, or power scaler may be used during scaling and root planing. Ultrasonic scalers vibrate at a frequency to help with removing stain, plaque and calculus. In addition, ultrasonic scalers create tiny air bubbles through a process known as cavitation. These bubbles serve an important function for periodontal cleanings. Since the bacteria living in periodontically involved pockets are anaerobic, meaning unable to survive in the presence of oxygen, these bubbles help to destroy them. The oxygen helps to break down bacterial cell membranes and causes them to lyse, or explode.

Since it is of the utmost importance to remove the entirety of the deposit in each periodontal pocket, attention to detail during this procedure is crucial. Therefore, depending on the depth of the pocket and amount of calculus deposit versus soft biofilm deposit, hand instruments may be used to complete the fine hand scaling that removes anything the ultrasonic scaler left behind. Alternatively, power scalers may be used following hand scaling in order to dispel deposits that have been removed from the tooth or root structure, but remain within the periodontal pocket.

Sonic and ultrasonic scalers are powered by a system that causes the tip to vibrate. Sonic scalers are typically powered by an air-driven turbine. Ultrasonic scalers typically use either magnetostrictive or piezoelectric systems to create vibration. Magnetostrictive scalers use a stack of metal plates bonded to the tool tip. The stack is induced to vibrate by an external coil connected to an AC source. Ultrasonic scalers also include a liquid output or lavage, which aids in cooling the tool during use, as well as rinsing all the unwanted materials from the teeth and gum line. The lavage can also be used to deliver antimicrobial agents.

Although the final result of ultrasonic scalers can be produced by using hand scalers, ultrasonic scalers are sometimes faster and less irritating to the client. Ultrasonic scalers do create aerosols which can spread pathogens when a client carries an infectious disease. Research shows no difference in effectiveness between ultrasonic scalers and hand instruments. Of particular importance to dentists themselves is that the use of an ultrasonic scaler may reduce the risk of repetitive stress injury, because ultrasonic scalers require less pressure and repetition compared to hand scalers.

A new addition to the tools used to treat periodontal disease is the dental laser. Lasers of differing strengths are used for many procedures in modern dentistry, including fillings. In a periodontal setting, a laser may be used following scaling and root planing in order to promote healing of the tissues.

After Scaling:
Following scaling, additional other steps may be taken in order to ensure disinfection of the periodontal tissues. Oral irrigation of the periodontal tissues may be done using chlorhexidine gluconate solution, which has high sustantivity in the oral tissues. This means that unlike other mouthwashes, whose benefit end upon expectorating, the active antibacterial ingredients in chlorhexidine gluconate infiltrate the tissue and remain active for a period of time. However effective, chlorhexidine gluconate is not meant for long term use. A recent European study suggests a link between the long term use of the mouthrinse and high blood pressure, which may lead to a higher incidence of cardiovascular events. In the United States, it is available only through a doctor’s prescription, and in small, infrequent doses it has been shown to aid in tissue healing after surgery.

Site specific antibiotics may also be placed in the periodontal pocket following scaling and root planing in order to provide additional healing of infected tissues. Unlike antibiotics which are taken orally to achieve a systemic effect, site specific antibiotics are placed specifically in the area of infection. These antibiotics are placed directly into the periodontal pockets and release slowly over a period of time. This allows the medication to seep into the tissues and destroy bacteria that may be living within the gingiva, providing even further disinfection and facilitation of healing. Certain site specific antibiotics provide not only this benefit, but also boast an added benefit of reduction in pocket depth. Arestin, a popular doxycycline site specific antibiotic claims the ability to regain at least 1 mm of gingival reattachment height.

In cases of severe periodontitis, scaling and root planing may be considered the initial therapy prior to future surgical needs. Additional procedures such as bone grafting, tissue grafting, and/or gingival flap surgery done by a periodontist (a dentist who specializes in periodontal treatment) may be necessary for severe cases or for patients with refractory (recurrent) periodontitis.

Patients who present with severe or necrotizing periodontal disease may have further steps to address during their treatment. These patients often have genetic or systemic factors that contribute to the development and severity of their periodontitis. Common examples include diabetes type I and type II, a family history of periodontal disease, and immunocompromised individuals. For such patients, the practitioner may take a sample from the pockets to allow for culture and more specific identification and treatment of the causative organism. Intervention may also include discontinuation of medication that contributes to the patient’s vulnerability or referral to a physician to address an existing but previously untreated condition if it plays a role in the periodontal disease process.

