Most people go for a dental checkup every 6-12 months without really understanding what is involved. Dentists recommend regular cleaning appointments, but fail to explain why brushing and flossing are not enough. We hope this page provides you a better understanding of what goes on during a regular appointment.

An average appointment should run you no more than 30 minutes to an hour. Since the procedure is essentially painless, you will rarely receive anesthesia - if you are feeling anxious though, your dentist can provide nitrous oxide, or “laughing gas”. Nitrous oxide is a gaseous drug that does not alleviate pain, but calms your mind and allows the procedure to continue without interruption.

During a regular appointment your dentist will do four essential things: dental checkup, scaling, polishing, followed by a fluoride treatment for some qualifying patients.

Dental checkup

During the dental checkup, your dentist will be on the lookout for various ailments – both inside and outside the mouth. Since oral health is linked to the body’s general health, dentists are trained to notice early signs of systemic disease even while you are still just getting comfortable in the dental chair.

A good dentist will take note of any enlarged lymph nodes in the head and neck region, as this is a sign of infection spreading through the body. Discolored facial skin can be indicative of liver dysfunction. An enlarged thyroid that the patient considers “normal” might actually be the result of hyper or hypothyroidism. Without going through the entire list, it is clear that a dental checkup begins before you have even opened your mouth.

Following the regular health questions, your dentist will likely sit you back in the chair and look inside your mouth. Your dentist is examining your teeth for decay (which may require x-ray confirmation) but that is just the beginning. Dentists are trained to examine your gums, palate, tongue, lymph nodes, and check for a host of conditions. Many diseases are unique to the mouth (oral cancer, gingivitis, periodontitis, etc), while many systemic diseases manifest themselves in the mouth (diabetes, herpes, leukemia, etc) – your dentist is trained to diagnose both varieties.

Clearly, a general dental checkup goes beyond examining the health of your teeth, though that itself can be a challenge.

Dental scaling

Assuming the checkup finds everything to be within a normal range, your dentist will likely begin scaling your teeth. In many dental offices, the dental hygienist does this step with the dentist checking the completed work. So what exactly is teeth scaling and why do you need it?

When you disregard brushing for a day, you will notice a “fuzzy” film on your teeth surface – this is plaque. Dental plaque is the accumulation of bacteria that have adhered to your tooth surface. Regular brushing and scaling can easily get rid of most of this plaque – but not all of it. Plaque resides in the pocket that exists between your gums and teeth, as well as hard-to-reach areas that your toothbrush misses.

Patient receiving dental scaling. Most scaling treatments are painless and do not require anaesthesia.

Within days, this plaque hardens or “calcifies” and is now termed calculus or “tartar”. Dental calculus cannot be removed by regular brushing or flossing – only a dentist’s scaling instruments can remove the bacterial colony. Even those of us who practice the best oral hygiene methods will have some calculus and this is what underlines the general recommendation to have a dental cleaning every 6-12 months.  Dental calculus, much like dental plaque, greatly increases the odds of dental decay.

During the scaling procedure, sharp scaling instruments are run inside the pockets that exist between your gums and teeth to remove the calculus. Your gingival tissue should never come in contact with the instrument. The procedure is painless, but in patients with poor hygiene, the calculus may be so great that the gums are sensitized and bleed with minimal contact. For these patients, your dentist may opt to provide local anesthesia to prevent pain sensation.

Patient receiving dental polishing. This is done almost always after the scaling procedure.

Dental polishing

Following the scaling, many dentists polish the teeth. While not as critical as scaling, polishing simply provides that fresh-from-the-dentist feeling that many people associate with having their teeth professionally cleaned.

Your dentist will apply pumice (sand-like substance) to a polishing bur attached to the dental drill. Running the device across teeth surfaces helps polish them and remove any remaining plaque.

Fluoride treatment

At the very end, your dentist may determine that you are in need of fluoride treatment. Fluoride foam or gel is then placed into small, flexible foam trays and placed over the teeth for 30 seconds. Afterwards the patient is directed to spit as much out as possible into a saliva ejector. It is best not to eat, drink or rinse for 30 minutes after the fluoride has been applied.

The fluoride helps to strengthen the teeth since the acids from bacteria in dental calculus and plaque will have weakened the surfaces. Fluoride is a natural mineral that gets built into your enamel and helps strengthen it. Excessive fluoride can cause flourosis of the teeth though – a dental condition. Since fluoride is often present in toothpaste and tap water, your dentist may opt to not give you this treatment. Fluoride treatment is largely reserved for children, and adults who have poor oral health. Question your dentist if you receive fluoride application at every appointment without justification.

Cost

The charge for a standard teeth cleaning and dental exam ranges from $50 -$135. The more extensive deep cleaning process called scaling and root planing is done by quadrants (upper right, upper left, lower right, lower left) at a cost of about $100 -$400 per quadrant depending on the severity of the problem or $400 -$1,600 for the entire mouth. Most dental insurance includes these procedures.

If you are at risk of periodontal diseases because of age, tobacco use, rate of accumulation of deposits, personal oral hygiene practices, or medical conditions such as diabetes or HIV infection, your teeth may need to be cleaned more often. Your dentist or dental hygienist can help you determine how often you should have your teeth cleaned.

Important considerations

If you have a heart condition, or have undergone recent heart surgery, it is extremely important to inform your dentist before the scaling procedure. Those with heart problems or heart defects are at high risk for developing a condition called bacterial endocarditis, which can seriously affect the heart. The only treatment needed prior to a dental cleaning, unless otherwise instructed, is a dose of antibiotics an hour before the cleaning.

If a dentist does not know the proper dosage, then one should contact one’s physician. Usually dentists will know the dosage, but if in doubt, one can also check with the American Heart Association, which lists all guidelines for bacterial endocarditis prevention.