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Dental question - deep pocket cleaning?

Old 08-16-2016, 01:39 PM
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Default Dental question - deep pocket cleaning?

My old dentist retired and I went to the person that bought his practice.

1) I liked the way the hygienist cleaned teeth. Better than the old one.
2) I hated that the dentist did not look at my mouth. She said she only does that during exams, the old dentist would give a quick look at ever visit.

The question is that in my wisdom teeth area and back molars where it is hard to reach I have some 4's in terms of pocket depth. Maybe one 5. She said she would give me novacaine and then really dig under the gums to clean. Also said she could only do one side of my face at a time which means 2 visits.

Does this make sense? Have any of you done this? My general rule is if it ain't broke.... but I want to protect my teeth which are not bad and I have not had any real work aside from cleaning in the last 20 years or so.

I also had a set of xrays done six months ago. The new dentist said she would like to take digital xrays next time I come in as they are clearer. My take is to wait a year. Seems like an upsell.
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Old 08-16-2016, 01:57 PM
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Yes... its a generally accepted practice now. Deep cleaning for pockets like those. Yours are not that bad that cleaning and care and watching will lessen them hopefully. I can see her point about getting better xrays. Then you will be good for a years. I don't think thats excessive since the older ones are not as detailed. But you can wait 6 months if you want.
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Old 08-16-2016, 01:59 PM
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Try something else first. I had some 5's and 6''s and someone told me to get a quality electric toothbrush and brush your teeth concentrating on the gums a couple times a day for several minutes. They will bleed on you. Try this for about 60 to 90 days and get the pockets checked again. I went from some 5's and 6's down to 2's and 3's. Told a friend about it and it worked for him too.
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Old 08-16-2016, 02:00 PM
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This is from my experience I am no dentist.

Either get them deep cleaned or have them pulled.

I opted to have the GAS and still only wanted to sit through one side at a time. Cleaning was covered mostly by insurance.

Doug
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Old 08-16-2016, 02:08 PM
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Originally Posted by joe.giuliano View Post
My old dentist retired and I went to the person that bought his practice.

1) I liked the way the hygienist cleaned teeth. Better than the old one.
2) I hated that the dentist did not look at my mouth. She said she only does that during exams, the old dentist would give a quick look at ever visit.

The question is that in my wisdom teeth area and back molars where it is hard to reach I have some 4's in terms of pocket depth. Maybe one 5. She said she would give me novacaine and then really dig under the gums to clean. Also said she could only do one side of my face at a time which means 2 visits.

Does this make sense? Have any of you done this? My general rule is if it ain't broke.... but I want to protect my teeth which are not bad and I have not had any real work aside from cleaning in the last 20 years or so.

I also had a set of xrays done six months ago. The new dentist said she would like to take digital xrays next time I come in as they are clearer. My take is to wait a year. Seems like an upsell.
If the numbers of the pocket depth are really 4mm and 5mm then that isn't very deep. It is a challenge to go to a dentist and not follow their recommendations, but at that depth as you know from your former dentist there are dentists who will monitor your pockets and if they get deeper then do something.

If there is calculus on the teeth then that should be removed. Some hygienists are more comfortable about getting the calculus off without the anesthetic and extra expense than others.

I also agree with you about waiting a year for fresh x rays unless you get a lot of decay or the x rays she has aren't clear (which may be what she is saying.)
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Old 08-16-2016, 02:17 PM
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My hygienist suggested I go for a separate pocket cleaning where novacain could be administered and I told her to just go for it. It may sound weird but I almost enjoy the deep scraping and cleaning. That said it was not bad at all and not all that much blood.

I finally discovered the disposable bulk floss tools and now floss daily. I also regularly use an electric toothbrush and use one of those mouthwashes that must have peroxide in it. Teeth are as strong as ever with no cavities in years.

My issue was a couple missed cleanings due to a retiring dentist and the new guy sucked (per my wife)
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Old 08-16-2016, 02:18 PM
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There are several factors that go into it.

1. Is there bleeding associated with those pockets (inflammation from active disease process)?
If no bleeding, I'll tend to leave things alone as that's a sign of stability.

2. How long have those pockets been there? Again, if things have been like that for a good couple years and have not changed for the worse, I consider that sign of stability.

3. Location.. 2nd molars and wisdom teeth are going to likely have some 4's and 5's in the average patient. Again, as long as they are healthy we leave things how they are.

