Do i need deep cleaning before braces?

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#1 Post by **poloaa** » Tue May 02, 2006 2:22 pm

Why i ask this question is because of my general dr asked me to do the deep cleaning, i don't know if i should trust him or not, why i dont' trust him is because he never talks, and my ortho never mention my gum or teeth got problems, is that good to do the deep cleaning?? How painful are they?? My braces will be put on may.12, so i want to make sure if i should do that before the braces???
Thanks.

#2 Post by **Teigyr** » Tue May 02, 2006 3:23 pm

I'd do it because things get more difficult after braces. Plus, I think it's always better to start with teeth as clean as possible

Once braces go on, sometimes they want you to remove your archwire before cleaning. It is a pain because it's just one more appt and scheduling step you have to go through. If it isn't removed, they can do the work but it's a little bit more difficult for them.

#3 Post by **missingu** » Tue May 02, 2006 7:15 pm

Generally the ortho will comment if s/he thinks there are perio problems prior to bracing. Also, is the dentist suggesting s/he do the "deep cleaning" or are they referring you to a periodontist.?

I thought deep cleaning was about gum problems. I'd consult a perio before doing anything, or at least another dental professional. It's a little suspect to suggest a deep cleaning before braces if it has never been suggested before.

And, unless I'm mistaken, it can be done after braces, too, so I'm a little unsure of the motivation for the suggestion.

#4 Post by **Flora2006** » Tue May 02, 2006 8:47 pm

I agree with Linda there. If you are not really trusting your dentist, maybe you should consult with another one. It's important to be able to trust your doctors...

With that said, I think you should have a cleaning done. It's important that your teeth are clean prior to getting the braces on. Maybe see your dentist/ortho again and ask if you really need a deep cleaning or a regular cleaning by your hygienist would be enough.

Good luck

and good luck on getting your braces soon!!

#5 Post by **rsprouse** » Tue May 02, 2006 8:54 pm

A "Deep Cleaning" is better known as a "Scaling and root planing". The clinician will numb the gums and will use instruments to remove plaque and calculus below the gum line. In health, you will have < 3 mm of pocketing around a tooth. That means that you have < 3 mm of space between the gum line and the base of the pocket (top portion of the attachment apparatus of the tooth). Research has proven that if a pocket is under 3 mm, then the bristles of a toothbrush can get in there to effectively clean the area. If the pocket is greater than 3 mm in depth, then typically a toothbrush cannot get to the area to keep it clean and a professional needs to go in there to clean away the bacteria. If done properly, the pocket will hopefully shrink back down below 3 mm and a patient can better take care of it themselves. Deep pocketing also leads to bone loss around a tooth which is irreversible.

That being said, it is a very good idea to have your teeth cleaned before you have your braces put on. Especially if you have deep pocketing. Remember, orthodontics is the breakdown and remodeling of bone to move the teeth, and you want a healthy environment to make sure the process runs smoothly. If you are uncomfortable with your dentist then you should seek another opinion. But, if you ask the dentist why s/he recommends a deep cleaning and they can back it up then you probably need it. This is the main reason for a deep cleaning. Hope that helps.

Best,
Rory

#6 Post by **poloaa** » Wed May 03, 2006 5:06 am

Thanks for all the great replies, i really appreciate. Do u think the ortho can tell if i need deep cleaning or not? My husband and i don't feel comfortable w/this current dentist, not only he doesn't talk to us, but also when i asked him about braces, he got no answer, just said something stupid like, "they are quite expensive, hmmm", and he did not even refer me to any of the ortho, i am the one to search for ortho, so he won't be able to help me w/any questions about anything or braces and i really think he maybe probably just to "make more money" about the deep cleaning issue. Thanks for everyone, i will ask my ortho if he has any nice dr to refer us on this friday when i get spacers. Good luck to all of you and me, = ).
Po

#7 Post by **rsprouse** » Wed May 03, 2006 5:16 am

Is your ortho competent enough to tell if you need a deep cleaning? Yes. But will he? Not likely.

