A comprehensive dental exam will be performed by your dentist at your initial dental visit. At regular check-up exams, your dentist and hygienist will include the following:
- Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss. X-rays also help determine tooth and root positions.
- Oral cancer screening: Check the face, neck, lips, tongue, throat, tissues, and gums for any signs of oral cancer.
- Gum disease evaluation: Check the gums and bone around the teeth for any signs of periodontal disease.
- Examination of tooth decay: All tooth surfaces will be checked for decay with special dental instruments.
- Examination of existing restorations: Check current fillings, crowns, etc.
Professional Dental Cleaning
Professional dental cleanings (dental prophylaxis) are usually performed by Registered Dental Hygienists. Your cleaning appointment will include a dental exam and the following:
- Removal of calculus (tartar): Calculus is hardened plaque that has been left on the tooth for some time and is now firmly attached to the tooth surface. Calculus forms above and below the gum line and can only be removed with special dental instruments.
- Removal of plaque: Plaque is a sticky, almost invisible film that forms on the teeth. It is a growing colony of living bacteria, food debris, and saliva. The bacteria produce toxins (poisons) that inflame the gums. This inflammation is the start of periodontal disease!
- Teeth polishing: Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.
Prophylaxis (Teeth Cleaning)
A dental prophylaxis is a cleaning procedure performed to thoroughly clean the teeth. Prophylaxis is an important dental treatment for halting the progression of periodontal disease and gingivitis.
Periodontal disease and gingivitis occur when bacteria from plaque colonize on the gingival (gum) tissue, either above or below the gum line. These bacteria colonies cause serious inflammation and irritation which in turn produce a chronic inflammatory response in the body. As a result, the body begins to systematically destroy gum and bone tissue, making the teeth shift, become unstable, or completely fall out. The pockets 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 prophylaxis/teeth cleaning
Prophylaxis is an excellent procedure to help keep the oral cavity in good health and also halt the progression of gum disease.
Here are some of the benefits of prophylaxis:
- Tartar removal – Tartar (calculus) and plaque buildup, both above and below the gum line, can cause serious periodontal problems if left untreated. Even using the best brushing and flossing homecare techniques, it can be impossible to remove debris, bacteria and deposits from gum pockets. The experienced eye of a dentist using specialized dental equipment is needed in order to spot and treat problems such as 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 to the dentist. Since prophylaxis involves a thorough examination of the entire oral cavity, the dentist is able to screen for oral cancer, evaluate the risk of periodontitis and often spot signs of medical problems like diabetes and kidney problems. Recommendations can also be provided for altering the home care regimen.
What does prophylaxis treatment involve?
Prophylaxis can either be performed in the course of a regular dental visit or, if necessary, under general anesthetic. The latter is particularly common where severe periodontal disease is suspected or has been diagnosed by the dentist. An endotracheal tube is sometimes placed in the throat to protect the lungs from harmful bacteria which will be removed from the mouth.
Prophylaxis is generally performed in several stages:
- Supragingival cleaning – The dentist will thoroughly clean the area above the gum line with scaling tools to rid them of plaque and calculus.
- Subgingival cleaning – This is the most important step for patients with periodontal disease because the dentist is able to remove calculus from the gum pockets and beneath the gum line.
- Root planing – This is the smoothing of the tooth root by the dentist to eliminate any remaining bacteria. These bacteria are extremely dangerous to periodontitis sufferers, so eliminating them is one of the top priorities of the dentist.
- Medication – Following scaling and root planing, an antibiotic or antimicrobial cream is often placed in the gum pockets. These creams promote fast and healthy healing in the pockets and help ease discomfort.
- X-ray and examination – Routine X-rays can be extremely revealing when it comes to periodontal disease. X-rays show the extent of bone and gum recession, and also aid the dentist in identifying areas which may need future attention.
Prophylaxis is recommended twice annually as a preventative measure, but should be performed every 3-4 months on periodontitis sufferers. Though gum disease cannot be completely reversed, prophylaxis is one of the tools the dentist can use to effectively halt its destructive progress.