Effectiveness:
A scaling and root planing procedure is to be considered effective if the patient is subsequently able to maintain their periodontal health without further bone or attachment loss and prevent recurrent infection with periodontal pathogens.

The long term effectiveness of scaling and root planing depends upon a number of factors. These factors include patient compliance, disease progress at the time of intervention, probing depth, and anatomical factors like grooves in the roots of teeth, concavities, and furcation involvement which may limit visibility of underlying deep calculus and debris.

First and foremost, periodontal scaling and root planing is a procedure that must be done thoroughly and with attention to detail in order to ensure complete removal of all calculus and plaque from involved sites. If these causative agents are not removed, the disease will continue to progress and further damage will result. In cases of mild to moderate periodontitis, scaling and root planing can achieve excellent results if the procedure is thorough. As periodontitis increases in severity, a greater amount of supporting bone is destroyed by the infection. This is illustrated clinically by the deepening of the periodontal pockets targeted for cleaning and disinfection during the procedure. Once the periodontal pockets exceed 6 mm in depth, the effectiveness of deposit removal begins to decrease, and the likelihood of complete healing after one procedure begins to decline as well. The more severe the infection is prior to intervention, the greater the effort required to arrest its progress and return the patient to health. Diseased pockets over 6 mm can be resolved through periodontal flap surgery, performed by a dental specialist known as a Periodontist.

Although healing of the soft tissues will begin immediately following removal of the microbial biofilm and calculus that cause the disease, scaling and root planing is only the first step in arresting the disease process. Following initial cleaning and disinfection of all affected sites, it is necessary to prevent the infection from recurring. Therefore, patient compliance is, by far, the most important factor that has the greatest influence on the success or failure of periodontal intervention. Immediately following treatment, the patient will need to maintain excellent oral care at home. Coupled with proper homecare, which includes but is by no means limited to brushing twice daily for 2–3 minutes, flossing daily and use of mouthrinse, the potential for effective healing following scaling and root planning increases. Commitment to and diligence in the thorough completion of daily oral hygiene practices are essential to this success. If the patient fails to change the factors that allowed the disease to set in – for example, not flossing and brushing only once a day – the infection will likely recur.

The process which allows for the formation of deep periodontal pockets does not occur overnight. Therefore, it is unrealistic to expect the tissue to heal completely in a similarly short time period. Gains in gingival attachment may occur slowly over time, and ongoing periodontal maintenance visits are usually recommended every three to four months to sustain health. The frequency of these later appointments is key to maintaining the results of the initial scaling and root planing, especially in the first year immediately following treatment.

Since the patient may still have pockets that surpass the effective cleaning ability of a brush or floss, it is vital to the long term success of their treatment that they return every 90 days in order to ensure that those pockets remain free of deposit. It must be explained that 90 days is not an arbitrary interval. At 90 days, the healing made possible by the scaling and root planing will be complete. This will allow the practitioner to re-measure pocket depths to determine whether the intervention was successful. At this appointment, progress will be discussed, as well as any refractory periodontitis. At 90 days from the original scaling and root planing, the periodontal bacteria, if any remains, will have reached its full strength again. Therefore, if there are remaining areas of disease, the practitioner will clean them again, and may place more site specific antibiotic. Furthermore, this appointment allows for the review of homecare, or necessary additions or education.A gingivectomy is usually performed when a patient has severe periodontal disease that cannot be cured with scaling and root planing or other periodontal procedures. Gingivectomies are performed to remove and reshape loose, diseased gum tissue and to reduce the depth of pockets between the teeth and gums. 

THE PROCEDURE

Before the procedure begins, the area will be completely numbed using a local anesthetic. Small incisions are then made and excess gum tissue is carefully removed. After all areas of diseased tissue are removed, a putty-like substance is then placed over the gums. This substance is designed to protect your gums as they heal. 

