A dental prophylaxis is a procedure performed routinely to thoroughly clean the teeth by removing plaque, tarter and stain which builds up on the surfaces of the teeth over time. Prophylaxis is an important dental treatment for preventing the progression of periodontal disease and gingivitis. 

Periodontal disease and gingivitis occur when bacteria from plaque colonize on the teeth and gingival (gum) tissue, either above or below the gum line. These bacterial colonies produce toxins causing  inflammation and irritation in the gum tissues which can lead to tissue and bone loss around the teeth.  The loss of the supporting structures (bone and gum tissues) around the teeth can cause the teeth to shift, become unstable, or completely fall out. The pockets or spaces between the gums and teeth become deeper and house more bacteria which may travel via the bloodstream and infect other parts of the body.

Reasons for preventative maintenance

Routine maintenance is necessary to help keep the oral cavity in good health, diagnose disease at an early stage, and also to minimize the progression of gum disease.

Here are some of the benefits of preventative maintenance appointments:

• Tartar removal – Tartar (calculus) and plaque buildup, both above and below the gum line, can cause serious periodontal problems if left untreated.  Even when using the best brushing and flossing home-care techniques, it can be impossible to remove debris, bacteria and deposits from gum pockets.  The experienced eye of a dentist or dental hygienist using specialized dental equipment is needed in order to spot and treat tartar and plaque buildup.
  
  
• Aesthetics – It’s hard to feel confident about a smile marred by yellowing, stained teeth.  Prophylaxis can rid the teeth of unsightly stains and return the smile to its former glory.
  
  
• Fresher breath – Periodontal disease is often signified by persistent bad breath (halitosis).  Bad breath is generally caused by a combination of rotting food particles below the gum line, possible gangrene stemming from gum infection, and periodontal problems.  The removal of plaque, calculus and bacteria noticeably improves breath and alleviates irritation.

Identification of health issues – Many health problems first present themselves in the oral cavity.  Since prophylaxis involves a thorough examination of the entire oral cavity, the dentist or dental hygienist is able to screen for oral cancer, evaluate the risk of periodontal disease, and often spot signs of medical problems like diabetes and kidney problems. Recommendations can also be provided for altering your home care regimen to encourage disease prevention.

What does preventative maintenance involve?

Most preventative maintenance procedures can be performed in the course of a regular dental visit. However, when active periodontal disease is present, several appointments may be required to effectively treat the infected areas and remove all tarter build-up and bacteria from below the gumline.  

1. Supragingival cleaning – The dentist or dental hygienist will thoroughly clean the tooth surfaces above the gum line with scaling tools to rid them of plaque and calculus.
   
   
2. Subgingival cleaning – This is the most important step for patients with active periodontal disease because the dentist or dental hygienist is able to remove calculus, plaque,  and bacteria from the gum pockets below the gum line where damage to the supporting structures occurs.
   
   
3. Root planing - This is the removal calculus and smoothing of the tooth root by the dentist or dental hygienist to eliminate any bacteria adhering to the tooth root.  These bacteria play an integral role in the breakdown of the gum tissues and bone surrounding the teeth, so eliminating them is crucial for the long-term stability of the teeth and supporting structures.
   
   
4. Medication - Following scaling and root planing, an antibiotic or antimicrobial gel may be placed in the deep gum pockets.  These localized antibiotics/antimicrobials promote fast healing in the deep pockets by killing bacterial over a period of several weeks. 
   
5. X-ray and examination – Routine X-rays can be extremely revealing when it comes to periodontal disease.  X-rays show the extent of bone loss, and also aid the dentist/dental hygienist in identifying areas which may need future attention.

Preventative maintenance is generally recommended twice annually, but may be recommended every    3-4 months for patient's at higher risk for the development or progression of periodontal disease.  Although periodontal disease cannot be completely reversed, routine preventative maintenance procedures are the best methods to minimize its destructive progress.