Q: I wasn’t in any pain before my dental cleaning and now my teeth are sooo sensitive.
A: Lets review what happens with some dental cleanings.
No one likes surprises, especially in connection with something you were not expecting to be painful. Most everyone would also like to have a pain-free visit when they visit their healthcare providers, but this depends on the state of your health, the level of care required, your own pain tolerance and most importantly, expectations. Tips for a Pain-free Dental Cleaning visit can be found here.
This is why communication is a crucial aspect of the dental care experience. Building a trusting relationship relies on open, honest and effective communication. This requires the efforts of both parities.
If you were experiencing discomfort during your visit or required the intensity of cleaning that would leave you in pain afterwards, it sounds like there was something missing in the communication process between you and your provider.
Let’s take a look at how this could have been avoided…
Scheduling Your Appointment
Ideally, effective communication takes place before, during and after your cleaning. It begins with the first phone call to schedule your appointment when the administrative staff gathers as much information as possible to determine the type of appointment necessary and the appropriate time required. The questions they ask you will help them determine what information both you and the dentist should have so that everyone will be prepared for the visit.
Established Patients – If you are already a regular patient at a dental office, make it a habit to come in for your regular check-ups and cleaning and are not having any current issues that you anticipate will have an impact on your appointment, then you can probably expect the kind of visit that you have become accustomed to at your dental office. If you have more tartar on your teeth than what is normally typical for you then your hygienist will let you know that your cleaning will probably be more involved than usual and suggest ways to help prevent future buildup. Your cleaning appointment may be longer than anticipated or spaced out over two visits. Communication should be ongoing throughout the appointment as the hygienist gauges your comfort level.
New Patients – If you are a new patient to a dental practice then it is difficult to anticipate the level of tartar buildup and the condition of your teeth and gums. The administrative staff scheduling your appointment will let you know what to expect your first appointment. It is at this time that you may feel comfortable discussing any sensitivities, anxieties or dental problems you may have so that your dental provider will be aware beforehand and as many comfort aids as possible can be made available to you. A better idea of how much time and effort is needed for your cleaning will be determined during your first exam and you will be advised of what to expect at your next appointment. At Your Smile Dental Care, we try to get your cleaning started during your first new patient visit, if time permits. Again, during your actual cleaning procedure, your provider should let you know what is happening at all times and assessing your comfort level should be an on-going process throughout your visit.
It is important to understand that there are different levels of cleaning depending on your dental health, the amount of tartar build-up in your mouth and when your last cleaning was. A proper assessment by one of the dental team members will determine how best to proceed with the safest, most comfortable and thorough cleaning they can provide. If you have a lot of tartar accumulation, then naturally your cleaning will probably be deeper and longer than a routine cleaning. You may even require several visits to complete your cleaning. All of this will affect your level of comfort, in addition to any dental sensitivities and anxieties you may already have.
There are times when a patient calls for a cleaning appointment and/or price, but has not had a dental visit in a very long time. This is where the communication begins. An experienced and thorough administration team will gather as much information as possible before discussing prices and scheduling the patient’s appointment. They will advise the patient that only a proper assessment by the dentist or hygienist can accurately determine the health of their mouth, the level of cleaning required and the associated price. Equipping the patient with this information beforehand will certainly avoid disappointment later.
The Stages of a Dental Cleaning Appointment
1. Pre Appointment – Before you even visit your dental office you should take note of anything that may directly impact your experience. Are you anxious? Do you have any sensitivities or sores in or about the mouth area such as cankers or cold sores? Are you in any pain or having a dental issue that could affect you during or after your cleaning? Letting your dental team member know these things beforehand will help them determine if they should modify or postpone your appointment.
2. Pre-Operative Assessment – Before the hygienist even begins cleaning your teeth, a medical and dental assessment is done. During the medical portion, you are asked a series of questions pertaining to your health. This is very important step since your current health and medications can have a direct impact on your dental health and level of sensitivity in your mouth. As the hygienist is evaluating your health, they are also determining how best to proceed with the safest, most comfortable and thorough cleaning they can provide. If it has been a number of years since your last cleaning and you have quite a lot of tartar build-up, a separate appointment may have to be scheduled to complete your cleaning. The hygienist will tell you what to expect at your cleaning appointment so that you will have no uncertainties.
3. Cleaning Stage – There are also different levels of cleaning depending on your dental health, the amount of tartar build-up in your mouth and when your last cleaning was. Sometimes your x-rays and the visual exam is all that is needed to determine the amount of build-up on your teeth. While other times, it’s not until the cleaning is underway that the amount of build-up is evident.
The hygienist will ask you to tell them if you experience any discomfort during the cleaning. They will also ask you periodically throughout the visit so that they can evaluate your level of comfort during your cleaning. Some people are sensitive to the water-spraying ultra-sonic cleaner, so the hygienist will switch to hand-scaling only. Others may not like the device that squirts air and water into their mouths. While still others are so sensitive or have so much cleaning to be done that they need a periodic break , laughing gas, pre-cleaning pain reliever or anesthetic.
A conversation about your concerns, fears or level of anxiety should take place before the cleaning actually begins, so that you can both come up with a solutions for a more comfortable visit. As mentioned, some local aesthetic or conscious sedation (laughing gas) or a pre-cleaning pain reliever can be offered beforehand. If the patient has no prior history of discomfort during dental cleaning and begins to experience pain, then an entirely different conversation has to take place to determine the cause. Sometimes, it is the provider’s technique, an unexpected level of tartar build-up or another underlying health/medication issue in the mouth/body.
