Prophy vs. Periodontal Maintenance

Prophy vs Perio Maintenance

Dr. Matthew Norman and Michelle Phillips, RDH

One of the most common questions that we are asked by our patients is, “what’s the difference between a prophy and a periodontal maintenance”?  We want to address that question in this edition of our blog.


When you have your comprehensive or new patient exam at Norman Dental, the doctor and your hygienist will perform a thorough evaluation of your gums to determine which type of cleaning best suits you.  The doctor or hygienist will measure a space between your gum and the tooth, which is known as a “pocket”.  A healthy pocket depth is 1-3 millimeters.  Areas that are observed to have pocket depths deeper than 3 millimeters may need to be cleaned more thoroughly than healthy areas.  Your dental team will also be looking for areas that bleed while taking these measurements, as a healthy pocket does not bleed.  Bleeding indicates the presence of inflammation, which is usually caused by bacteria located within the pocket.  Inflammation in the gum tissue can cause bone loss around the teeth.  This information is how your dental team determines whether a prophy or periodontal maintenance procedure best suits you.  We will discuss each procedure in more detail below.
A prophylaxis, or prophy, is a dental cleaning on a healthy mouth.  healthy tissueThe insurance code specifies this procedure to involve the scaling and polishing of all coronal surfaces (the crown of the tooth).  Therefore, no scaling or cleaning occurs below the gum tissue.  Scaling is followed up with polishing to remove the fine debris and stain from the teeth. A typical “prophy” patient comes every 6 months for their professional hygiene appointment.


A periodontal maintenance consists of a more involved “cleaning”.  The hygienist starts by using a Cavitron or ultrasonic scaler.  The ultrasonic scaler is designed to clean below the gums and to break away heavy calculus/tartar that accumulates on the root surface of the tooth.  Microscopic vibrations from the scaler loosen the hard deposits away from the tooth and the water flushes the debris away.  This process also forces oxygen into deeper pockets.  This is heunhealthy mouthlpful because much of the bacteria that causes periodontal disease is anaerobic, meaning it needs an environment without oxygen to survive and grow.  When the ultrasonic scaler introduces oxygen into the gum pockets, it kills the bacteria present.  Next, the teeth are hand scaled and polished to remove fine deposits below and above the gum line.  Finally, the hygienist will irrigate the deeper pockets with an antibiotic rinse to kill any residual bacteria present.  Typically, when you have been classified as a patient needing a periodontal maintenance procedure, your status usually never changes.  This is because bone loss around the teeth is irreversible, and the presence of bone loss causes the periodontal health to be compromised.  A typical “periodontal” patient comes every 3 or 4 months for their professional hygiene appointment.



Whether it is a standard prophy or a periodontal maintenance procedure that best suits your individual need, your Norman Dental team will work with you to endure your teeth and gums stay healthy for a long time to come!

Your Dental Health Can Indicate Other Health Issues

Your Dental Health Can Indicate Other Health Issues

By: Matthew Norman, DDS and Michelle Phillips, RDH


Your teeth, gums, tongue, and overall oral health are a reliable indicator of other overall health issues. Heart disease, diabetes, HIV, osteoporosis and eating disorders are examples of health issues which have symptoms visible in the mouth. Teaming with your Dental Office for regular checkups can help identify these conditions.


Cardiovascular disease is very closely linked with the health of your mouth and the presence of infection. Those with periodontal (gum) disease are at higher risk of developing cardiovascular disease. Some studies have suggested that heart disease, clogged arteries and even stroke may be associated with the oral bacteria present with periodontal disease. Your mouth has an abundance of bacteria— both good and bad. Bacteria have the ability to enter your bloodstream, especially in an unhealthy mouth with swollen or bleeding gums. Once in your bloodstream, the dangerous bacteria can pass to your heart and cause infection in the inner lining of the heart. This is a very important reason to maintain optimal oral hygiene. By practicing good brushing and flossing habits, bacteria remain at healthy levels and have a lessened chance of entering the bloodstream.



Your mouth is the gateway to the rest of your body and can reveal a great deal about your overall health.  Diabetes is an example of a systemic disease which has a direct relationship with your oral health.  Diabetes inhibits the body’s ability to fight against infection.  People with diabetes must keep their blood sugar levels under control.  When a diabetic patient has uncontrolled blood sugar levels, the risk of having more-frequent and severe gum infections increases—opposed to those with controlled blood sugar levels.



Other systemic diseases that can be detected based on conditions present in the mouth.  HIV / AIDS patients are prone to having painful sores in the mouth.  They also have an increased risk of developing thrush—a fungal infection in the mouth.  Osteoporosis is a condition in which the bones become weak and fragile. This includes the bones of the jaw that support your teeth, which can eventually lead to tooth loss.  Patients suffering from eating disorders, such as bulimia, can cause chemical erosion to their teeth due to the stomach acid which consistently comes in contact with the teeth.


