The subject of dental scaling is one that we all encounter almost daily in our clinical practice. We often forget to think about it on a deeper level because of the complexity of our daily work. In a clinic, scaling patients should account for 1/4-1/3 of the entire outpatient population, and I believe that the reward is directly proportional to the effort. Wang Yinyu, Department of Dentistry, White City Hospital
Thinking about scaling starts at the psychological level. What kind of people need scaling treatment? What kind of treatment is needed? What kind of people will come to the clinic for scaling treatment voluntarily? What will you gain from a pleasant communication with the patient? We should be psychologically targeted and comfortable in dealing with them.
The customers of dental scaling can be divided into three categories
First, customers who come to the clinic on their own initiative. They come to the clinic for gum and periodontal disease. Such patients mainly present with redness, pain, bleeding and psychological stress. They are obedient to the physician’s preaching and easy to communicate, and out of this rare trust the physician needs to be more attentive and delicate in the treatment.
Second, from other diseases incidentally detected periodontal hidden problems. This type of patient depends on the language skills of the doctor. That is, to emphasize the danger of hidden diseases, but do not make the patient feel that the doctor is taking credit for the cure and cheating him out of his money. In fact, many patients who need dental scaling treatment in the clinic belong to this category.
Third, introduced by other patients or themselves to do routine cleaning treatment. This kind of patients will have to sell their goods to know the family. This is the most difficult category, but also the one in which the practitioner is most likely to feel proud.
Indications, contraindications and examination visits
The main purpose of scaling is to combat oral disease, not simply to look good. Scaling can reduce the inflammatory condition of gingivitis and periodontitis, but scaling alone cannot cure periodontitis. To cure periodontal disease, further professional treatment should be performed after scaling.
Scaling is good for oral health, but it is not suitable for everyone, especially for certain people who suffer from systemic diseases. Scaling can bleed, so patients with bleeding disorders must choose the time of scaling carefully and have their teeth scaled only after systemic diseases are stabilized. Patients suffering from infectious diseases such as hepatitis and tuberculosis should truthfully explain their condition to the medical staff before scaling.
So the questioning should be thorough, especially about the past history. It is important to note that many systemic diseases are first manifested periodontally on the gums.
(1) People with various bleeding disorders, patients with thrombocytopenia, leukemia, uncontrolled type 2 diabetes mellitus. Patients with uncontrolled hyperthyroidism, etc. should be pre-applied with appropriate amount of pro-coagulant drugs to control the coagulation rate to avoid more bleeding during scaling.
(2) Patients suffering from certain acute infectious diseases, such as acute hepatitis active, tuberculosis patients, etc., should also wait for the disease to stabilize before they can go to the hospital for scaling. This is partly because of your own condition, in addition should also avoid infecting others.
(3) Patients with local inflammation of soft and hard tissues in the oral cavity in the acute phase (except acute necrotizing gingivitis) should wait until the acute phase has passed before scaling, in order to avoid the spread of inflammation delayed blood.
(4) Patients suffering from malignant tumors in the gum area are not easy to receive routine scaling to avoid the spread of tumors.
(5) Patients with active angina pectoris, myocardial infarction that has occurred within six months, as well as hypertension and heart failure that have not been effectively controlled, are not easily treated with routine scaling. Patients who have used pacemakers should not use ultrasonic scaling.
In addition, the scaling process is usually a little sore, and may bleed a little if there is a lot of inflammation or a lot of calculus, or if it has been a long time since the scaling.
We will ask you about your previous scaling experience and then check the basic condition of your mouth and ask you about any unusual problems. Carefully check the distribution of calculus, the degree of denseness and gum inflammation, as well as possible sensitive areas such as wedge-shaped defects and root surface exposure, and be sure to inform the patient of the possible tooth soreness and gum bleeding during scaling and explain the reasons.
When scaling to the appropriate tooth position (upper and lower anterior areas) remind again to raise your hand if there is discomfort. Inform the patient in advance that bleeding is inevitable when scaling the subgingival area with calculus. This can save the practitioner a lot of trouble. If the patient does not understand the treatment and has a burden on his or her mind, he or she should briefly explain some misleading rumors to the patient before the treatment is done and try to relieve the patient’s worries. The physician should be confident in his language and physical actions to establish a sense of trust for the patient.
Common scaling misconceptions
Myth 1: Scaled tartar is part of the tooth
Tartar is calcified or calcifying plaque and other deposits on the surface of the teeth, as hard as scale in a warm water bottle. Tartar is divided into supragingival tartar and subgingival tartar, usually supragingival tartar. Tartar mainly accumulates in the large teeth and the inner side of the teeth, the side not easily brushed by toothbrushes, in fact, you can observe it with a mirror or feel it with the tip of your tongue, clean teeth do not have these deposits.
Myth 2: Cleaning will destroy the enamel on the surface of the teeth and cause damage to the teeth
Our periodontal often has some calcified hard deposits – tartar, which is difficult to remove even if we brush our teeth every day, therefore, professional scaling is needed. At present, most dental cleaning is ultrasonic scaling, which uses ultrasonic vibrations to shake down the tartar and polish the tooth surface to remove the damage caused by tartar to the teeth and periodontal tissues. During the cleaning process in a regular hospital, the scaling head can form small scratches on the enamel surface, but the enamel can repair itself from such small scratches. It is important to note that unregulated and incorrect handling can damage the surface of the teeth.