4. Medical history and habits? Smoking, diabetes are tough on oral/periodontal health.

If things are pretty stable and its a couple 4's and maybe a few 5's around molars and the old dentist's hygenist wasn't doing anything except a glorified tooth brushing, you might see those pockets shrink a millimeter or so after a good cleaning.

It's good to hear that the new hygenist did a good job. But not so good to hear that the new dentist isn't sitting down to check you out. Its not so much a factor of looking at the teeth, but more importantly looking at the mouth and throat when I see a patient every 6 months. Sure I look at their teeth, but I look real hard at their oral tissues. Gums, tongue, cheeks, throat all manifest medical conditions in their own right. We call it an oral health & cancer screening, and it might save your life.

My soapbox... Way too many dentists are on the sales bandwagon these days... Its a damn shame. Makes our profession untrustworthy. And the corporate doc-in-a-box clinics are the absolute worst about it. Coupons and fancy commercials to get you in the door, and then they up-sell you and a-la-carte you to the bank. I am very conservative in my practice and I try to help patients in the most efficient and economical ways I can. But I guess that's why I don't have a spanking new 40ft CC sitting out back either.
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Old 08-16-2016, 02:45 PM
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Originally Posted by joe.giuliano View Post
My old dentist retired and I went to the person that bought his practice.

1) I liked the way the hygienist cleaned teeth. Better than the old one.
2) I hated that the dentist did not look at my mouth. She said she only does that during exams, the old dentist would give a quick look at ever visit.

The question is that in my wisdom teeth area and back molars where it is hard to reach I have some 4's in terms of pocket depth. Maybe one 5. She said she would give me novacaine and then really dig under the gums to clean. Also said she could only do one side of my face at a time which means 2 visits.

Does this make sense? Have any of you done this? My general rule is if it ain't broke.... but I want to protect my teeth which are not bad and I have not had any real work aside from cleaning in the last 20 years or so.

I also had a set of xrays done six months ago. The new dentist said she would like to take digital xrays next time I come in as they are clearer. My take is to wait a year. Seems like an upsell.
It's legit. I had yuuuuuuge perio problems from neglecting the dentist for way too many years, until I finally HAD to go because my jaw swelled up and was in horrible pain. It's taken a few years, but I'm pretty much 2's and 3's now, even had LANAP laser surgery to try and fix the deep pockets. In my case, I have a couple of molars in the back that are 5-6's due to the way the roots grow, just no way around it. The digital xrays will show that.

The deep cleaning is indeed painful and it takes awhile, which is why they split into two sessions.

Surprised you still have your wisdom teeth. I got rid of mine in my 30's, as they were crowding all the other teeth and created perio problems. You might want to consider that, as well. It WILL help your teeth spread a bit and they will be easier to clean. My last visit, I was in and out with Peggy the hygienist in about a 1/2 hour. All was looking great!
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Old 08-16-2016, 02:55 PM
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Originally Posted by RingLeader View Post
There are several factors that go into it.

1. Is there bleeding associated with those pockets (inflammation from active disease process)?
If no bleeding, I'll tend to leave things alone as that's a sign of stability.

2. How long have those pockets been there? Again, if things have been like that for a good couple years and have not changed for the worse, I consider that sign of stability.

3. Location.. 2nd molars and wisdom teeth are going to likely have some 4's and 5's in the average patient. Again, as long as they are healthy we leave things how they are.

4. Medical history and habits? Smoking, diabetes are tough on oral/periodontal health.

If things are pretty stable and its a couple 4's and maybe a few 5's around molars and the old dentist's hygenist wasn't doing anything except a glorified tooth brushing, you might see those pockets shrink a millimeter or so after a good cleaning.

It's good to hear that the new hygenist did a good job. But not so good to hear that the new dentist isn't sitting down to check you out. Its not so much a factor of looking at the teeth, but more importantly looking at the mouth and throat when I see a patient every 6 months. Sure I look at their teeth, but I look real hard at their oral tissues. Gums, tongue, cheeks, throat all manifest medical conditions in their own right. We call it an oral health & cancer screening, and it might save your life.

