What happens at a dental exam and cleaning, in order

The sequence has a purpose. Charting usually comes before the cleaning, because deposits and bleeding points give us information that's lost once the cleaning begins.

  1. Medical history and medications

    Blood thinners, bisphosphonates, diabetes, a new heart valve, a joint replacement, and anything that dries the mouth can all change our approach to treatment. Please mention any changes, even ones that seem unrelated to your teeth.

  2. X-rays, if you are due

    Usually taken early so they can be read alongside the examination. The interval depends on your decay risk rather than on the calendar. See dental x-rays.

  3. Periodontal charting

    A blunt probe measures the depth between gum and tooth at six points per tooth, along with any bleeding and recession. These are the numbers you hear being read aloud. One to three millimeters without bleeding is healthy. Deeper readings, or bleeding, suggest inflammation and possible bone loss.

  4. Oral cancer screening

    A brief part of the visit that many patients never notice. We examine and palpate the tongue, floor of the mouth, cheeks, palate, tonsil area, and the lymph nodes along the jaw and neck. Some changes are easy to see and some are not, which is why we check the whole area.

  5. Scaling

    Calculus is plaque that has hardened into a mineral deposit a toothbrush can no longer remove. We remove it with hand instruments, an ultrasonic tip, or both. This is the part of the appointment that improves gum health.

  6. Polishing

    A rubber cup and a mildly abrasive paste remove surface stain. Polishing is largely cosmetic, and the scaling step is what benefits the health of your gums.

  7. The examination and the conversation

    Each tooth is checked for decay, cracks and failing restorations, followed by the bite, the wear, the jaw joint and the x-rays. The visit ends with a conversation: Dr. Brosi will explain what he found, what's urgent, what can reasonably wait, and what happens if a problem is left untreated.

What a routine cleaning misses when there is gum disease

A routine cleaning works above the gumline and a short distance beneath it. That's enough when the tissue is healthy and the pockets are shallow.

Once periodontal disease is established, deposits sit further down the root, in pockets of four, five or six millimeters, where a routine cleaning can't reach them. The mouth can feel better for a few weeks while the disease continues below the gumline. That's why the charting comes first. The usual treatment is scaling and root planing, one section of the mouth at a time with the area numbed, followed by a shorter recall interval. More on gum disease.

How to get more out of the appointment

A few small preparations change what we can accomplish together in the hour.

  • A current medication list, supplements included, along with anything that has changed since your last visit.
  • Recent diagnoses. Diabetes and gum disease each make the other harder to control, so this information matters.
  • Your questions, written down. Bring them up at the start of the visit and we can give them more time than questions raised at the end.
  • No extra scrubbing the night before. Gums that have been brushed hard tend to bleed and swell, which makes the charting read worse than the underlying condition.
  • Any dental plan details you have. Bring the card or the plan information with you, and you're welcome to ask about cost when you call. See insurance and payment options.

Questions about exams and cleanings

Will the cleaning hurt?

It usually involves more pressure and cold water than pain. Inflamed gums are tender, and exposed roots can be sharply sensitive to cold. Topical numbing gel helps, and a local anesthetic can be used for deeper work. Let your hygienist know early if you're uncomfortable.

My gums bleed when they are cleaned. Is that normal?

Bleeding is common, and it's usually a sign that the tissue is inflamed. The usual cause is plaque at the gumline. Some medications, pregnancy and certain medical conditions can also cause bleeding, so please come have it looked at. Cleaning the area less doesn't resolve it. See brushing and flossing.

Will a cleaning whiten my teeth?

A cleaning removes surface stain from coffee, tea, red wine and tobacco, so teeth often look brighter afterward. That's stain removal rather than whitening. The underlying color of the tooth is unchanged, and changing it takes teeth whitening.

Do I have to ask for the oral cancer screening?

No, it's part of every examination: a visual and manual check of the tongue, floor and roof of the mouth, cheeks, throat and neck, looking for anything abnormal, particularly a sore that hasn't healed within two weeks. Tobacco and heavy alcohol use raise the risk.

I have not seen a dentist in years. Where do we start?

We'd be glad to see you. We usually start with an examination, x-rays, and a list of findings in priority order. Urgent items come first, and the rest can be scheduled over time in an order that suits you. Meet Dr. Brosi or read the patient FAQ page.