Hygienist and Dental Hygiene - Richmond Road DentalRichmond Road Dental

Dental Hygiene

Dental Hygiene has evolved from the traditional “scale and polish”. Prevention of disease is fundamental to modern dentistry. Alongside dentists, hygienists deliver and reinforce oral education to motivate you to create a positive behaviour change which is long lasting. Hygienists help to impart the necessary knowledge and skills so patient’s can take responsibility for their own oral health.

Research shows that the build up of plaque and subsequent bacteria can cause gum disease in those people who are susceptible. However we do not know fully who is susceptible to this disease process.

Excellent home oral hygiene is of fundamental importance to tackling periodontal disease besides regular professional debridement. Time will be spent during your appointment not only cleaning your teeth and gums but educating you on the best methods of maintaining a beautiful and healthy smile. This advice will be personalised and tailored to your dentition, lifestyle and circumstances in order to be maximally effective. You need to actively work together with your hygienist to achieve your goal.

Hygienists are now able use a vast array of scalers, polishes, pastes and air polishers to professionally clean your teeth and gum pockets. This not only ensures the removal of any tartar and plaque, but also stains caused by smoking, drinking red wine, tea and coffee, the use of certain mouthwashes and stain caused by chromogenic bacteria.
Fundamental to a healthy dentition is excellent oral hygiene. Creating good protocols from a young age sets a foundation for keeping teeth and gums healthy long term. We therefore also encourage children where necessary to see the hygienist. This may be as a one off, long term or alongside other treatments such as orthodontics where good oral hygiene becomes more difficult to maintain due to appliances.
As well as tooth decay and gum disease, poor oral hygiene has been linked to systemic disease. Studies are now linking gum disease with many other conditions including heart disease and stroke. Scientists believe that inflammation caused by the bacteria involved with periodontal disease may be responsible for the association. Untreated gum disease increases a susceptible individual’s risk. Early detection leads to easier and simpler treatment and to a better quality of life.

The hygienist will:

  • make you feel more confident about your smile
  • gently make your teeth and gums feel fresher and healthier
  • give you great advice about how to look after your oral health
  • remove stains and improve your smile
Richmond Road Dental Smile
Apart from advising you on how to clean your teeth and gums, the hygienist may also discuss your diet with you, especially if you suffer from repeated decay lesions requiring fillings. Clever yet simple dietary changes can eliminate dental caries which is currently the largest preventable cause for child hospital admissions in the UK.

Additionally they are able to advise you on the cessation of smoking. Smoking is closely related to gum disease. Any reduction in the amount of cigarettes smoked or ideally a complete cessation is beneficial to the health of your teeth and gums as well as your overall well being.

Treatment under Direct Access to a hygienist

Treatment under direct access means a private visit to the hygienist without seeing a dentist for an examination first. The hygienist can carry out an assessment, complete any subsequent treatment and advise you on your disease progression. However most still prefer to work under the prescription of a dentist. They will refer you to a dentist for an assessment should they find anything of concern. After the dental assessment, the hygienist would then be able to treat you under the prescription of a dentist.
Visits to hygienists do not substitute for full dental examinations, the frequency of which depend on your needs and can vary from 6 months to 2 years.

Referral to dentists

If the hygienist advises you to see a dentist, it is because they feel it is in your best interest, or it is outside the scope of what they are trained and allowed to do, or they are uncertain about treating you without further advice.
In very rare circumstances a hygienist may be unable to start treatment until you have seen a dentist. These may relate to your medical history and general health or the condition of your mouth.


Plaque is a soft sticky bacterial biofilm that adheres to tooth surfaces particularly those close to gum margins. It is easily removed by mechanical toothbrushing and interdental brushes or floss/tape. The bacteria in plaque can cause tooth decay and gum disease if not removed regularly.