He is a specialist in the wide umbrella of dentistry concentrating on orthodontics. He will likely not feel comfortable giving a clinical diagnosis in a different realm of treatment. But I am sure that your ortho knows quite a few general dentists or periodontists that he can refer you too for a second opinion. Just like any form of medicine, if you are uncomfortable with your provider or don't trust a diagnosis, ALWAYS get a second (or third) opinion. No harm in wanting the best care for yourself.

Good Luck,
Rory

#8 Post by **Joanna20** » Wed May 03, 2006 11:32 am

Hey, I'm not sure if I'm getting a deep cleaning or not, but if ur dentist recomended it I think it's worth a thought. But if u don't trust him don't go see him no more, get another one!
Joe

#9 Post by **poloaa** » Thu May 04, 2006 10:32 am

Thanks again, i would like to know if i should do my deep cleaning at the periodontics office instead of the general dr? right??

#10 Post by **Flora2006** » Thu May 04, 2006 10:42 am

I would go and get a deep cleaning at the perio. just because they are more specialized in that...I'm sure the dentist can do it...but still.

It's like with braces, some dentists do braces as well...but it's not their specialty at all.

Good luck

#11 Post by **poloaa** » Thu May 04, 2006 11:20 am

Is me again, i think i m right, i have never told my dr that i want to do the deep cleaning, but he has got the authorization from my ins. company and i got their letter and tell me i m pre approved to have it done in his office, it doesn't sound right to me because i have never say anything when he asked me to do the deep cleaning, so again, i think i will be sure to do it in the periodontics, i dont think i can trust "this guy", lol. Now i m worried about if my ins compnay lwi let another dr do it for me (periodontics)?? Thanks.

Po

#12 Post by **rsprouse** » Thu May 04, 2006 3:07 pm

It is normal to get pre-approval for an SRP before it is performed. It is like a filling, the clinician provides the insurance company with radiographs and/or clinical information and they will approve/deny the pre-approval. If it was approved, then the clinical need for the procedure exists according to your insurance company. Which is confirmation to you that it is needed unless the clinician provided them with false information (which is illegal).

If you are uncomfortable, then you really should seek care elsewhere. The pre-approval means nothing and you will be covered if you go to another office.

Flora, "Deep Cleaning" is a skill test for all hygiene and dental boards. Any licensed dentist or hygienist will be competent enough to perform the procedure. It will most likely be performed by a hygienist, whether at a general dentist's office or at a periodontists office. It is a very basic skill and one in which most clinicians can handle (unlike orthodontics where complex cases need to be handled by an ortho and not a GP).

Regards,
Rory

#13 Post by **Flora2006** » Thu May 04, 2006 4:08 pm

rsprouse wrote:
Flora, "Deep Cleaning" is a skill test for all hygiene and dental boards. Any licensed dentist or hygienist will be competent enough to perform the procedure. It will most likely be performed by a hygienist, whether at a general dentist's office or at a periodontists office. It is a very basic skill and one in which most clinicians can handle (unlike orthodontics where complex cases need to be handled by an ortho and not a GP).

Regards,
Rory

Oh I didn't know...thanks for the info

#14 Post by **missingu** » Thu May 04, 2006 9:28 pm

rsprouse

I beg to differ on the pre-approval issue. Depending on the insurance company, some providers are "in-network" and some aren't. If the pre-approval is for an in-network, and the perio or other provider is out-of-network, the pre-approval is worthless.

Are you a dentist or something?

#15 Post by **rsprouse** » Fri May 05, 2006 6:04 am

Regarding pre-approval on an SRP, it is a procedure only covered once every 24 months (generally) for most dental insurance providers. If a patient of a general dentist has not been a patient of record for at least 24 months then it is in the best interest for the office to get pre-approval. Patients don't like unexpected charges and office's don't like upset patients. This is true regardless if a dentist is "in-network" or not.

You are correct, if we are talking about a longstanding patient and the office is sure that it will be covered then it does not need pre-approval. And even if the office is "out-of-network", if they are taking the time to get pre-approval then they will most likely be collecting some form of payment from the insurance company, albeit less than the charge for "in-network". Of course there are plenty of clinicians out there that do not accept insurance and the patient may be responsible for full payment and will be reimbursed by the insurance company directly.

Nope I am not a dentist, but I will officially be one in about a year (knock on wood). As always, YMMV as every insurance plan is different and rules and regulations vary from state to state.