Your Dental Visit: What to Expect|
Most people are familiar with the typical dental checkup visit. If the office has a dental hygienist, he or she will clean your teeth, do an evaluation and sometimes take X-rays. Then the dentist will check the X-rays and your teeth for signs of decay, check your gums for changes, and check for signs of oral cancer or other diseases.
From time to time, however, your dentist should do a more thorough exam. This is called a comprehensive examination. It includes a thorough look at your entire mouth, head and neck area. The dentist also will ask about your medical history, and you will get X-rays if indicated.
A comprehensive examination likely will be done the first time you visit a dental office. Even if you have had regular care under another dentist, your new dentist will want to become familiar with your health. This will allow him or her to notice changes or problems more easily during future visits.
Some activities are standard for a checkup or comprehensive exam, but dentists and hygienists have their own style and skills. If your dentist doesn't do everything listed here, that doesn't necessarily mean he or she isn't doing a good job. If you are concerned, ask why certain things are left out or why others are included.
The order in which things are done may vary as well. And it doesn't all have to be done at every visit.
An important part of every visit is updating your medical history. Your dentist will want to know if you've had any changes in your health or your medicines since your last visit.
Mention everything about your health, even if you don't think it relates to your mouth. Many diseases can affect your mouth and teeth. Researchers continue to discover ways in which oral health is related to overall health. For example, people with diabetes are at a higher risk of developing periodontal disease. Research also suggests that periodontal infection can affect your blood sugar levels. It can make your diabetes harder to control. Other health conditions may require your dentist to change the type of anesthesia given.
Bring a list of all medicines you take, with dosages. Some medicines cause dry mouth, which can increase the risk of cavities. Your dentist also will want to check that any drug he or she prescribes doesn't interact with drugs you are already taking.
Your dentist needs to know everything that may help him or her diagnose problems or treat you appropriately. Tell your dentist:
Your fears — Many people have fears of the dentist that go back to childhood. Pain control and treatment techniques change constantly. The things you fear most may not exist any longer, or there may be new and improved ways of dealing with them. If you fear you have a particular disease or condition, let your dentist know. He or she can look for signs and either diagnose the problem or set your mind at ease. Often, just talking about your fears will take some of the edge off.
Your overall health —
Tell your dentist if you've been diagnosed with any diseases or are taking any new medicines. It is important to tell your dentist about all medicines you take. This includes prescriptions and over-the-counter medicines. Even diseases that seem to be unrelated to the mouth may require a different approach to dental treatments or prevention.
Your dental health —
Before the examination starts, tell your dentist if:
You think you have a new cavity
- Your teeth have become sensitive
- You feel lumps inside your mouth
Don't wait to see if the dentist catches it or silently hope the dentist misses it. By telling your dentist your symptoms, you may help him or her make an early diagnosis.
During a comprehensive examination, your dentist will look at much more than just your teeth. He or she will check other areas inside and outside your mouth for signs of disease or other problems. You likely will receive these evaluations:
Head and neck —
Your dentist will check your head and neck, temporomandibular (jaw) joint, salivary glands and lymph nodes in your neck area.
He or she will look at your face, neck and lips to make sure there are no unusual swellings, lip dryness, bleeding or other abnormalities that need to be checked further.
Your temporomandibular joint is the joint that guides your lower jaw when you open your mouth. It's often called the TMJ. To see if the joint is working properly, your dentist will ask you to open and close your mouth and to move your lower jaw from side to side. You will be asked if you have had any pain or soreness in the joint. Your dentist may touch the joint while you open and close your mouth. This allows the dentist to feel for hitches or catches in movement that may indicate problems.
Your dentist also will touch salivary glands and lymph nodes in your neck area. Swelling or tenderness there may indicate infection or disease.
Soft tissue —
The soft tissues of the mouth include the tongue, the inside of the lips and cheeks, and the floor and roof of the mouth. Your dentist will check for spots, cuts, swellings, growths or other abnormal areas.
A periodontal examination involves checking the gums and supporting structures of the teeth. First, your dentist will look at the gums for signs of redness or puffiness. He or she may poke them gently to see how easily they bleed. These symptoms may indicate gum disease. Your dentist may use a special probe to measure the depth of the pockets between your teeth and your gums. Pockets deeper than 3 millimeters often indicate periodontal disease. If your dentist determines that you have periodontal disease, he or she may refer you to a periodontist. This is a specialist who treats diseases of the gums.