Provider Technique – This is subjective issue and let’s be honest, most patients, who have had experience with dental cleanings have preferences that take shape over time and would like to have a choice when it comes to who will be providing their services. It’s important they be comfortable with the person who will be cleaning their teeth. When it comes to carrying out deep cleanings in a relatively gentle and thorough manner, some providers will do all they can to help accomplish this. Although the dental staff booking appointment will not make provider judgments to patients, it doesn’t hurt to let them know what your preferences, expectations and concerns are. In doing so, they may steer your appointment towards a provider that can best suits your needs. Unless a specific recommendation has been made by your family or friends to you, it is difficult to know what to expect at a new office. Being upfront is useful to the dental team and begins the open and honest communication relationship that helps make your healthcare experiences more predictable.
4. Post Operative Assessment – After your cleaning, the hygienist will tell you what you can expect in terms of post-cleaning discomfort, if any. Most people, who come in for regular cleanings, have no post-cleaning discomfort – in fact, their mouth feels clean and refreshed! If there was a lot of accumulation on your teeth and the cleaning was more involved, then they will recommend the use of a pain reliever/anti-inflammatory, like ibuprophen, to get you through the day. There should be no surprises after your cleaning, if you are kept informed. If there was any uncertainties during the appointment, then your dental office will usually recommend that you call them if you have any questions over the next few days after treatemnt.
It’s difficult to remove all of the plaque that builds up on your tooth surfaces even if you’re paying extra close attention. There is a small, free space between your teeth and your gums where you would insert your floss during home cleaning. You’ll notice, as you floss, that you are removing food and some soft, sticky plaque. The plaque that remains on your teeth in this space can become hard within a matter of days as your saliva begins to deposit minerals into it.
This hardened plaque is called calculus, commonly known as “tartar.” Calculus can only be removed by a professional dental cleaning using special scaling instruments. When a lot of tartar has built up on your tooth surfaces, especially below the gum line, it’s removal can sometimes lead to increased tooth sensitivity.
In order to understand why, you have to know that the hard tissue that covers the root is much less calcified than enamel is, making it more sensitive to irritants and temperature changes in the mouth. In order to protect the sensitivity anatomy of the root, your gums and underlying bone closely “hug” and insulate it from these sensations.
Much like your pant pockets that you may fill with stuff, the tartar accumulating under the gums is widening and deepening this free space between your gum and your root surface. It destroys the fibers that attach the gums to the tooth, and, if left long enough, will begin destroying supporting bone. Unfortunately, this destruction is usually a silent process that most people do not even realize is happening.
When your dental team member has removed this toxic tartar, you are now left with an enlarged pocketed area which is the space where the tartar use to be. This space is open to the mouth and the root surface is exposed to the hot and cold sensations, bacteria and other irritants it would otherwise have been covered with by tartar or protected from if the gum tissue was attached to it more snugly as it used to be.
Sometimes, there is so much tartar that has built up over time and is so far deep under your gums that it can not all be removed in one appointment Your hygienist will then ask that you make another appointment is a few weeks time. During this time your gums may be a little swollen from the scaling treatment, much like any wound would swell after being treated. The swelling will go down and shrink back to a level that will allow your hygienist to revisit the area in order to remove the remaining tartar safely and with less sensitivity.
Given time and proper home care, this pocketing of the gum can be reduced in size. However, destroyed gum tissue and attachment fibres are much more difficult to repair as they do not grow back once damaged.
We can not emphasize the importance of good oral hygiene at home. Your body has amazing
healing capabilities, but you must be patient and follow your dentist’s instructions.
Many people are quick to think that the dental team has done “something wrong” and this is why their teeth are now sensitive, yet were not before their appointment. It is important to remember that your teeth and gums are like any other part of your body. Damage can be occurring silently, without you ever having symptoms. When you visit us, we see the signs; we notice the damage that is already occurring.
We assume that you are here to see us for the care and attention that you deserve. Oftentimes, this requires more involved treatment that may leave you feeling some discomfort and tenderness afterwards. As one would expect after their family physician or surgeon has performed some invasive procedure, there will be a time of healing. Depending on the level of care needed, healing may be slower than you anticipated, but if you follow our instructions and the prognosis is good, we would expect your healing to be progressive.
Understand that disease and damage can occur in your mouth without you even realizing it. There are lots of people who lead very active and healthy lifestyles, who still have unhealthy conditions or diseases of the body. We have patients who are surprised to learn that, even with diligent home care, there is still room for improvement. Neglect is usually not intentional.
We often find ourselves back on the topic of communication. Open and frank conversations have to take place between you and your healthcare provider and you should expect nothing less. We assume that when you walk through our door you expect care and attention. It is with this in mind that we offer our patients advice or suggest improvements without the need for scolding or shame them. You should expect the type of partnership with your healthcare providers that is built on mutual respect and that allows you to speak freely and have these frank conversations.
Professional dental cleanings are important. The health of your teeth and gums depend on them. Neglect is not noticed so much when you are young, but as you age the warning signs and damage become increasingly more evident.
If you would like some tips on how to make your next cleaning more comfortable, see our blog: Tips for a Pain Free Dental Cleaning.
Yours in Better Health,
The Your Smile Dental Care team