Digital radiography (digital x-ray) is the latest technology used to take dental x-rays. This technique uses an electronic sensor (instead of x-ray film) that captures and stores the digital image on a computer. This image can be instantly viewed and enlarged helping the dentist and dental hygienist detect problems easier. Digital x-rays reduce radiation 80-90% compared to the already low exposure of traditional dental x-rays.
Dental x-rays are essential, preventative, diagnostic tools that provide valuable information not visible during a regular dental exam. Dentists and dental hygienists use this information to safely and accurately detect hidden dental abnormalities and complete an accurate treatment plan. Without x-rays, problem areas may go undetected.
Dental x-rays may reveal:
- Abscesses or cysts.
- Bone loss.
- Cancerous and non-cancerous tumors.
- Decay between the teeth.
- Developmental abnormalities.
- Poor tooth and root positions.
- Problems inside a tooth or below the gum line.
Detecting and treating dental problems at an early stage may save you time, money, unnecessary discomfort, and your teeth!
Are dental x-rays safe?
We are all exposed to natural radiation in our environment. Digital x-rays produce a significantly lower level of radiation compared to traditional dental x-rays. Not only are digital x-rays better for the health and safety of the patient, they are faster and more comfortable to take, which reduces your time in the dental office. Also, since the digital image is captured electronically, there is no need to develop the x-rays, thus eliminating the disposal of harmful waste and chemicals into the environment.
Even though digital x-rays produce a low level of radiation and are considered very safe, dentists still take necessary precautions to limit the patient’s exposure to radiation. These precautions include only taking those x-rays that are necessary, and using lead apron shields to protect the body.
How often should dental x-rays be taken?
The need for dental x-rays depends on each patient’s individual dental health needs. Your dentist and dental hygienist will recommend necessary x-rays based upon the review of your medical and dental history, a dental exam, signs and symptoms, your age, and risk of disease.
A full mouth series of dental x-rays is recommended for new patients. A full series is usually good for three to five years. Bite-wing x-rays (x-rays of top and bottom teeth biting together) are taken at recall (check-up) visits and are recommended once or twice a year to detect new dental problems.
Panoramic X-rays (also known as Panorex® or orthopantomograms) are wrap-around photographs of the face and teeth. They offer a view that would otherwise be invisible to the naked eye. X-rays in general, expose hidden structures, such as wisdom teeth, reveal preliminary signs of cavities, and also show fractures and bone loss.
Panoramic X-rays are extraoral and simple to perform. Usually, dental X-rays involve the film being placed inside the mouth, but panoramic film is hidden inside a mechanism that rotates around the outside of the head.
Unlike bitewing X-rays that need to be taken every few years, panoramic X-rays are generally only taken on an as-needed basis. A panoramic x-ray is not conducted to give a detailed view of each tooth, but rather to provide a better view of the sinus areas, nasal areas and mandibular nerve. Panoramic X-rays are preferable to bitewing X-rays when a patient is in extreme pain, and when a sinus problem is suspected to have caused dental problems.
Panoramic X-rays are extremely versatile in dentistry, and are used to:
- Assess patients with an extreme gag reflex.
- Evaluate the progression of TMJ.
- Expose cysts and abnormalities.
- Expose impacted teeth.
- Expose jawbone fractures.
- Plan treatment (full and partial dentures, braces and implants).
- Reveal gum disease and cavities.
How are panoramic X-rays taken?
The panoramic X-ray provides the dentist with an ear-to-ear two-dimensional view of both the upper and lower jaw. The most common uses for panoramic X-rays are to reveal the positioning of wisdom teeth and to check whether dental implants will affect the mandibular nerve (the nerve extending toward the lower lip).
The Panorex equipment consists of a rotating arm that holds the X-ray generator, and a moving film attachment that holds the pictures. The head is positioned between these two devices. The X-ray generator moves around the head taking pictures as orthogonally as possible. The positioning of the head and body is what determines how sharp, clear and useful the X-rays will be to the dentist. The pictures are magnified by as much as 30% to ensure that even the minutest detail will be noted.
