Concerns About Postponed Cleaning

[AnxiousWretch]

Hello, it's me again. There are times I'd like to think I wouldn't have to come around again, but the dental anxiety creeps up like a wave and crashes down like a tsunami.

Back on August 15th, I had a deep cleaning, prefaced by an anxiety attack well-documented on these forums, and subsequent post going on about how everything went swimmingly. I did note how they scheduled a follow-up in January—five months out—when standard procedure typically stands at three or less, but shrugged my shoulders at the time.

Come today, January 6th, about a week out from the appointment, they wanted to confirm the follow-up on January 13th. Due to some mandatory work projects that week, the date became unteneable, and I asked to reschedule. I assumed there might be a few weeks of difference, instead it was a few months into May 9th—the earliest opening. I was debating if there was any alternative, and perhaps debating if I could find a way to weasel out of work; but they were insistant that they couldn't hold the date, and I just hurriedly agreed out of the time pressure.

I've heard of people scheduling a year apart for cleanings, but it's uncommon, and those people are typically not predisposed to gum issues. In my case, it's a year following a deep cleaning, concerns about periodontitis, and suggestions that I might be placed on a three or four month rotation or transferred back on a six month rotation at my referring dentist, which was supposed to be dependant on the outcome of this appointment—and I'm worried I might be forced into a bad outcome through events out of my control?

It's an especially bad situation, because this perdontist's office is the only one in town—a consolidation of three other periodontists—so there's no immediate alternative. If it were just a cleaning, I don't think getting scheduled at my referring dentist would be too outrageous, but this was supposed to be a follow up, and I'm under the assumption that they would want to clear me first before sending me back?

tl;dr should I be concerned about an appointment scheduled a year apart from a deep cleaning? Is this going to exacerbate potential issues? Are these cases where periodontists want to address the follow-up themselves, or would a cleaning at a general dentist's be acceptable?

Sorry for prattling on, the call was only just over an hour ago, and I'm still in a fight-or-flight daze alongside the usual anxieties.

 

[Gordon]

should I be concerned about an appointment scheduled a year apart from a deep cleaning?

In an ideal world, your plaque control would have improved enough that a deep cleaning wasn't required... part of the reason for recalling periodontal patients frequently is to gee them up about their plaque control
TLR -)) If you've been working hard on your oral health then delaying the visit for a few months won't matter muc.

Is this going to exacerbate potential issues?

No.

Are these cases where periodontists want to address the follow-up themselves, or would a cleaning at a general dentist's be acceptable?

Kind of both They would want to monitor your condition themselves, but the cleaning part isn't anything special needing a periodontist to do it themselves.

 

[AnxiousWretch]

Thanks Gordon. There's still some residual anxieties, but if it's a matter of personal hygiene, and unlikely to exacerbate issues—that's still some relief!

Admittedly, there are points where my routine has slipped. There are depressive slumps where I only manage to brush and floss once a day for weeks at a time, but I'm also one of those OCD sorts who'll sit in front of the mirror for thirty minutes making sure to get every nook and cranny on even a normal day—which I'm sure doesn't balance out, but I'd hope at least makes up for some of it?

It's uhh, an improvement over a previous me, who's hygiene can be described as "arbitrary" at best, but I'm not sure if it's enough of an improvement—and that eats at me sometimes.

I ask about the follow-up partially because I'm in an ambiguous referral limbo at the moment. The general dentist refers me to the periodontist for a single sudden 12mm+ pocket, the periodontist does not find said pocket but does see modest pockets and recommends a deep cleaning, says I'll probably go back to my general dentist on a six month schedule if everything clears, but the hygienist performing the deep cleaning says patients who usually get them are retained there on 3-4 month schedules for life—so, it's been modestly stressful trying to figure out what the actual situation is.

Likewise, I'm not sure if waiting for the periodontist to conduct the now almost year interval cleaning, or trying to arrange with the general dentist for a cleaning at the six month interval is the better option?

 

[Gordon]

One really thorough cleaning a day is preferable to three perfunctory ones

Ideally the periodontist should be evaluating the response to the deep clean and how you're maintaining things, if you were doing well and your plaque control was good, then an annual visit with him would be fine, with your GDP doing in-between cleanings if necessary.

 

[AnxiousWretch]

That's reassuring, at least! A little taken back at the ratio, if I'm honest—but reassuring!

