I’ll go a little off topic here, but there is a lot of misinformation about gum disease; many patients (and dental professionals for that matter) don’t understand the nature of the disease they’re trying to manage, and hence there is confusion about what you’re actually trying to achieve with oral hygiene.
Apologies in advance for what may be seen as a scientific ‘ lecture’ and a ridiculously long post, but I genuinely believe that knowledge of the science is crucial to tackling gum disease, and making it clear that what you do at home is the crucial factor in managing the disease.
Basically we all form plaque on our teeth, which is full of microorganisms - that is a normal process, and scientists have a name for such collections of previously free-floating organisms; a ‘biofilm’. A plaque biofilm that forms in your mouth, and is less than a day old, is not really going to have much harmful bacteria in it. However the longer these biofilms are left undisturbed the more complex they become, and the more types of bacteria start to live in them, and these produce toxins.
We each have an individual threshold for when our body recognises these bacteria and toxins as a threat, and when this does happen, our immune systems fire up and start a process to tackle these; this leads to inflammation, which can ultimately lead to loss of bone and loss of gum attachment, and you’ve guessed it- tooth loss.
So some lucky people could probably leave plaque undisturbed for long periods of time and never suffer gum disease - and in contrast others could suffer from it if they leave plaque undisturbed for longer than a day- we’re all different in how our bodies react to the plaque. There are researchers trying to determine how we can predict this, but we don’t know at present. The three main things that we do know have influence are genetics (so be careful if you have parents or siblings that have lost teeth due to gum disease) smoking, and poorly controlled diabetes.
So disturbing the plaque biofilm on a daily basis is really the only way to manage the disease and prevent tooth loss - you’ve got to make your mouth totally inhospitable to the bacteria and their toxins that are triggering your immune response, and the only way to do that is to ‘knock down’ their lovely biofilm houses every day - so they don’t get cosy and reproduce whilst inviting their erstwhile friends and family round to stay; triggering your body’s immune ‘alarm system’ so to speak.
Once you know about biofilm it becomes clear that it is totally illogical to expect that having somebody disturb the plaque biofilm a few times a year (eg with a scale and polish) but leave it undisturbed the rest of the time, will halt the disease. You might as well save your time and money as it is going to have little effect.
The only sure-fire way to manage gum disease effectively is to physically disrupt the plaque biofilm by using the biggest interdental/bottle brush that will fit between your teeth, and brush along the gum lines - every day. You can also use a ‘single tufted brush’ where there are gum pockets. Flossing is not recommended for people who have gum disease as it is not as good at this physical disruption, although for it is good for removing plaque where the teeth meet (the ‘contact point’) and therefore may be helpful for preventing decay here, and also for those who are interested in preventing gum disease and can’t fit the brushes in.
Water picks may help a little, but you need a very powerful jet to disrupt a biofilm - think of it like a green layer of scum on a pond bottom or on stone flags- and the jury’s out as to whether the pressure from water picks is sufficient to do this. It's certainly better than doing nothing.
Removal of tartar/calculus isn’t completely necessary as long as the plaque biofilm is being disrupted. However biofilms are more likely to form and be harder to disrupt on tartar/calculus, therefore most dental professionals will try to remove it as part of the treatment they provide.
The idea of a ‘deep clean’ is for the dental professional to disrupt the biofilm in the deep gum pockets that form as part of gum disease, as even the biggest interdental brushes cannot reach here. The hope is that these pockets will then ‘heal’ and close up, meaning all the remaining biofilm can be reached to be disturbed by the patient in future. However this healing can never occur unless the daily disruption of the biofilm is being done by the patient higher up.
So again paying and going through the sometimes not-pleasant procedure of a deep clean (I should say it is normally pain-free when being performed with local anaesthetic, but can make your gums sore for a while afterwards), without carrying out the oral hygiene methods at home is utterly pointless. It may make you feel better in terms of thinking you’re doing something to help, but the reality is it’s going have little effect on the speed at which you lose your teeth.
So really a dental professional who doesn’t give you this oral hygiene advice is actually being negligent. If the biofilm disruption is not being done daily at home, the treatment they are providing is bordering on useless. With this in mind, some dental professionals now will not perform such cleaning until the patient is able to do the daily biofilm disruption.
I do feel sorry for people who have the misfortune to develop gum disease- particularly those whose immune system is on ‘high alert’ and has early onset severe periodontal disease type. The good news is the most common form is the chronic slowly progressing one that often occurs in our (ahem) later decades, which often only takes an improvement in the biofilm disruption at home to successfully manage.
I agree that dental professionals can sometimes be construed as patronising and lecturing their patients, particularly as this concept of periodontal/gum disease is only just filtering down to patients and the profession. It is difficult to explain succinctly (as I have demonstrated!) so the advice on how to disrupt the biofilm often comes across as a shaming/accusation of not cleaning properly, when really it should be seen as a way of managing a chronic disease.
Any advice about how dental professionals could approach these conversations to communicate effectively would be really useful. But also please don’t see the dental professional as giving you a lecture to make you feel small or stupid - they may be going about it in a very high handed manner, but they really are trying to help you.