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Difficult Prophy FAQ


Difficult Prophy

1) What is a difficult prophy?

A difficult prophy is a term we use to describe a treatment for a patient who is showing early signs of periodontitis, commonly called gingivitis.  It is basically the same type of cleaning as a regular prophy, but takes more time/resources due to the presence of more tartar buildup that may be more difficult to remove.  The removal of the tartar promotes tissue health and prevents progression of gingivitis into periodontitis. 

2) What are the signs of gingivitis?

Gingivitis is characterized by red, inflamed gums that bleed easily.  The gums are usually a little swollen due to the inflammation which results in deeper “periodontal pockets.”  Patients with gingivitis often bleed easily when brushing and flossing. 

3) Can’t I get rid of gingivitis using mouthwash?

No.  While your dentist or hygienist may recommend using a mouthwash to help treat gingivitis, mouthwash alone will not prevent or cure gingivitis.  The plaque and tartar on the teeth are what cause gingivitis.  Until these are removed, the gingivitis will not resolve.  

4) What are periodontal pockets and how do they become inflamed?

A periodontal pocket is a natural occurring space between the tooth and gum tissue that surrounds each tooth below the gum line.  This area is warm and moist and provides a nutrient rich environment for bacteria, especially if plaque and calculus aren’t removed regularly.  The periodontal pocket becomes inflamed when your body initiates an inflammatory response to the bacteria living in the plaque and calculus in the pocket in order to try to kill and remove the bacteria from your body. 

5) How long does a difficult prophy take?

We generally schedule between 60 and 90 minutes with a hygienist for a difficult prophy.  Most of this time will be spent removing tartar buildup.  Vitals, x-rays, recording perio pockets, and exam with the dentist should have been completed prior to this appointment. 

6) Does a difficult prophy cost more than a regular prophy?

Yes.  The fee is a little higher due to the extra time and resources that the procedure requires.  This additional fee is generally not covered by dental insurance.

7) If the appointment is less than 90 minutes will it cost less?

No.  Although time is one factor that we use to determine the cost of a procedure it is not the only factor.  While a prophy appointment is scheduled for 60 minutes of chair time it only takes 20 minutes for the hygienist to actually scale the teeth.  The hygienist will definitely spend more than 20 minutes scaling teeth during a difficult prophy and this scaling will require more skill and possibly more equipment to remove the calculus.  The doctor will diagnose the periodontal condition and will recommend a difficult prophy instead of a regular prophy if additional time/resources will be needed to reach an optimal result. 

8) I am concerned that the cleaning will be painful.  What can you do to make the procedure more comfortable?

Sometimes a patient will report feeling discomfort during a difficult prophy.  Let us know if you are uncomfortable or have sensitive teeth.  We have several options for your comfort, including various numbing agents as well as sedation options.  If you have any such concerns please let us know ahead of time so we can make your experience as comfortable as possible!  There is no additional cost for anesthetic agents, but sedation options do carry a fee. 

9) What sedation options does Yelm Dental offer?

We offer several options to ensure your comfort including light sedation using nitrous oxide (laughing gas), moderate sedation using oral medication (with or without the addition of nitrous oxide), or I.V. sedation.  If you are interested in taking advantage of one of these options, see the additional information we have posted on our website under "IV Sedation", and we will be sure to discuss your options when you come in.  There are advantages and disadvantages to each method of sedation, so let’s talk it over and find out which option is right for you.

10) What happens if I choose not to proceed with a Difficult Prophy?

When the early signs of periodontal disease are ignored and the condition worsens, the tartar buildup grows, more harmful bacteria begin to colonize the periodontal spaces, and the result is bone loss that eventually leads to tooth loss!  Once the bone has been lost, it becomes more difficult to keep tartar buildup away. 

11) Will I need a Difficult Prophy for every subsequent appointment?

Not usually.  Once your hygienist removes the tartar buildup and discusses prevention techniques with you, you should be able to keep your gums healthy with a regular prophy appointment every 6 months.  If your home care does not improve you may require repeat therapy and more frequent follow-up care.