Not only is saliva your main defense mechanism against the harmful bacteria and viruses in your mouth, but it can be a tool in diagnosing systemic disease.   Dental offices now have the ability to test and analyze your saliva.  The testing can diagnose many diseases such as: diabetes, Parkinson’s disease, cirrhosis of the liver, oral cancer, breast cancer, HIV, hepatitis, periodontal disease and cardiovascular disease.  These conditions have specific markers which show up in your saliva that these tests can identify.  Salivary tests are completely harmless and non-invasive to perform.


Your mouth is a vital information source about the condition of your overall health.  Practicing excellent oral hygiene will help to keep your mouth and teeth healthy, as well as other areas of your body.  It is important to see your dentist on a regular basis to ensure your mouth is in a healthy condition.  Your regular dental appointment is also an opportunity for your dentist to examine your mouth and check for conditions which can indicate the presence of other diseases.


Optimal Oral Health for Optimal Overall Health

Optimal Oral Health for Optimal Overall Health 

Matthew Norman, DDS and Michelle Phillips, RDH

Many correlations exist between periodontal (gum) disease and systemic diseases such as heart disease, diabetes, respiratory diseases, and even pregnancy.  The mouth is the gateway to the rest of the body, and it is becoming more and more evident that an infection in your mouth can affect the rest of your body.

Periodontal disease is infection of the gums.  In a healthy mouth, gums are pink, firm and do not bleed when brushed and flossed.  It is very important to brush your teeth twice a day, floss once a day, and to visit your dentist regularly.  At a routine hygiene appointment, the dentist and dental hygienist review your medical history and evaluate your gums to screen for all forms of periodontal disease and gingivitis.  Gingivitis is the lowest classification of periodontal disease, meaning inflammation of the gums.   Remember, healthy gums don’t bleed!

Heart disease is probably the most commonly linked systemic disease to periodontal disease.  Bacteria are present in bodies of all living creatures.  Some bacteria are not harmful and actually help keep the body healthy, but some bacteria are harmful to your body.  This same situation of helpful/harmful bacteria exists in your mouth.  Any bacteria (good or bad) present in your mouth can be transmitted into your bloodstream, especially when the gums are bleeding due to unmanaged periodontal disease or gingivitis.  Once in your bloodstream, bacteria can reach all other areas of your body, including your heart.  When bacteria enter the bloodstream, it attaches itself to the fatty plaques in your heart vessel arteries (coronary arteries) and contributes to the formation of clots.  One with coronary artery disease has thickened walls of the coronary arteries from the buildup of plaques and the blood clots can obstruct blood flow.  This leads to a lack of oxygen needed for the heart to properly function, which can lead to a stroke and even a heart attack.  Those with periodontal disease are more likely to suffer from coronary artery disease than those without periodontal disease.  Also, unmanaged periodontal disease can worsen a preexisting heart condition.

Diabetes is a chronic systemic illness which is becoming more and more prevalent in the United States.  The American Diabetes Associated estimated in 2011 that nearly 26 million people (8% of the total US population) have diabetes and this number continues to grow rapidly.  A person with diabetes is more likely to have periodontal disease than a non-diabetic, especially one who doesn’t have their diabetes under control.   The diabetic patient is more likely to develop infections and because their wound-healing ability is impaired, oral infection is more difficult to treat.  The relationship between diabetes and periodontal disease has also been found to be two-directional, meaning that the worsening of one condition can cause the other to worsen.  Therefore a diabetic patient, who also suffers from periodontal disease which is unmanaged, is more likely to lose control of their diabetes and suffer from diabetic complications.

Respiratory diseases are also directly linked to periodontal disease.  The bacteria in your mouth can be drawn into your lungs to cause respiratory diseases like pneumonia.  When you inhale, the bacteria in your mouth can settle into your lower respiratory tract and cause infection.  Patients with Chronic Obstructive Pulmonary Disease (COPD) have a higher risk of experiencing complications, when unmanaged periodontal disease is also present.

Many people are unaware that a relationship exists between periodontal disease and pregnancy.  When a woman is pregnant, it is common for her to develop a condition called Pregnancy Gingivitis.  During pregnancy, a woman experiences changes in her normal hormone levels.  These changes can cause the gum tissue to become much more sensitive food and plaque levels in the mouth, which lead to inflammation and bleeding in the gums.  The hormonal changes can even make it easier for the bad bacteria that we discussed earlier to grow.   Some bacteria have even been found to cause complications with pregnancy, such as pre-term births.  It is very important for the pregnant patient to see their dentist and dental hygienist for routine hygiene visits to ensure their mouth is in a healthy condition.

In summary, it is crucial for everyone to visit their dentist regularly – especially those who have a systemic disease, which can increase their risk of developing periodontal disease.  Your dentist and dental hygienist should be evaluating your periodontal health on a regular basis to ensure your mouth is in a healthy condition.  Regular dental visits will allow the dental team to check for signs of gingivitis and periodontal disease, and recommend treatment if treatment is necessary.  It is also important to be aware that a cure does not currently exist for periodontal disease.  Those with periodontal disease must maintain their dental health with excellent home care and regular dental hygiene visits.  As with any other disease, early detection is critical.  The sooner the condition is discovered and treated, the better the outcome.