What is periodontal maintenance?
It is the cleaning for someone whose gum disease has already been treated, usually with scaling and root planing. A routine cleaning is prevention for healthy gums. Periodontal maintenance is ongoing care for gums that have been through disease, and it reaches further below the gum line, into the pockets the disease left behind. Insurance paperwork lists the two as different procedures.
Gum disease is managed rather than cured. Treatment brings it under control and lets the gums tighten up, but bone the disease has taken does not grow back by itself, and the pockets that remain are places a toothbrush cannot reach. Maintenance keeps those places clean, which gives the disease far less chance to restart.
Why every 3 to 4 months instead of six?
The bacteria that cause gum disease live below the gum line, and in a deep pocket they are out of reach of brushing and flossing. After a thorough cleaning they settle back in, and given long enough, they rebuild to the level that inflames the gums and starts wearing away bone again.
Coming back every 3 to 4 months clears them out before they get there. Six months is fine for healthy gums, but for pockets it is long enough for the bacteria to get back to work. Your interval is set for your gums, and if they stay stable over time, we will review it with you.
What happens at a periodontal maintenance visit?
The visit starts with measurements. The hygienist checks the depth of the pocket around each tooth and notes any bleeding, then compares both with last time. That tells us whether things are stable, improving or slipping, and it is how trouble gets caught while it is still small.
Then comes the cleaning: tartar and bacteria are cleared from each pocket, below the gum line, and the teeth are polished. If a pocket is tender, the area can be numbed first.
If one pocket stays deep while the rest settle down, we may place ARESTIN in it. It is an antibiotic in powder form, put directly into the pocket after cleaning, where it releases slowly at the source instead of going through your whole body. We will tell you how long to leave that spot alone with floss afterward.
Does insurance cover periodontal maintenance?
Often, though not necessarily the way it covers a routine cleaning. Many plans class periodontal maintenance separately, which can mean a different share of the cost, and some count it against the same twice-a-year limit as cleanings. Plans differ, so check yours, or call us with your plan details and we will tell you what it covers here.
We file the claim for you and give you a written estimate before treatment; see insurance for the plans we work with. Without insurance, the Virginia Dental Club is a membership plan for people in exactly that position. It is not insurance: no deductible, no annual maximum, no waiting period.
Looking after your gums between visits
What you do at home decides how well maintenance works. The pockets we clean every few months need daily help in between:
- Brush twice a day with the bristles angled toward the gum line, where the bacteria collect.
- Clean between your teeth every day. Floss, small interdental brushes and water flossers all work, and the one you will actually use is the right one.
- If you smoke, stopping is one of the most useful things you can do for your gums. Smoking makes gum disease worse and can hide the bleeding that would warn you of it.
- If you have diabetes, keeping it well controlled helps your gums too. The two conditions are linked.
- Call between visits about bleeding gums, a tooth that feels loose or a bad taste that will not go away, rather than waiting for your next appointment.
Questions patients ask
Why can't I just have a regular cleaning?
A regular cleaning is designed for healthy gums and does not reach into the pockets gum disease leaves behind. Used on gums that have had gum disease, it leaves the bacteria in those pockets undisturbed, which is how the disease comes back.
Will I need periodontal maintenance for good?
Most people who have had gum disease treated stay on it, because lost bone does not grow back and some pockets usually remain. If your gums stay stable for a long time, the interval can sometimes be stretched. We will review it with you rather than keep you on a schedule you do not need.
Does periodontal maintenance hurt?
It is more thorough than a routine cleaning, and some pockets can be tender. If they are, the area can be numbed before cleaning. Tell the hygienist if anything is sore and they will adjust.
What is ARESTIN?
An antibiotic placed directly into a gum pocket after it has been cleaned. It is a fine powder that releases the medicine slowly where the bacteria are, rather than through your whole body. We use it for a pocket that stays deep when the rest of the mouth is improving.
What happens if I skip my maintenance visits?
The bacteria rebuild in the pockets, and the gums can slip back toward active gum disease, often without pain to warn you. If you have fallen behind, come back anyway. It is easier to pick things up now than later.