My soapbox... Way too many dentists are on the sales bandwagon these days... Its a damn shame. Makes our profession untrustworthy. And the corporate doc-in-a-box clinics are the absolute worst about it. Coupons and fancy commercials to get you in the door, and then they up-sell you and a-la-carte you to the bank. I am very conservative in my practice and I try to help patients in the most efficient and economical ways I can. But I guess that's why I don't have a spanking new 40ft CC sitting out back either.
This is what I wanted to hear. I smoke the occasional cigar. Have no bleeding or swelling and its been that way for a long while. There was some recession on a tooth but I think I aggravated it by brushing way too hard (she agreed). I just ordered a water pik/electric toothbrush system and will be more diligent for a three months and then go back.

The dentist did mention a twice a year mouth exam for cancer screening but I had one for my last cleaning. Still bugs me she would not take a minute to look quick like the old doc did. I may look for a new dentist closer to my house.
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Old 08-16-2016, 03:15 PM
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Joe, I was having similar problems with "pocket depth". Hygenist suggested a water pik. I bought one and have been using it religiously every morning for well over a year and my "numbers" have improved significantly.
I dunno if it helps, but I take and empty gallon water jug and fill it 1/2 full with hydrogen peroxide, dump in about 6 oz of mouthwash then fill the rest with water. That's the concoction i put in the water pik.
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Old 08-16-2016, 03:23 PM
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Originally Posted by RingLeader View Post
I am very conservative in my practice and I try to help patients in the most efficient and economical ways I can. But I guess that's why I don't have a spanking new 40ft CC sitting out back either.
You have a sweet Mako and a clear conscience, that beats the 40 ft CC all day long.
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Old 08-16-2016, 04:17 PM
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4s aren't that bad. I had it done a while back. They also told me it would take a couple of visits normally. However, since mine weren't that bad, they were able to do it all at once with no novacaine. It wasn't that bad. A few spots hurt, but not too bad.
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Old 08-16-2016, 05:12 PM
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Originally Posted by Boataholic View Post
Joe, I was having similar problems with "pocket depth". Hygenist suggested a water pik. I bought one and have been using it religiously every morning for well over a year and my "numbers" have improved significantly.
I dunno if it helps, but I take and empty gallon water jug and fill it 1/2 full with hydrogen peroxide, dump in about 6 oz of mouthwash then fill the rest with water. That's the concoction i put in the water pik.

Of what he speaks this man knows. I use a 50/50 mix of mouth wash (cheap stuff at Walmart or Dollar General). Let the regular hygenist do the deep clean and then Water Pick daily on high. You may have to work up to the max setting but be sure to go there.

JT
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Old 08-16-2016, 05:37 PM
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Its 100% legit.

I was bad and didn't see the dentist for 7 years. I flossed daily and brushed religiously, always. Only ever had one cavity.

I wasnt having problems, but finally the wife made me go. I was paranoid. Soon as I sat down they took x rays and said they could do the descaling/general cleaning but I would need to come back at least twice for deep cleaning. However, they did say that besides significant buildup below the gumline, my teeth were 100% pristine. No cavities, and gums a bit inflamed, but otherwise healthy.

I went back twice, one visit for each side as you've said. Worst part was the numbing shot, and even that I barely felt. They put some numbing gel on first. An hour each time and now I'm good to go.

That was 5 months ago, and my next cleaning is in 4 weeks.

I was extremely lucky because I have an excellent hygienist and a dentist who I trust. Total out of pocket was $400. You can bet your ass I won't skip a 6 month cleaning again though!

Both times I had it done at 9am and was eating lunch at noon with zero pain whatsoever. Very simple procedure.
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Old 08-17-2016, 04:52 AM
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Try and brush at least twice a day with a good electric toothbrush, in the morning and at night before bed, and floss once a day. I usually floss at night, at least I try to, I do occasionally skip a few days. Also use a good mouth wash after brushing, I like original Listerine. That will help close up those gaps and minimize bleeding gums.
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Old 08-17-2016, 05:11 AM
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Is a pocket a cavity? If so it would seem to depend on how wide the cavity was also therefore how easy to clean, right?

As recommended by Hygenist Also I make my pown mouthwash one part H peroxide to about 3-5parts water (Doc says use double the water ) with a splash of basic blue mouthwash. Mix it in a used gatorade bottle will last several weeks ifused after brushing flossing twice a day. Seems to make a difference.
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Old 08-17-2016, 07:33 AM
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No .. a pocket is a space where the gum has receded away from the tooth forming a pocket Where food can accumulate and bacteria thrive. Which then makes the tooth lose even more gum contact.
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