Myth 3: Scaling causes tooth soreness and can increase the gap between teeth, making them loose
Some people feel a slight soreness and softness in their teeth after scaling, and even feel that their gaps have become bigger. This is because some of the hard tissues on the tooth surface are subjected to mechanical friction after scaling and the teeth are slightly irritated. However, the damaged tooth surface will soon be calcified by the minerals in saliva, and the sensitivity symptoms will disappear. If the gap between the teeth is larger, it means that there is periodontal disease itself and the gums have receded, giving the illusion of a wider gap after removing the tartar. This is not caused by treatment, but by the periodontal disease itself. If the tartar is not removed in time, the gums will further recede, which will lead to loose teeth instead.
Myth 4: Once you start cleaning your teeth, you will have to keep cleaning them again and again, which is a waste of money
Regular “dental cleaning” is an important measure of oral health care, every six months to a year to the dental hospital for dental cleaning, not only can remove the tartar, plaque, pigment, thoroughly clean teeth, maintain oral hygiene, but also early detection of dental disease, in fact, is to save money. However, it is important to note that dental cleaning should be done by a trained dentist. A dental cleaning with inferior technology and irregular operation will not only fail to achieve the purpose of dental cleaning, but also accelerate the deposition of tartar.
Myth 5: Dental cleaning can be infected with hepatitis B and other infectious diseases
At present, the Ministry of Health attaches great importance to the infection control of oral treatment, and has set high level requirements for disinfection and sterilization of oral instruments, in regular dental hospitals, single-use supplies such as mouthwash cups, gloves, masks, instruments to avoid stain film, etc. to implement “one person, one use, one discard”, for instruments in contact with patient saliva or blood to implement For instruments that come into contact with patients’ saliva or blood, “one person, one use, one disinfection (sterilization)” is implemented. The scaling head and handpiece are cleaned and disinfected by pre-vacuum sterilization to achieve sterility to prevent blood-borne infections (such as AIDS, hepatitis B and C) from spreading among patients through the scaling head and handpiece.
Myth 6: Scaling will make the gap between teeth bigger and bigger
The actual situation is just the opposite, the gap between teeth is not bigger because of scaling, but the tartar and bacteria act on the gums and alveolar bone for a long time, making the gums and alveolar bone recede and the gap between teeth become bigger, which we usually do not notice. Once the tartar is removed, the gap is exposed and we feel that the gap has become bigger. So we should scaling in time to remove tartar and prevent gum and alveolar bone recession.
Myth 7: Whitening vs. scaling
Some patients come to the clinic with the question of whether scaling can whiten their teeth?
The practitioner who receives them should be realistic. Inform the patient that scaling will not improve the color level of the teeth, but only restore the teeth to their original appearance. Scaling is a treatment as well as a care. If the physician has time and the patient is interested, he or she can explain about dental whitening, such as peroxide whitening, hydrogen peroxide whitening, intra-dental whitening, and cold light whitening. Your detailed explanation is also a contribution to yourself to the clinic.
Practical operation
First, the patient is asked to rinse with hydrogen peroxide and rinse with water (the purpose of the hydrogen peroxide rinse is to reduce the bacterial content of the droplets in the mouth when the teeth are cleaned later). Then the gums are disinfected with a cotton swab dipped in Amyl iodine. Good disinfection is also a safeguard for the doctor. Doctors and patients who have the conditions need to wear goggles and adjust the chair position.
1. first adjust to half of the total power, power and then start gradually change (front teeth can be adjusted down). 2. test spray, test vibration.
3. zoning, according to the zone in order to clean the treatment do not have missed.
4. Flexible use of a variety of dental cleaning machine head, do not use a dental cleaning head to do all the work. Minimize gum damage and bleeding.
5. vibration angle.
6. force, generally only the head should be placed lightly on the surface of the calculus, do not add force to the teeth.
7. Polishing meticulously after scaling to emphasize the importance of polishing.
8. medication, you can spot iodine glycerin, Pellegrino (contraindicated use see instructions), etc. on the bleeding gums.
9. Review in six to eight weeks as prescribed by the doctor.
10. Oral education (bass brushing method, choice of toothbrush bristles, etc.).
11. Patients with severe bleeding, after cleaning an area or several teeth with hydrogen peroxide pressure treatment, so that the mouth will not appear bloody phenomenon.
12. Severe heart disease, kidney disease to use postoperative antibiotics to prevent infection.
Summarize.
Routine dental cleaning at least once a year, smoking and drinking tea and coffee and other people can consider a little more frequently. In foreign countries is generally once every three months. In the process of treatment, depending on the patient’s oral condition, severe periodontitis can be divided into batches, first wash the outer surface, and then make an appointment to do an in-depth cleaning next time or again. In fact, this is very important, now the patient is mainly to wash the comfort to evaluate your level, especially people who bleed a lot, if it is convenient to re-visit the best arrangement in 2 to 3 scaling, because those layers of decades of calculus removed at once will inevitably have discomfort, and patients go back to the cold and acid sensation is particularly sensitive!
After the cleaning, make sure to tell the patient what reactions are normal (cold and acid sensitivity, etc.), so that the patient can go back to these situations and imply from the bottom of his heart that he thinks these are normal and does not have to worry about them; secondly, it is important for the patient to return to visit the customer within 3 days after the cleaning, asking him how he feels after the cleaning and which areas he needs to improve. If you learn how to clean your teeth, then you will get a “fortune”!