Advanced Cosmetic & General Dentistry of DC – Arousha Jahangiri DDS

Full Mouth Debridement for Periodontal Evaluation – Dental Procedure Code Description

Periodontal disease affects the gums and bone to which a tooth is attached. It is a bacterial infection that causes tooth loss and gum recession, and is often the result of infrequent visits to the dentist for routine adult prophylaxis.

The disease is also marked by excessive amounts of plaque and tartar that make evaluation of your oral health difficult. As a result, a full mouth debridement is often necessary to complete a proper evaluation and subsequent cleaning.

The American Dental Association describes a full mouth debridement as the “gross removal of plaque and calculus that interfere with the ability of the dentist to perform a comprehensive oral evaluation.”

Quite simply, this code covers the removal of plaque and tartar that is so prominent in the mouth that removing it will take a considerable amount more effort and time than in a typical cleaning.

Furthermore, after removal, additional procedures such as scaling and root planing (SRP) may be necessary, or specifically, scaling and root planing (SRP) for one to three teeth, as well as a prophylaxis (prophy).

Neither are included within this code’s description, and come subsequent to full mouth debridement.

The procedure for full debridement is like any other prophy, with the exception of the time involved and the fact that some form of anesthetic may sometimes be used to numb the area. This can be necessary if you experience sensitivity due to recessed gums that have exposed the tooth’s cementum, or because you anticipate a degree of anxiety during the procedure.

It is worth nothing that this dental procedure code covers the debridement of materials from above the gumline only, and if buildup exists below the gumline, other dental codes such as those related scaling and root planing are used instead.

What is plaque?

Most people have heard of the word “plaque,” and know it’s not something you want on your
teeth. Yet, they don’t know what exactly plaque is or how it contributes to dental decay.
Plaque is a sticky, colorless film of bacteria that lives on the surface of your teeth and along the
gumline. It accumulates from normal daily activities such as eating and drinking, especially if
you’ve been consuming a lot of sugars and starches.
Ever had that fuzzy feeling on your teeth that goes away after you give them a good brush?
Yep, that’s plaque.
Plaque is what contributes to dental decay, as bacteria like to consume the sugars in your mouth
and excrete acids that wear away at your tooth enamel.
When you don’t regularly brush and floss away plaque, it forms tartar. Tartar is the calcified
substance on your teeth that only a professional cleaning can remove.

To regularly remove plaque:
1. Brush thoroughly with fluoride toothpaste at least twice a day.
2. Floss at least once a day to remove plaque that your brush can’t reach.
3. Visit us for your regular dental cleanings.

Protecting Yourself Against Oral Cancer

Those at Risk for Oral Cancer
Passing certain age thresholds and engaging in certain lifestyle habits can place you at increased
risk for oral cancer. For example, men tend to have higher rates of oral cancers than women.
Here is the short list:
· Patients age 40 and older (95% of all oral cancer cases)
· Patients age 18-39 who use tobacco, are heavy drinkers, or may have a previously diagnosed
oral HPV infection.

Warning Signs
If you experience any of the below symptoms lasting more than 7-10 days, please seek the
advice of your doctor. Also, keep in mind that aside from an obviously sore throat, the below
symptoms can present themselves in the absence of pain. Look out for changes that can be
detected on the lips, inside the cheeks, palate, and gum tissue surrounding your teeth and

• Reddish or whitish patches in the mouth
• A sore that fails to heal and bleeds easily
• A lump or thickening on the skin lining the inside of the mouth
• Chronic sore throator hoarseness
• Difficulty chewing or swallowing

