Preventive Dentistry and Cleaningsin Beverly Hills

Cleanings at Dr. Kiyan Mehdizadeh's Beverly Hills practice start at $300. What a visit costs above that depends on whether you need a routine cleaning or periodontal therapy, and that is decided by the examination and the periodontal charting rather than assumed in advance. You are given the figure before treatment begins, not afterwards.

They are pocket depths in millimetres, six around each tooth. One to three millimetres with no bleeding is healthy. One to three with bleeding is gingivitis: normal depth, inflamed tissue, and fully reversible. Four millimetres is the start of a pocket that a brush can no longer keep clean. Five to six means attachment and bone have been lost and instrumentation has to go beneath the gum. Seven and deeper is advanced, where root grooves and furcations put some surfaces out of reach from above the gum line.

Gingivitis is inflammation confined to the gum. It resolves completely once the biofilm causing it is removed. Periodontitis is what happens when that inflammation reaches the bone and the attachment between tooth and bone is lost, and that bone does not grow back on its own. The practical consequence is that gingivitis is a cleaning-and-home-care problem while periodontitis is a lifelong management problem, and the point of measuring is to catch the first before it becomes the second.

A routine cleaning removes plaque and hardened deposit from the crown of the tooth and just below the gum margin. Scaling and root planing goes beneath the gum to clean the root surface itself where pockets have formed, usually one quadrant at a time under local anaesthetic so that it can be thorough rather than merely tolerable. It is a treatment for a disease rather than a deeper polish, and it is followed by a re-evaluation at four to six weeks to measure which pockets actually closed.

Arestin is minocycline hydrochloride, 1 mg, in bioresorbable microspheres placed directly into a periodontal pocket immediately after root planing. Its FDA label indicates it as an adjunct to scaling and root planing for reduction of pocket depth in adult periodontitis, and states plainly that the mechanism as an adjunct is unknown. In the combined clinical trials the mean pocket depth change at nine months was 1.42 mm with Arestin against 1.18 mm for root planing alone. That is a real but modest addition, which is why it is placed only in the pockets that warrant it rather than throughout the mouth.

Perio Protect uses prescription trays with a sealed edge that hold a low-concentration hydrogen peroxide gel against the gum tissue and into the pocket between appointments. In a six-month randomised, examiner-blind trial using 1.7% gel alongside scaling and root planing, sites deeper than 5 mm at baseline reduced by 1.50 mm compared with 0.55 mm for root planing alone, and 72 percent of those sites came back to 5 mm or less against 28 percent of controls. The difference in bleeding in that same study only approached statistical significance. It is prescribed as an addition to in-office therapy, never as a replacement for it.

Most patients are seen every six months. A three or four month interval is used where periodontitis has been treated, where pockets remain deeper than average, or where there is extensive veneer, crown or implant work whose margins need watching. Three to four months is not an upsell: it is roughly how long the subgingival biofilm takes to reorganise after it has been disrupted, which is why periodontal maintenance runs on that cycle.

Yes, and for a structural reason. Glazed porcelain and composite are scratched by instruments and prophylaxis pastes that are entirely safe on enamel, and a scratched surface picks up stain faster from then on. Implants matter more still: an implant is fused directly to bone with no periodontal ligament, and the soft tissue collar around it has fibres running parallel to the surface rather than inserting into it, so the seal is weaker and inflammation spreads faster. Implants are probed and radiographed on a schedule to catch peri-implant mucositis, which is reversible, before it becomes peri-implantitis, which involves bone that does not come back.

You may, if you grind or clench. The signs are flattened biting surfaces, hairline cracks in enamel, fillings that keep fracturing and ceramic that chips with no obvious cause. A guard is worn at night so that it takes the load instead of the teeth. Where crowns or veneers have been placed it is usually the least expensive item on the whole treatment plan and the one that protects the most expensive.

The lips, tongue, floor of the mouth, palate, tonsillar area and the soft tissue of the neck are examined by sight and by touch at each hygiene visit. Anything unusual is recorded and photographed, and you are told what was found rather than only noted in the file. Where a finding has not resolved on its own within a short review period, you are referred for a specialist opinion.