Three stages of dental care for healthy gums

As we age, we’re more likely to develop some form of gum inflammation or gum (periodontal) disease. In fact, nearly half (42%) of all adults aged 30 years and older already have periodontitis.

Gum disease fast facts

Here’s a gum disease refresher from the U.S. Centers for Disease Control and Prevention.

Periodontal (gum) disease is a broad term for conditions such as gingivitis and periodontitis, which involve infection and inflammation of the tissues (e.g., gum and bone) around the teeth.

• Gingivitis is the mildest type of gum disease — signs include red, swollen or easily bleeding gums.

• The good news is that gingivitis is preventable and reversible with good oral hygiene (such as brushing twice daily and flossing daily) and regular professional treatment.

• Periodontitis is a more serious type of gum disease that involves bone loss around teeth. Though it’s a leading cause of tooth loss, periodontitis can be managed and slowed down with professional treatment.

• Diabetes, smoking and poor oral hygiene are all associated with having serious gum disease.

• Tooth loss can lead to a poor diet, difficulty speaking and a lower quality of life.

• Having a dental checkup at least yearly allows for early detection of gum disease, as well as treatment.

The difference between a regular cleaning and a deep cleaning

The type of cleaning a dentist recommends can change over time, and those visit types reflect the health of the gums.

Here’s how each service fits into the progression of gum disease — from prevention to treatment to long-term care. We’ve also included a mention of what shows up on bills and explanations of benefits. The ADA procedure codes for billing are in parentheses.

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Visit type 1: Routine Prevention — Prophylaxis (D1110)

A standard cleaning (also known as a dental prophylaxis) that includes an examination and cleaning to prevent cavities and gum disease. This is your regular, usually twice-yearly cleaning to remove plaque and tartar from the crowns of your teeth — the parts normally visible above the gumline.

Simply put, this preventive dental procedure plays a key role in preventing gum disease, cavities and other dental issues before they start. It includes a full examination, including the professional removal of plaque and tartar. It may also include X-rays or other assessments depending on your oral health needs, and often a polish or fluoride treatment to help protect against future decay.

This is the baseline stage. If your gums remain healthy, this is where you’ll stay, and dental prophylaxis is all you need.

Classified as preventive; typically covered at the highest rate.

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Visit type 2: Treating Active Disease — Scaling and Root Planing (D4341/D4342)

A deeper cleaning below the gumline used to treat diagnosed periodontal disease. This procedure, called scaling and root planing, is another term for dental deep cleaning.

Plaque is always forming on your teeth. If your teeth aren’t cleaned well, the bacteria in plaque can cause your gums to become inflamed, causing them to pull away from your teeth and form spaces called pockets. Plaque then gets trapped in these pockets and can’t be removed with regular brushing. If untreated, gum disease can lead to bone and tooth loss.

Scaling and root planing involves removing plaque and tartar above and below the gumline (scaling), and then smoothing the tooth root to help prevent further buildup of tartar and bacteria, and to help your gums reattach to the tooth (root planing).

This is the shift from prevention to active therapy. Once performed, the patient is considered periodontal.

Classified as periodontal/basic treatment. Covered, but with deductibles or different cost-sharing than routine cleanings.

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Visit type 3: Ongoing Management — Periodontal Maintenance (D4910)

Regular follow-up care after scaling and root planing to keep periodontal disease controlled. Periodontal maintenance visits occur every three to four months for cleaning, including underneath your gums. Your dentist can adjust the schedule of your cleanings accordingly.

Gum disease, especially at later stages, is chronic and recurrent. Without regular maintenance following scaling and root planing, it can return and progress. Periodontal maintenance includes deep cleaning of periodontal pockets, monitoring of gum health and attachment levels, removal of tartar and plaque above and below the gumline, monitoring for signs of disease progression, and X-rays as needed to check on bone levels.

This is the long-term stage. After periodontal disease has been treated, maintenance becomes the standard visit type. Patients rarely return to routine prophylaxis unless fully re-evaluated.

Covered as periodontal care; usually higher cost-sharing than prophylaxis but allowed more frequently.

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These visit types line up with gum health: prevention (D1110), treatment (D4341/4342), and long-term control (D4910).

All visit types are generally covered by insurance, but they appear under different benefit categories.

Hopefully, you can stay in the routine prevention stage forever. But if you do develop periodontal disease and your dentist advises scaling and root planing, know that it’s what’s necessary to stop gum disease from advancing further. The goal is to keep your teeth and gums healthy so you can keep your natural teeth for years to come.