Reducing risk
If you do not visit the dentist regularly, you could be missing out on the benefits of early cancer
detection. Currently, just over half of all those diagnosed with oral cancer survive more than
five years – a statistic driven by late diagnosis – so please visit your dentist and get an oral
exam at least once a year. If you are considered “high risk,” (see list above) you should be
receiving an oral exam at least every six months, if not more frequently.
Below is a short list of healthy habits you can start doing now, which may reduce your risk.
• Avoid all tobacco products
• Avoid or reduce your consumption of alcohol
• Consume more fruits and vegetables (good for everything, of course)
• Avoid excessive sun exposure that can result in cancer of the lip (using lip balm with an SPF
of at least 30 can be helpful)
• Avoid exposure to environmental hazards (wood dust, formaldehyde, printing chemicals)
• Conduct a self-exam monthly so you can catch any of the symptoms listed above. Use a
small hand-held mirror so you can see the back of your mouth and tongue. If you haven’t been in to see us in a while,
give us a ring at 202-331-1644, and we’ll show you how to perform this exam in
between visits.Oral cancer is serious business. Yet, it can be managed when caught early. So, do the right thing
and visit your dentist regularly, and get that screening.

Proper Brushing FAQs

Mouth open or mouth closed?
After lunch or after dinner?
Flat or at an angle?
We brush our teeth every day (hopefully!), but who knew it was this complicated. Just grab a
brush a get to work, right?
Not so fast, my friend! There are actually some best practices to be mindful of when brushing
those pearly whites.
The trick is cutting through the fat and finding out exactly what works. We live in a world of
alternate facts, truthiness, and lists of “7 Ways to Keep Your Teeth Clean Without Picking Up a
Toothbrush.” What’s even correct these days?!
Fear not, because we’ve got you covered with this handy FAQ (frequently asked questions)
guide. We’ll keep it simple with some easy dos and don’ts of brushing. Let’s get to it!
Proper Brushing Habits
Don’t: Keep your brush flat
Do: Use a 45-degree angle when brushing
Don’t: Use looooooooong strokes. No need to cover your whole mouth in one stroke!
Do: Use short, side to side strokes
Don’t: Brush with the force of a giant. This isn’t a strongman contest!
Do: Gently cover all areas. A gentle touch helps prevent wear and tear on your enamel
Don’t: Go one and done
Do: Brush at least twice a day, especially after eating or drinking something acidic (like citrus or
Don’t: Be sentimental and use the same toothbrush for life
Do: Change your toothbrush every 3-4 months. A trick to remember: switch out on the first day
of each season
Don’t: Be average – the average person brushes their teeth for 45 seconds
Do: Brush for a full 2 minutes. A helpful trick: say the alphabet while brushing a certain section,
move to the next section after you hit Z.
Don’t: Keep your toothbrush in a closed container
Do: All your toothbrush to air dry
Don’t: Store your toothbrush on the sink counter where bathroom particles can get on it
Do: Store your toothbrush in the medicine cabinet
Don’t: Wield a tough-bristled brush
Do: Use a soft-bristled toothbrush, which is much better for your tooth enamel
And there we have it! Some easy practices to keep that perfect smile.
Remember: Brushing is only 4 minutes out of the day, so why not make it the best 4 minutes of
the day!

How to Know if You Have a Cavity

So, how do you know if you have a cavity? Well, depending on the severity of your tooth decay,
you may experience a variety of symptoms. Here are some of the accompanying symptoms that
go along with tooth decay.
• Nothing (in the early stages)
• A toothache or spontaneous tooth pain
• Tooth sensitivity
• Pain (slight or severe) when eating something sweet, hot, or cold
• Staining (brown, black, or white) on the surface of your tooth
• Visible holes in your tooth. Those holes are cavities
• Pain when biting down

The best time to catch a cavity is in the early stages, when there are few, if any, symptoms. Keeping your twice yearly (or more) visits with us will ensure we catch them in time. We will let you know the best course of treatment for your particular situation. The recommendation
could be as easy as watching and waiting to see if we find any tooth decay in the very
early stages.

As always, brush twice a day with a fluoride toothpaste, floss at least once a day, and try to
minimize the amount of sugar in your diet.
These steps will help you be proactive in preventing cavities.
Even better, your teeth will thank you for it!