AFTER THE PROCEDURE
After the procedure, it is important to eat only soft foods and to drink only cool or slightly warm liquids while the putty is in place and your gums are healing. It is important to keep the mouth clean after the procedure. While it is important not to brush in the area where the procedure was performed, it may be possible to brush and floss the rest of the mouth. After a few weeks the gums will be completely healed and it will be possible to resume brushing and flossing, though this should be done gently at first. 

GUIDED TISSUE REGENERATION 

Periodontal disease causes bone loss around teeth, which can increase the chances for tooth loss. Once a tooth has been lost, the supporting jaw bone will disappear over time. This can make wearing dentures uncomfortable. However, simple techniques are now available to regrow lost bone, provide support for dental implants, or to improve esthetics beneath a fixed bridge.

Guided tissue bone regeneration does not always require the removal of bone from any other part of the body. Instead, many options use membrane barriers, tissue stimulating proteins, or bioactive growth factor gels. Occasionally bone grafting procedures are required; bone grafts can be from your own bone, tissue banks, or synthetic materials. The goal of each of these treatment options is to stimulate the body to grow new bone or to hold the space for the bone to regenerate into.

​The bone and gum tissue should fit together like a turtleneck around your neck. But when periodontal disease is present, this supporting tissue and bone is destroyed and pockets in the gums develop. Eventually, if too much bone is lost, the tooth will need to be extracted.

Guided tissue bone regeneration helps the body to regenerate lost bone. By repairing the damage done by periodontal disease, this procedure will increase the chances of keeping your natural teeth and will decrease the odds of serious health problems associated with periodontal disease.

​GUM GRAFTING


​Receding gums happen when the gum line moves toward the root of tooth, leaving a larger portion of tooth enamel exposed. It is one of the most noticeable and damaging results of gum disease. Unfortunately, not many patients receive treatment because they are unaware of their gum recession. Receding gums can happen very gradually and is often not noticeable until the symptoms become severe. These symptoms include sensitivity to extreme temperatures, exposure of the roots, and teeth that appear “long”. Without gum tissue surrounding the tooth and its root, the risk of cavity and decay is greatly increased. This makes it important to fix receding gums as soon as possible.
Gum grafting is the procedure in which receding gums are repaired by taking tissue from another area and attaching it to the gum line. In addition to the obvious health benefits, gum grafting can help patients who are unhappy with the aesthetic appearance of their teeth. It can help to reduce the amount of tooth shown and increase the gum line to a more attractive level. There are currently three types of gum grafting available:
​Occlusal, or bite, adjustment is a procedure performed to remove tiny interferences that keep teeth from coming together properly.  These interferences can prevent the jaw from closing in its anatomically correct position.  Interferences can develop as teeth develop, can occur following an accident, or they can accumulate over time with wear.  Dental work such as fillings, crowns, bridges, and extractions can also cause interferences. 
Interferences can prevent the jaw from fully sliding into its anatomically correct position.  This means that the muscles of the jaw and neck are never able to fully relax.  This may result in severe headaches and neck aches.  Many develop bruxism, or teeth grinding, as their jaw seeks its natural position.  Bruxism can cause bone loss, tooth loss, and receding gums.  Overtime, patients may develop tempromandibular joint issues, or TMJ, if they go untreated.

HOW CAN I KNOW IF MY BITE IS “OFF”?

During your examination, your doctor will examine your jaw closely and may notice symptoms that your bite may be off.  Some symptoms include if the jaw does not open evenly on both sides, if the jaw makes a clicking noise as it opens, if the enamel has been ground away in certain areas, or if there are fractured teeth.  Chronic symptoms of bruxism, headaches or neck aches, are also clues that the bite may be off. 

HOW IS MY BITE FIXED?
Before the procedure begins, the doctor will have you bite on a very thin piece of mylar paper.  The mylar paper transfers color to the areas where contact occurs.  The doctor will then smooth the area where the marks have been left removing just enough of the tooth or restoration to eliminate the interference.  This process will be done on all areas where the mylar paper left color on the tooth until the jaw is able to get into its normal position.

GUM TREATMENTS : teeth cleaning in Panipat

​Yamuna Enclave Branch
#278,Yamuna Enlcave, Panipat 

Timings: 10 am to 8 pm  

Call us now 

​98129-12946, 98121-05400

​Sanoli Road Branch
Basement Lotus Hospital, Sanoli Road

​Timings: 10 am to 8 pm