Calculus is the hard mineral deposit on tooth surfaces as a result of the calcification of plaque which has been left on the tooth. It can form above and below the gum line and once it has formed it can only be removed professionally. With a good effective oral hygiene regime it will not reform.
This is as a result of the process of inflammation caused by bacterial plaque irritation at the gum margin. Gingivitis is the very early stage of gum disease and is characterised by puffy, red and swollen gums that bleed. It is reversible and resolves completely with the implementation and maintenance of good oral hygiene. Patients will benefit from seeing the hygienist as well especially if calculus is present. If this is left untreated it can progress to bone loss and periodontal disease.

bleeding gums

Gum disease proper is characterised by the irreversible destruction of the periodontium (structures holding the teeth in) as a result of the immune reaction between us and bacterial plaque at gum margins. The result is pocketing, gum recession, bone destruction and bleeding which can eventually lead to tooth mobility and eventual tooth loss. Periodontitis requires further treatment than Gingivitis. Patients will require thorough debridement of all accessible tooth surfaces. Sometimes this may require local anaesthetic. In more severe cases, the patient may be referred to a local Periodontal Specialist for an opinion and possible treatment. Following the initial therapy maintenance is often provided between the two practices long term.Some patients may benefit from the use of antimicrobials to supplement their treatment such as antibiotics, either systemic or local, and Periochips (small self dissolving chips inserted into pockets which release antimicrobials directly to the pocket flora to help eliminate stubborn residual bacteria). This treatment is very successful and will help slow down the rate of destruction and hopefully prevent the loss of the affected teeth.

There are several causes of bad breath, the most common of which is a poor level of oral hygiene. Bacteria normally found in the mouth can produce unpleasant smelling gases (Volatile Sulphur Compounds; VSCs). These bacteria are also responsible for gum disease and tooth decay mouth. Other causes of bad breath are food and drinks such as garlic, onions, coffee and alcohol, smoking, crash dieting, certain medications (nitrates and some chemotherapy drugs) and certain medical conditions such as dry mouth.In addition to cleaning thoroughly between the teeth it is recommended that you also clean your tongue on a daily basis with a tongue scraper or by brushing it with a toothbrush. Certain mouthwashes are available on the markets which have been designed to specifically neutralise VSCs.
Smokers have been shown to not only suffer with a more aggressive form periodontal disease but also to show a poorer response to treatment. They have more teeth affected by periodontal disease; have deeper pocketing, less bleeding and greater bony destruction. Data also shows smokers lose more teeth than those who do not. The differences are due to constriction of blood vessels, suppression of the immune system and changes in the oral cavity as a result of the irritants and chemicals found within the cigarette smoke. Smokers suffering with periodontal disease are therefore more likely to require a specialist referral and the use of antimicrobials.
Your dental hygienist will use various instruments and devices (ultrasonic cleaner, air jet and diamond polisher) to loosen and remove the plaque deposits from your teeth. This plaque removal is called ‘debridement’. Once all the surfaces are smooth your hygienist will polish your teeth and give them a thorough clean, using both a rotating brush and a prophylaxis paste (a special gritty toothpaste-like material) or a salt jet. Your teeth will then look cleaner and both your teeth and your mouth will feel much cleaner.
Most people find that the cleaning process is relatively painless; you may feel tickling vibrations, the cooling mist of water, and the feeling of pressure during “scraping”. Some people find scaling uncomfortable because their gums are already inflamed, and sometimes the teeth themselves may be sensitive. Topical numbing gels can be used to prevent this discomfort, or you may need a local anaesthetic, which the hygienist is qualified to give if needed. Desensitising toothpastes are a great way long term to diminish sensitivity.
This really depends on several factors including your level of disease progression, effectiveness of your oral hygiene regime and medical history. It generally ranges from 3 monthly for those patients already suffering with periodontal disease, 6 monthly for the vast majority and possibly as long as yearly for those few patients with superb oral hygiene and minimally restored dentitions. Your dentist will advise you on the recommended interval for your particular needs.
If plaque is allowed to build up undisturbed, the resultant tartar will be much more difficult to remove. A more in depth debridement may be necessary which will usually be more uncomfortable and may require a local anaesthetic, especially if your gums are already sensitive or suffering from gum disease.

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