The routine dental cleaning, technically known as prophylaxis, is a preventative procedure performed to maintain oral health and prevent the progression of gum disease. While a dentist oversees the process, the cleaning is most often carried out by a licensed dental hygienist, who specializes in removing hardened deposits. This procedure focuses on eliminating mineralized debris and accumulated bacteria that cannot be effectively removed by daily brushing and flossing at home, protecting the teeth and surrounding gum tissues from infection and decay.
The Preliminary Oral Assessment
The cleaning process begins not with a scaler, but with a thorough visual assessment of the entire oral cavity. The hygienist performs a comprehensive check of the gums, tongue, cheeks, and throat, looking for any signs of inflammation, swelling, discoloration, or other abnormalities that might indicate underlying health issues. This initial inspection helps to identify areas where gingivitis, the early stage of gum disease, may be present.
A specialized instrument called a periodontal probe is then used to measure the depth of the gingival sulcus, the small pocket of space between the tooth and the gum line. Healthy pocket depths typically measure three millimeters or less, and any reading greater than four millimeters may suggest the presence of periodontitis, which involves the destruction of supporting bone tissue. This diagnostic step helps the hygienist plan the intensity and focus of the cleaning, ensuring that problem areas are addressed.
If the patient has had recent X-rays, the hygienist reviews these radiographic images to locate calculus buildup beneath the gum line or between the teeth. This helps identify hard-to-reach areas of concern that are not visible during the surface examination.
Scaling: Removing Buildup Above the Gumline
The core of the procedure involves scaling, which is the removal of deposits that have accumulated on the tooth surface. These deposits exist in two forms: plaque, a soft, sticky film of bacteria that is constantly forming, and calculus or tartar, which is plaque that has hardened or mineralized over time. Plaque can often be removed with diligent home care, but calculus is a rock-like deposit that requires professional intervention because it cannot be removed by brushing or flossing.
The hygienist often starts the removal process with an ultrasonic scaler, which utilizes high-frequency sound waves to break up large, tenacious deposits of calculus. This device converts electrical energy into rapid mechanical vibrations. A constant stream of water is emitted from the tip to cool the instrument and flush away the debris dislodged by the vibration.
The water spray also generates a phenomenon called cavitation, where imploding bubbles near the tooth surface create shock waves that further help disrupt and dislodge the bacterial biofilm and calculus. This method is highly efficient for quickly removing the bulk of the hardened material from the tooth surface, often causing less discomfort than traditional scraping methods. The ultrasonic tool is designed to remove these hardened deposits without damaging the tooth structure or enamel.
After the initial pass with the ultrasonic scaler, the hygienist meticulously performs manual scaling using specialized hand tools like curettes and sickles. These sharp instruments allow for a tactile and precise approach to remove any remaining fine deposits. The manual tools are effective for smoothing out surfaces and ensuring the complete removal of calculus, especially near the delicate gumline and in between teeth. The goal is to leave the tooth surface as smooth as possible, making it harder for new plaque to adhere and begin the cycle of calculus formation.
Polishing, Flossing, and Final Protection
Following the thorough removal of calculus and plaque, the next step is polishing the teeth to further smooth the enamel surface. This step uses a low-speed rotary electric polishing tool fitted with a small rubber cup, often called a prophy angle. The cup holds a slightly abrasive, professional-grade paste that buffs away microscopic roughness and removes surface stains left behind from food, drink, or tobacco.
Polishing is important because a smooth tooth surface is less likely to hold onto the sticky bacterial film of plaque, thereby slowing the rate of future deposit accumulation. After polishing, the hygienist performs a detailed flossing session, which serves two important functions. Flossing ensures that any remaining polishing paste or loose debris between the teeth is completely removed and allows the hygienist to check the tightness of the contacts between adjacent teeth.
The final protection step involves the application of a fluoride treatment, which is a mineral known to strengthen tooth enamel. Fluoride is typically applied as a gel, foam, or varnish and is left on the teeth for a short period of time. This treatment works to remineralize microscopic areas of the enamel that may have been weakened by acid attacks from bacteria, providing an extra layer of protection against future tooth decay until the next dental visit.