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Prophy (Regular Cleanings)
A prophy includes a series of procedures where plaque, calculus, and stain are removed from all surfaces of the teeth above the gumline. This is done with hand instruments, ultrasonic scalers, and coronal polishing. Only a licensed dental professional is qualified to determine the need for oral prophylaxis. Only a dentist, dental hygienist, and trained dental assistant can perform the procedure.

Periodontal Maintenance
A periodontal maintenance procedure (PMP) is defined as a procedure that is recommended following periodontal treatment (such as scaling and root planing) and continues at varying intervals, determined by the clinical evaluation of the dentist.

These intervals can be as frequent as every two months and they can be extended as long as six months, depending on the patient. Keeping up you're your PMP interval is important because periodontal disease can recur without adequate follow up.

PMP includes removal of plaque and tartar above and below the gums, scaling and root planing of specific areas, and polishing. PMP is always completed following active periodontal treatment such as scaling and root planing or more extensive gum surgery.

Scaling and Root Planing
Scaling and Root Planing is a special type of treatment that goes deeper BELOW the gum line to remove contaminated debris and bacteria, most often performed on patients with active periodontitis.

This seems to be a procedure that causes so much confusion for patients in trying to understand the difference between "just a cleaning" and Scaling and Root Planing, and the need/reason for this procedure.

Scaling and Root Planing is done to remove soft sticky plaque and hard crusty calculus that is loaded with bacteria, around and BELOW the gum line on root surfaces. A professional polishing or prophy removes only the soft sticky plaque and hard crusty calculus that is ABOVE the gum line on the crown of the tooth. It is a method of treating gum disease when pockets formed around the teeth have a measurement of greater than 3mm and there is evidence of bleeding and tissue attachment loss.

1. Scaling
Scaling is a procedure that meticulously removes contaminated biofilm, plaque, calculus, micro-organisms, and toxins from around the gum line down to the bottom of each periodontal pocket in order to obtain a healing response.

2. Root Planing
Root planing involves smoothing the root surfaces of your teeth with thin instruments so gum tissue can more firmly reattach to roots that are clean and smooth to prevent tooth loss and sensitivity problems. This procedure makes it more difficult for plaque, calculus, and bacteria to accumulate along these root surfaces.

Because this procedure goes deeper than a regular cleaning, your mouth may be numbed. The cleaning may take one to six visits to complete. Depending on the extent of the disease, you may need one or more quadrants of the mouth to be treated with scaling and root planing.

Some Reasons Why Root Planning May Be Necessary
• To control the growth of harmful bacteria. (bacteria ABOVE the gum line are less aggressive bacteria whereas the bacteria BELOW the gum are more DESTRUCTIVE and DANGEROUS!
• Helps pocket wall reattach firmly to the clean root surface to create a pocket depth that can be better maintained by patient
• Prevent further bleeding of the gums from disease
• Reduces inflammation
• Reduces discomfort
• Prevent bone loss
• Prevent gum disease related tooth loss
• Reduce systemic disease

Home Care after Root Planing and Scaling
1. Rinse with warm salt water every few hours (1/2 tsp. salt in 8oz water) for the remainder of the day to encourage healing and sooth discomfort.
2. Be careful not to bite or chew your lip, cheek or tongue while they are numb. Avoid chewing for 2 hours after this procedure or until numbness has worn off.
3. Keep your fingers and tongue away from the areas that have been treated.
4. Take Tylenol or ibuprofen according to directions on the manufacturer label for a couple of days to help with the discomfort; do NOT take Aspirin because it may prolong bleeding.
5. Rinse your mouth with Closys or Chlorohexidine, if prescribed by dentist, to reduce oral bacteria.
6. Do not smoke or chew tobacco for 72 hours after the procedure to allow for healing.
7. Gently brush and floss your teeth after each meal.

How you care for your teeth and gums at home after treatment is critical to reduce the risk of recurring periodontal disease.

Trigeminal Neuralgia
As requested, we are doing a follow-up to our article last month about facial pain – specifically Trigeminal Neuralgia.

The trigeminal nerve is one of the main nerve branches in the face. It’s the 5th cranial nerve and the most widely distributed one in the head. Trigeminal Neuralgia (or TN) is when chronic pain develops in association with the trigeminal nerve. There are two types of TN. TN1 is sporadic, sudden, extreme shock or burn – like feeling of pain that lasts usually under 2 minutes. TN2 is constant aching, burning, or shooting pain that is typically a little duller than TN1. Some people can have both types at the same time (bilateral TN), but TN1 is the most prevalent. TN usually affects only one side of the face and is most common in women over 50.

TN can result from various conditions, the most common being a blood vessel that presses on the trigeminal nerve as it exits the brain stem. This pressure starts to wear away the protective covering (myelin sheath) of the nerve - triggering pain signals to the brain.
Treatment options for TN are subpar at best (in my option). Almost all surgical treatment options have a best outcome of 1-3 years of relief for type 1 TN (some even resulting with permanent numbness in various areas of the face). The most invasive treatment is called Microvascular decompression (MVD). This treatment involves creating a small hole in the mastoid bone behind the ear and, through it, the surgeon places a “cushion” between the nerve and the compressing blood vessel. This procedure provides the longest lasting relief of about 12-15 years.

If you suffer from TN and want to avoid surgery then more than likely your doctor will want to put you on an anti-convulsive medication which dampens the pain signal to the brain. There is another non-surgical option, that needs to be studied further, but the treatment outcome seems to be very promising. That option is an acupuncture (specifically the Xiaguan ST7 point) injection of a high dose of vitamin B12. The study that was done found Vitamin B12 injections were far more effective than anti-convulsive oral medication.

It does seem very plausible that some TN could be a result of a vitamin B12 deficiency. As we know (from last month’s Vitamin B12 article) that it can take years for a B12 deficiency to show up because our bodies store so much of it. Plus, as we get older, our bodies have a hard time converting B12 into its usable form: methylcobalamin. I’m hopeful that more research is being done regarding the correlation between TN and B12 deficiency. I only found one study that was done and that was 11 years ago and in China.

I hope this article helped shed some light on trigeminal neuralgia for y’all. If you or someone you know suffers from TN, have them get their vitamin B12 levels checked. It’s not going to hurt anything and may get them on a path to finally being pain free.

- Jocelyn RDH

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