Maintenance Appointments – Are They Important?
Maintenance appointments are not only important, they are essential. The analogy I give to this is the following: A patient goes to the physician and finds out he has hypertension, or high blood pressure. A medication is prescribed. The physician or a member of the physician’s staff then tells the patient to return in three months to see how the new drug is working. That next appointment, three months later, we all would agree, is of paramount importance. The blood pressure could be too high. The blood pressure could be too low. There could be side effects to the medication that need to be addressed. By not following this important advice to come in to the office after three months, the patient is putting himself at risk.
It is the exact same thing in dentistry.
There are times a dentist or hygienist needs to see the patient more frequently for many different reasons, some of which may not be readily apparent to the patient. So when you hear, “brush twice a day and see your dentist every six months,” (a slogan developed by a toothpaste manufacturer), this may not be the case. More frequent visits to the dentist may be necessary. They may be essential.
At times, the dentist needs to see the patient more frequently to clean under the gums to attempt to reduce the inflammation that may exist. Scaling and root planing is the term that is used that describes this treatment, as opposed to a simple cleaning in which the gums are basically healthy. Research has shown that the recolonization of bacteria in a pocket in the gum takes about 45 days to develop after a thorough cleaning. More frequent cleanings in those patients that are more susceptible to gum problems can be very beneficial. Patients with periodontal risk factors are often advised to get their hygiene appointments every three months. Those patients that are in even greater risk are often seen by a periodontist (gum specialist) on alternate appointments. That is, those patients are seen by a periodontist, then, three months later, by their regular dentist, and then three months later by the periodontist. This is often a preventative approach to keep them out of harm’s way.
Sometimes the need for more frequent appointments has to do with checking the bite and checking untoward forces that could be placed on teeth, crowns or bridgework. If a patient comes in for a regular maintenance appointment in a timely fashion, problems are often caught before they become serious. Sometimes it is as simple as having the bite adjusted, and at other times it may mean that the patient will need an oral appliance that will redistribute the negative forces more evenly. I often give the analogy of the collapse of the Mianus River Bridge in June 1983. Inadequate inspection by the State of Connecticut was to blame in not checking the pin and hanger assemblies of the bridge. People living in the area said they heard unusual noises coming from the bridge weeks before the collapse. It is the same thing in dentistry. If a tooth, crown or bridge show signs of increased wear, fremitus (vibration) and/or mobility, we may be able to prevent a collapse (in the Mianus River Bridge analogy) of the dentition.
Recently, we had a new patient referred to our office to replace a missing tooth with an implant. The patient was missing one tooth, a lower right second molar. When I inquired why this patient lost this one tooth when all the other teeth seemed fine, he said that he once had a root canal completed on that tooth and then disregarded the suggestion by the endodontist (root can specialist) that he see his restorative dentist within a few days to have the tooth restored. The patient cracked the tooth one month later and needed the tooth extracted because of the severity of the fracture.
Patients are often placed on more frequent maintenance appointments to check the soft tissues like the tongue, lips, palate, throat and mucosa of the cheeks. I have male patients that like to use smokeless tobacco. Very often they show something called leukoplakia, white striations of the tissue. These changes in the tissue may be pre-malignant and require a more frequent maintenance schedule so we can check for further changes. (BTW: Smokeless tobacco is not safe. Because it is smokeless, many people, unknowingly, think it is harmless. The National Cancer Institute lists 28 known carcinogens in smokeless tobacco).
So when a dentist, physician or qualified staff member states that you are to be seen more frequently, or even directs you to be seen sooner than you may of thought necessary, my advice is to “follow directions!”
…and have your blood pressure checked, as well.
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