Panoramic X-rays are an important diagnostic tool and are also valuable for planning future treatment. They are safer than other types of X-ray because less radiation enters the body.
The cephalometric X-ray is a unique tool, which enables the dentist to capture a complete radiographic image of the side of the face. X-rays in general offer the dentist a way to view the teeth, jawbone and soft tissues beyond what can be seen with the naked eye. Cephalometric X-rays are extraoral, meaning that no plates or film are inserted inside the mouth. Cephalometric and panoramic X-rays display the nasal and sinus passages, which are missed by intraoral bite-wing X-rays.
Cephalometric X-rays are usually taken with a panoramic X-ray machine. The adapted machine will have a special cephalometric film holder mounted on a mechanical arm. An X-ray image receptor is exposed to ionizing radiation in order to provide the dentist with pictures of the entire oral structure. The advantage of both cephalometric and panoramic X-rays is that the body is exposed to less radiation.
Cephalometric X-rays are not as common as “full sets” or bite-wing X-rays, but they serve several important functions:
- Provide views of the side profile of the face.
- Provide views of the jaw in relation to the cheekbone.
- Provide information about “bad bites” or malocclusions.
- Allow measurement of the teeth.
- Identify fractures and other injuries to the teeth and jawbone.
- Assists in orthodontic planning.
How are cephalometric X-rays taken?
Cephalometric X-rays are completely painless. The head is placed between the mechanical rotating arm and the film holder, which is placed on another arm. The arm rotates around the head capturing images of the face, mouth and teeth. The clarity and sharpness of these images will depend on the positioning of the body. The images are usually magnified up to 30%, so any signs of decay, disease or injury can be seen and treated.
After capturing cephalometric X-rays, the dentist will be able to see a complete side profile of the head. This can assist in orthodontic planning, and allow an immediate evaluation of how braces might impact the facial profile and teeth. Another common use for this type of X-ray is to determine specific measurements prior to the creation and placement of dental implants.
Oral Cancer Exam
According to research conducted by the American Cancer society, more than 30,000 cases of oral cancer are diagnosed each year. More than 7,000 of these cases result in the death of the patient. The good news is that oral cancer can easily be diagnosed with an annual oral cancer exam, and effectively treated when caught in its earliest stages.
Oral cancer is a pathologic process which begins with an asymptomatic stage during which the usual cancer signs may not be readily noticeable. This makes the oral cancer examinations performed by the dentist critically important. Oral cancers can be of varied histologic types such as teratoma, adenocarcinoma and melanoma. The most common type of oral cancer is the malignant squamous cell carcinoma. This oral cancer type usually originates in lip and mouth tissues.
There are many different places in the oral cavity and maxillofacial region in which oral cancers commonly occur, including:
- Salivary Glands
- Oropharyngeal Region (throat)
Reasons for oral cancer examinations
It is important to note that around 75 percent of oral cancers are linked with modifiable behaviors such as smoking, tobacco use and excessive alcohol consumption. Your dentist can provide literature and education on making lifestyle changes and smoking cessation.
When oral cancer is diagnosed in its earliest stages, treatment is generally very effective. Any noticeable abnormalities in the tongue, gums, mouth or surrounding area should be evaluated by a health professional as quickly as possible. During the oral cancer exam, the dentist and dental hygienist will be scrutinizing the maxillofacial and oral regions carefully for signs of pathologic changes.
The following signs will be investigated during a routine oral cancer exam:
- Red patches and sores – Red patches on the floor of the mouth, the front and sides of the tongue, white or pink patches which fail to heal and slow healing sores that bleed easily can be indicative of pathologic (cancerous) changes.
- Leukoplakia – This is a hardened white or gray, slightly raised lesion that can appear anywhere inside the mouth. Leukoplakia can be cancerous, or may become cancerous if treatment is not sought.
