Your Dental Visit: What to Expect

1. Types of Dental Visits
2. Checkups
3. What To Tell Your Dentist
4. The Gag Reflex
5. The Comprehensive Examination

Types of Dental Visits
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 examination and 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 cancer or other diseases.

Periodically, however, your dentist should do a more thorough examination, usually called a comprehensive examination. A comprehensive dental examination not only checks for tooth decay, but includes a thorough examination of your entire mouth, head and neck area.

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 so that he or she can notice changes or problems more easily during future visits.

Although some activities are standard for typical checkups and comprehensive examinations, dentists have their own style and skills. If your dentist doesn't do everything listed, 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 not everything necessarily will 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 health changes since your last visit and if you've started, stopped, reduced, increased or changed medications.

Mention everything about your health, even if you don't think it relates to your mouth. Many diseases can have significant effects on your mouth and teeth, and researchers continue to discover ways in which oral health is related to overall health. For example, researchers who examined the effects of diabetes on the mouth and teeth found that people with diabetes are at a higher risk of developing periodontal disease. Research also suggests that periodontal infection can have an effect on your blood sugar levels and 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 medications you are taking, with dosages. Some medications cause dry mouth, which can increase the risk of cavities. Your dentist also will want to check that any medication he or she prescribes doesn't interact with medications you already are taking.


What To Tell Your Dentist
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, so the things you fear most may not exist any longer. If you fear you have a particular disease or condition, let your dentist know so he or she can look for signs and either set your mind to rest or make a definitive diagnosis. Often, just talking about your fears will take some of the edge off.

Your overall health — Your dentist should know if you've been diagnosed with any diseases or are taking any new medications. Even diseases that seem to be unrelated to the mouth may require a different approach to dental treatments or prevention.

Your dental health — If you think you have a new cavity, if your teeth have become sensitive or if you feel lumps on the inside of your mouth, tell your dentist before the examination starts. 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.


The Comprehensive Examination
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. The comprehensive exam likely will include these evaluations:

Head and neck — Your dentist will check your head and neck, your temporomandibular joint, your 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, often called the TMJ, is the joint that guides your lower jaw when you open your mouth. To see if your temporomandibular 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 to feel for hitches or catches in movement that may indicate problems.

Your dentist will touch salivary glands and lymph nodes in your neck area to feel for swelling or tenderness that 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 look at these areas to check for spots, lesions, cuts, swellings or growths that may indicate problems with oral health.

Periodontal — 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 and 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, a specialist who treats diseases of the gums.

Occlusion — 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 do further checks by having 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 examining every tooth surface visually (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 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 — X-rays, also called radiographs, will be taken to help your dentist look for decay or other oral health problems


Checkups
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 will typically 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 make treatment recommendations. Here's what to expect:

Cleaning — 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, but only dental instruments can remove calculus. Some dental hygienists use ultrasonic instruments to blast away the larger chunks of tartar and follow up with hand instruments to thoroughly clean the teeth. Other hygienists use only hand instruments.

Polishing — 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 to scrub away the stains. The polishing substance will feel gritty in your mouth. You will be given a chance to rinse periodically.

Prevention — The hygienist may offer additional 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 instruct you to use a disclosing agent to test your brushing ability. A disclosing agent is a red solution or tablet that, when applied to the teeth or chewed, attaches to plaque and colors it to make it visible. Then you brush your teeth. Any remaining plaque will be clearly visible, highlighting the areas the brush missed. Not all dentists and hygienists recommend disclosing agents because they can be tricky to use. That's because the disclosing agents will highlight areas of plaque that can be removed only by professional polishing, and they can 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.

X-rays — X-rays, also called radiographs, may or may not be taken during your checkup. In the past, many dentists took X-rays at every checkup. But current recommendations by the U.S. Food and Drug Administration (FDA) state that X-rays do not always need to be taken at every visit. Although dental X-rays are safe, the FDA says unnecessary exposure should be limited because the effects of radiation are cumulative, and people are exposed to radiation from numerous other sources as well. Some people may be able to go as long as two years between X-rays, whereas others may need them every few months. You dentist should take into consideration the results of your clinical examination, your dental history and your individual risk for developing cavities. If you are seeing a dentist for the first time, ask for a copy of your X-rays from your former dentist to avoid repeating X-rays unnecessarily.

Treatment recommendations — If your dentist finds any problems during the examination, he or she will make recommendations for the next steps to fix them. These may include a referral to a specialist (such as a periodontist or orthodontist), further tests for diagnosis, or a suggestion that you return for restoration work or more intensive periodontal cleanings.


The Gag Reflex
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, which 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). By warning the dentist or hygienist ahead of time, they should be able to avoid certain sensitive areas. Also, there may be things you are doing to aggravate the problem. 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, and tension can heighten the sensitivity. 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 you keep your mind off your throat.

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