Your dentist may check how well your teeth fit together by examining your bite. First, you will be asked to bite naturally. If the teeth don't seem to fit together properly, your dentist may have you bite down on special wax or paper. Your teeth make an impression in the wax that can help show how your teeth meet. The paper makes temporary marks on your teeth that show where your teeth come together.
Clinical examination of teeth —
Your dentist will check for decay by looking at every tooth surface (using a mirror to see the back sides of teeth). He or she also will poke your teeth with a tool called an explorer to detect cavities. Decayed tooth enamel is softer than healthy enamel. If you have fillings, permanent bridges, crowns or other restorations, your dentist will check to make certain that they remain whole and sound and that the teeth around them have no sign of decay.
X-rays, also called radiographs, will be taken to help your dentist look for decay (cavities) or other oral health problems that cannot be seen during the clinical exam. X-rays also provide the best way for the dentist to see a need for root canal treatment, or bone loss that may indicate advanced gum disease.
During a checkup visit, you sometimes will see two professionals —
your dentist and the dental hygienist if the office has a hygienist on staff. The hygienist typically will check your gums and teeth, clean and polish your teeth, and talk to you about caring for your teeth and gums properly at home. Your dentist also may do a clinical examination, diagnose problems and recommend treatments. Here's what to expect:
The purpose of a professional dental cleaning is to remove the hard calculus (also called tartar) from above and just below the gum line. Brushing and flossing at home removes plaque. Only dental instruments can remove calculus. Some dental hygienists use ultrasonic instruments to blast away the larger chunks of tartar. They follow up with hand instruments to thoroughly clean the teeth. Other hygienists use only hand instruments.
After the calculus is removed, the crowns of your teeth (the parts that show) may be polished to remove plaque and surface stains. Typically, but not always, an abrasive substance is applied to the teeth with a small rotating rubber cup or brush. This helps to scrub away stains. The polishing substance will feel gritty in your mouth. You will be given chances to rinse.
The hygienist may offer instructions for oral care at home based on the results of the exam. He or she may demonstrate how to brush and floss properly. Sometimes, the hygienist will teach you to use a disclosing agent to test your brushing ability. A disclosing agent is a red solution or tablet that is applied to the teeth or chewed. The agent attaches to plaque and colors it to make it visible. Then you brush your teeth. You'll be able to see any plaque that you missed. Not all dentists and hygienists recommend disclosing agents because they can be tricky to use. For example, they may highlight some areas of plaque that can be removed only by professional polishing. They may also stain tooth-colored fillings. Some experts recommend using a disclosing agent only at the dentist's office, and only if the hygienist is prepared to polish any remaining red color off the teeth afterward. Other dental experts, however, believe that disclosing agents are a useful tool for improving oral hygiene practices. They recommend that some patients use them at home.
X-rays may or may not be taken during your checkup. In the past, many dentists took X-rays at every checkup. But the U.S. Food and Drug Administration (FDA) currently says that X-rays are not needed at every visit. Although dental X-rays are safe, the FDA says unnecessary exposure should be limited because the effects of radiation add up over time. People also are exposed to radiation from many other sources. Some people may be able to go as long as two years between X-rays. Others may need them every few months. Your dentist will consider the results of your clinical examination, your dental history and your individual risk for developing cavities. Then he or she will decide if you need X-rays during your check-up visit. If you are seeing a new dentist for the first time, ask for a copy of your X-rays from your former dentist. This will help you to avoid repeating X-rays.
Treatment recommendations —
If your dentist finds any problems, he or she will recommend steps to fix them. These may include a referral to a specialist (such as a periodontist or orthodontist). You also may need further tests for diagnosis. You may have to return to the dentist for a filling or more intensive periodontal treatment.
The gag reflex, located on the back wall of the throat, helps keep objects from going down your windpipe. If you have ever put your fingers too far back in your mouth and felt like gagging or throwing up, you've discovered the gag reflex. Some people have a very sensitive gag reflex. This makes going to the dentist very difficult.
If you are one of these people, talk with your dentist about your concerns. Sometimes, a new dentist or hygienist may place instruments in a sensitive spot, touching the soft palate (the entrance to your throat). If you warn the dentist or hygienist ahead of time, they should be able to avoid certain sensitive areas.
It's also possible that something you are doing makes the problem worse. For example, some patients draw their tongue back to give the dentist room to work, but they end up gagging themselves. You and your dentist or hygienist can work together to find ways to avoid gagging movements.
Distraction may also work. Patients who are highly concerned about gagging become tense in the chair. This can make you even more sensitive. Bring a portable music device and listen to music, practice meditation or focus on trying to keep your feet elevated one inch off the chair. These kinds of distractions can help keep your mind off your throat.