What happens at a dental exam and cleaning, in order
The sequence is deliberate. Charting comes before cleaning, because deposits and bleeding tell us things that get washed away once the cleaning starts.
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Medical history and medications
Blood thinners, bisphosphonates, diabetes, a new heart valve, a joint replacement, and anything that dries your mouth all change what we do. Mention changes even when they seem unrelated.
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X-rays, if you are due
Taken early so they can be read alongside the exam. The interval depends on your decay risk rather than the calendar. See digital x-rays.
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Periodontal charting
A blunt probe reads the depth between gum and tooth, six points per tooth, along with bleeding and recession. Those are the numbers you hear called across the room. One to three millimeters without bleeding is healthy. Deeper, or bleeding, means inflammation and possible bone loss.
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Oral cancer screening
The part most patients do not realize is happening. We look at and feel the tongue, floor of the mouth, cheeks, palate, tonsil area, and the lymph nodes along the jaw and neck. These cancers start where you cannot see.
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Scaling
Calculus is plaque that has hardened into a mineral deposit a brush no longer touches. It comes off with hand instruments, an ultrasonic tip, or both. This is the part that improves gum health.
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Polishing
A rubber cup and mildly abrasive paste to lift surface stain. Polishing is cosmetic. It is not what makes gums healthy, and a polish on its own is not a cleaning.
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The examination and the conversation
Tooth by tooth for decay, cracks and failing restorations, then the bite, the wear, the jaw joint and the x-rays. Then what was found, what is urgent, what can wait, and what happens if it is left alone.
What a routine cleaning misses when there is gum disease
A routine cleaning works above the gumline and a short way beneath it. That is all it needs to do when the tissue is healthy and the pockets are shallow.
Once periodontal disease is established the deposits sit further down the root, in pockets of four, five or six millimeters, where a routine cleaning cannot reach. Things look better for a couple of weeks while the infection carries on destroying bone underneath. That is why charting comes first. The treatment is scaling and root planing, a quadrant at a time with the area numbed, then a shorter recall interval. More on gum disease.
How to get more out of the appointment
Small things that change what can be done for you in the hour.
- A current medication list, supplements included, and anything that changed since your last visit.
- Recent diagnoses. Diabetes and gum disease pull each other in the wrong direction, so we would rather know than guess.
- Your questions, written down. People forget them the moment the chair goes back. Raise them at the start, not on your way out.
- Do not brush extra hard the night before. Scrubbed gums bleed and swell, which makes the charting read worse than your mouth really is.
- Any dental plan details, so the front desk can work out your portion before treatment rather than after. See insurance and payment options.
Questions about exams and cleanings
Will the cleaning hurt?
Mostly pressure and cold water rather than pain. Inflamed gums are tender and exposed roots can be sharply sensitive to cold. Topical numbing gel helps, and a local anesthetic is available for deeper work. Say something early rather than enduring it.
My gums bleed when they are cleaned. Is that normal?
Common, but not normal. Bleeding means the tissue is inflamed, almost always from plaque at the gumline. Healthy gums do not bleed when probed or flossed, and the answer is not to clean the area less. See brushing and flossing.
Will a cleaning whiten my teeth?
It lifts surface stain from coffee, tea, red wine and tobacco, so teeth often look brighter. That is stain removal rather than whitening. The underlying color is unchanged, and changing it takes teeth whitening.
Do I have to ask for the oral cancer screening?
No, it is part of the exam: a visual and hand check of the tongue, floor and roof of the mouth, cheeks, throat and neck, looking for anything that does not belong, particularly a sore that has not healed in two weeks. Tobacco and heavy alcohol raise the risk.
I have not seen a dentist in years. Where do we start?
With an exam, x-rays, and an honest list in priority order. Nothing else gets done that first visit unless something is urgent. Then you set the pace. Meet Dr. Brosi or read the patient FAQ page.