Are there different approaches to a dental hygiene (cleaning) appointment?

RDH teamIf you are over the age of twelve, chances are you have had a prophylaxis (teeth cleaning) by more than one dental hygienist over the years. Have you ever wondered why one hygienist started by cleaning the ‘inside’ (called lingual, the side closest to your tongue) of all your lower teeth first, while another started by cleaning the inside of one quadrant of your teeth (one quarter) and then the outside (called the facial)?

Dental hygiene schools teach their students to be methodical as they clean the teeth, in order to be thorough and avoid missing any areas. We have found it helps our patients for our hygienists to share their approach at the beginning of the appointment, as there is more than one way to be consistent and thorough. A helpful perspective is “Different strokes for different folks” because each cleaning appointment is customized within the format, to meet the individual needs of the specific patient.

At the beginning of the appointment, after asking if you have any concerns, the oral cancer screening is completed by the hygienist. It is helpful to keep in mind that the hygienist is cleaning both above the gumline and below the gumline.

In one approach used, the dental hygienist then begins your cleaning by assessing the amount of mineralized deposit (tartar) on the lower anteriors (the front teeth from cuspid to cuspid). This is the most common area to have mineralized deposit because there are so many salivary glands underneath the tongue. These salivary glands are continuously releasing mineral rich saliva. If these minerals make contact with a plaque-covered tooth, the plaque acts like a web and traps the minerals. If allowed to remain on the tooth surface for hours, the minerals will crystalize on the tooth surface and the patient will not be able to brush the tartar off. That is where the benefits of dental hygienist appointments become apparent. The dental hygienist can either use hand instruments or an ultrasonic instrument (or both) to remove the tartar.

Stepping forward in this approach, after having cleaned the lower anterior teeth, the hygienist generally has you turn your head to the left. In this way, the hygienist has access to clean the upper and lower cheek (buccal) side of the teeth on your right side, and then the tongue-side (lingual) surfaces of the left side of the mouth. Then you are asked to turn your head to their right, to allow access to the cheek side of the left of your mouth, and then the lingual surfaces of the right side. A large salivary gland, the parotid, is located on the inside of the cheek opposite the first and second molars, which the hygienist checks well for tartar.

The last area to be scaled in this approach is the upper anterior teeth from cuspid to cuspid. As this area is easily accessible and easily seen by you and most patients, it is usually fairly clean. After scaling with hand instruments and, or the ultrasonic instrument, the hygienist will polish your teeth with prophy paste (you get to choose the flavor), usually polishing the lower arch, and then the upper arch. Hygienists have a tendency to be detailed and thorough, so don’t be surprised if they check and double-check for any remaining tartar, stain, or plaque.

By the time the hygienist flosses your teeth, your teeth should feel slippery and clean! Oh, what a nice feeling!


How often do I need dental x-rays?

A frequent question we hear is, “Doctor, how often do I need dental x-rays?” The guiding principle in radiation is ALARA (As Low As Reasonably Achievable). What ALARA means in lay terms: as infrequent as possible to still achieve excellent diagnosis and care.

Many patients comment that their insurance policy allows (or doesn’t allow) for a specific interval for x-rays. Their policy has to do with what the insurance company designates as ‘reasonable’ (often termed ‘usual and customary’), based on premiums and costs, NOT on a clinical examination and evaluation of a patient’s individual circumstances and needs. Dentists must apply clinical judgment in deciding when and what type of radiologic (x-ray) examination to prescribe to optimize each patient’s oral health.

There is no recommended frequency for panoramic radiograph (x-ray) or full-mouth surveys (FMX). The decision to repeat a panoramic radiograph or FMX should be based solely on the individual patient’s needs (not on the frequency allowed in the dental insurance contract). The only imaging examination with a frequency recommendation is the bitewing, and its frequency based on an assessment of the patient’s caries (decay) risk. In summary, the clinical decision is:

  • Based on findings from the patient history and the clinical examination
  • Tailored to the needs of the individual patient
  • Influenced by the patient’s risk of dental disease
  • Supported by the dentist’s knowledge of disease progression and utility of various imaging techniques

Additionally, some factors the dentist considers in deciding when to prescribe radiographs are:

  • Health status of a new or established patient
  • Date and availability of the most recent prior radiographs
  • Patient age and stage of dental development
  • Risk of dental caries (decay)
  • Clinical evidence of periodontitis (gum disease)
  • Number of teeth and desire for prosthodontics care
  • Pain, swelling or other signs or symptoms of dental disease

If you have more detailed questions about your particular circumstances, please contact Dr. Mastrovich and our helpful office team at 760-741-6650 and

We welcome your comments and general questions below, and we will try to answer as many as possible here in our Ask the Dentist blog.

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