- Lumps – Soreness, lumps or the general thickening of tissue anywhere in the throat or mouth can signal pathological problems.
Oral cancer exams, diagnosis and treatment
The oral cancer examination is a completely painless process. During the visual part of the examination, the dentist will look for abnormality and feel the face, glands and neck for unusual bumps. Lasers which can highlight pathologic changes are also a wonderful tool for oral cancer checks. The laser can “look” below the surface for abnormal signs and lesions which would be invisible to the naked eye.
If abnormalities, lesions, leukoplakia or lumps are apparent, the dentist will implement a diagnostic impression and treatment plan. In the event that the initial treatment plan is ineffective, a biopsy of the area will be performed. The biopsy includes a clinical evaluation which will identify the precise stage and grade of the oral lesion.
Oral cancer is deemed to be present when the basement membrane of the epithelium has been broken. Malignant types of cancer can readily spread to other places in the oral and maxillofacial regions, posing additional secondary threats. Treatment methods vary according to the precise diagnosis, but may include excision, radiation therapy and chemotherapy.
During bi-annual check-ups, the dentist and hygienist will thoroughly look for changes and lesions in the mouth, but a dedicated comprehensive oral cancer screening should be performed at least once each year.
VELscope® Oral Cancer Screening
Oral cancer is often deemed the “forgotten disease,” because it kills more people than testicular cancer, cervical cancer and cancer of the brain each year and receives little publicity in return. Each year, over 30,000 Americans contract oral cancer, and only 57% of these people will live for more than five years without treatment.
Many people believe that if they abstain from tobacco and alcohol use, oral cancer will not affect them. Tobacco and alcohol use does contribute to oral cancer; however, 25% of those diagnosed abstain from both substances.
The best way to stay protected from oral cancer is to get annual oral cancer screenings. Most dentists perform an oral cancer exam during a regular dental checkup. The FDA-approved VELscope® offers dentists another examination tool to help detect oral cancer in its earliest stages. The VELscope® is a blue excitation lamp, which highlights precancerous and cancerous cell changes.
How does the VELscope® work?
The VELscope® uses Fluorescence Visualization (FV) in an exciting new way. Essentially, bright blue light is shone into the mouth to expose changes and lesions that would otherwise be invisible to the naked eye. One of the biggest difficulties in diagnosing oral cancer is that its symptoms look similar to symptoms of less serious problems. The VELscope® System affords the dentist important insight as to what is happening beneath the surface.
The healthy soft tissue of the mouth naturally absorbs the VELscope® frequency of blue light. Healthy areas beneath the surface of the soft tissue show up green, and the problem areas become much darker.
Here are some of the advantages of using the VELscope® System:
- Can be combined with digital photography.
- Detects lesions, white and red patches.
- Detects problem areas that cannot be seen under white light.
- Exposes precancerous and cancerous tissue.
- Helps dentists check that diseased soft tissue is completely removed.
- Helps diagnose oral cancer in its earliest stages, exponentially increasing the chance of survival.
- Quick, painless examinations.
How is the VELscope® examination performed?
The VELscope® examination literally takes only two or three minutes. It is a painless and noninvasive procedure that saves many lives every single year.
Here is a brief overview of what a VELscope® examination is like:
Initially, the dentist will perform a regular visual examination of the whole lower face. This includes the glands, tongue, cheeks and palate as well as the teeth. Next a pre-rinse solution is swilled around the mouth for slightly less than a minute. The dentist provides special eyewear to protect the integrity of the retinas. The lights in the room are dimmed to allow a clear view of the oral cavity.
The small VELscope® is bent to project blue light inside the mouth. Lesions and other indicators of oral cancer are easily noticeable because they appear much darker under the specialized light.
If symptoms are noted, the dentist may take a biopsy there and then to determine whether or not this is oral cancer. The results of the biopsy dictate the best course of action from there. Otherwise, another oral cancer screening is performed in one year’s time.