Admittedly, I can't be sure how good is good enough, or if the response to the deep clean would be acceptable at this point. Working opinion between my GDP and Periodontist's office is somewhere between, 'generally sufficient but there's some build-up in hard-to-reach areas' and 'you would not be here if you were good at taking care of your oral health', respectively. That familiar ambiguity.

That said, with what you said in mind, going from an intermediary period from August to January, to August to May, probably isn't that significant a wait in the grand scheme of things—so I'll probably follow your advice and wait it out.

A little worried that when the time comes, that it will tip the scales in favor of 3-4 month intervals instead of 6 month ones, or being retained at the periodontist's office rather than sent back to GDPs, but I suppose we'll burn that bridge when we get there—hope for the best, prepare for the worse, and such.

 

[Gordon]

A little worried that when the time comes, that it will tip the scales in favor of 3-4 month intervals instead of 6 month ones, or being retained at the periodontist's office rather than sent back to GDPs

It should be a dynamic process ideally though, with intervals being increased/decreased along with your plaque control and or disease progression, recall intervals should be assessed regularly.

 

[AnxiousWretch]

It should be a dynamic process ideally though, with intervals being increased/decreased along with your plaque control and or disease progression, recall intervals should be assessed regularly.

Oh, is that how it works? Or, well, how it should work?

I think I passively mentioned the concern to the hygienist performing the deep cleaning, and she stated that nobody ever reverted back from a three month cycle, or at the very least, she never handled anyone who did—I don't know it is a case of subjective experience or survivorship bias, but that shook me a little bit walking out.

I don't really have a good reference for this sort of thing. My grandmother was locked on a similar three month interval for the past few years, but her bridgework was notably undermined; my grandfather just never followed up out of stubborness; and as the unwitting trailblazer for friends my age, I'd be the one telling them and not the other way around.

 

[Gordon]

Might be a case of your weird (to me) insurance system dictating how things are done over there too, there seems a strange distinction between different kinds of cleaning for instance.

 

[AnxiousWretch]

Might be! As I understand it, routine cleanings and periodontal maintenance aren't too different practically, but insurance here will typically only cover the former twice a year—so I could see that being the case.

Mildly annoying if it is, since I'm uninsuranced and paying out-of-pocket regardless, but that's a different kind of anxiety for a different time.

 

[AnxiousWretch]

Figured I ought to make a follow-up post out of posterity. Long and short of the matter is pretty much, "not very optimal, but optimistic"—putting me on the 3-4 month cycle of periodontal maintanence that I was fretting about. They're ping-ponging me between the periodontist and my dentist, though, so that's something at least?

The nine month delay didn't seem to matter much, even given my questionable routine, and there were general improvements in pocket depth despite everything. I asked if it would matter if there was some delay to periodontal maintainence since I'm sometimes out of town for lengthy periods, but they didn't seem particularly concerned, and said that they were basically keeping an eye on me for my "unique situation", i.e. some crowded and rotated teeth.

There was talk about gradually expanding the maintanence period if trends continued, which they seemed to imply would be relatively soon given improvements, but I'm also not sure what the threshold is for that—whether they just want stability or actual reduction of depths to a certain level?

Anyway, optimistic about circumstances, even if I'm not happy with the current situation. I'm sure the periodontist is a great man, but I also don't want to see him again, and return to some sense of normalcy with the usual six month cleanings—only a few more appointments, hopefully. Probably won't keep too posted about this unless something comes up, but no news is usually good news!

 

[Gordon]

Probably won't keep too posted about this unless something comes up, but no news is usually good news!

Thanks for the update. I hope to not hear from you again too soon

In an ideal world the intervals between visits in this stage (the dental jargon for it is MPT=Maintenance Phase Therapy) would be adjusted flexibly depending on how things are going.

As a general rule you want to see:
1) No bleeding on probing
2) No visible plaque or calculus deposits
3) No increase in pocket depths

But when you have to work with fairly rigid insurance company rules and regulations this isn't always possible.

 

[honeybee91]

@AnxiousWretch hello, I have an appointment in two days with a new dentist and I’m due for my periodontal maintenance. When you went to have yours were you numbed? I don’t know what to expect so I’m a bit nervous.

On the positive side I have really been diligent flossing and brushing and I have very little tarter and no inflamed or bleeding gums so I’m praying to the universe that my pockets are stable. I’m about 6 weeks overdue for my cleaning so I’m nervous at what this new office will say.