Understanding the Five Stages of Tooth Decay

Did you know there are five distinct stages of tooth decay? And, that in the first stage of decay, you
can actually take steps to reverse the progression of the disease? Indeed, it’s true. In the first stage
of decay, whether you’re a child or an adult, the application of fluoride via fluoride treatments, your
toothpaste and even the local water supply can stop a cavity from penetrating through the enamel
and reaching its second stage. Even the saliva in your mouth and the foods you eat help to re-mineralize
a tooth in jeopardy. But that’s just the first stage! What about the rest? Understanding how a
cavity progresses can assist you in preventing each successive stage from occurring in your
children. There’s always a lot going on in that little mouth!
Stage One: White Spots
In stage one, the tooth begins to show signs of strain from the attack of sugars and acids, and
white spots will begin to materialize just below the surface of the enamel. These white spots are
representative of the demineralization of the tooth and can be easy to miss because they’re likely
to occur on your child’s molars. A dental exam, of course, is designed to catch such cavities! Can
you see why regular visits to the dentist are recommended? As mentioned previously, at this
stage, the cavity can be repaired without the need to excavate the tooth Stage Two: Enamel Decay
Stage two marks the beginning of the end for the surface enamel that is being attacked.
Initially, the tooth erodes from the underside outward, so the outer enamel will still be intact
for the first half of this second stage. Once the cavity breaks through the surface of the
enamel, there is no turning back, and your child will need to have the cavity corrected with a
filling. Stage Three: Dentin Decay
If a cavity in your child’s mouth were to progress beyond stage two without you knowing,
you’d tend become aware of it when it started to hit stage three because it would probably
start to cause some pain. At this level, the cavity begins to eat away at the second level of
tooth material that lies beneath the enamel: the dentin. A filling can still be used to stop the
onslaught of bacteria assaulting the tooth in order to prevent the cavity from reaching the
tooth’s most critical component: the pulp.
Stage Four: Involvement of The Pulp
Once the cavity reaches the pulp, it’s going to hurt. A lot. So if you’ve unfortunately missed all
the signs to this point, a screaming child or moaning teenager will certainly let you know there
is a big problem. Stage four is serious, and a root canal is the only option of treatment at this
stage, save for a complete extraction.Stage Five: Abscess Formation
In the fifth and final stage of a cavity, the infection has reached the tip of the root and exited
the tip of the tooth’s structure. This in turn infects the surrounding tissues and possibly the
bone structure. Swelling would be commonplace and pain severe. In children (as well as
adults) an abscess can be fatal if not dealt with immediately. Root canal or extraction would
be the order of the day should decay reach this stage

What in the World Is that Smell?

“Pssst!” “Hey, what’s that smell? … I’m not so sure it’s the onions you had on that pizza this afternoon – it might be that you’ve just got bad breath.” 
Has a friend ever shared this kind of news with you? Probably not. Most of us, in fact, go about our daily lives unaware the brilliant sentences we speak, are also being delivered with an accompanying odor …  of significantly, less brilliance. Egad! But, do not fret, while halitosis can be embarrassing, it can also be addressed once its underlying cause is known. Let’s take a look at some of those reasons, and learn some tips that’ll help you be the one with the freshest breath in the room.

What Causes Bad Breath?

The causes of bad breath range from the simple to the serious, but most often, it’s the result of gum disease brought on by inadequate brushing and flossing. Halitosis can also be caused by certain foods you consume (like garlic and onions), acid reflux, post-nasal drip, sinusitis and tonsoliths.  More seriously, however, illnesses such as cancer and diabetes can present themselves in this way, so it’s important to visit a dentist if your breath issues are prolonged.

Tips to Keep the Bad Breath Monster Away

Outside a visit to your dentist, a few simple tricks will help you care for your mouth in ways that can translate into fresh breath:

  • Floss daily, or use a water irrigation tool.
  • When brushing, don’t forget to brush your tongue and the inside of your cheeks.
  • Purchase an inexpensive tongue-scraper and use it as part of your nightly routine. A scraper will allow you to reach the very back of your tongue that is difficult to reach with a brush.
  • Get regular cleanings from your dental hygienist to keep plaque and gingivitis at bay.
  • And, avoid smoking or too much alcohol. Both dry out your mouth which can lead to bad breath, and can contribute to a higher incidence of oral cancer.

These days, we understand finding the time to stay on top of your oral hygiene can be a challenge. But, the rewards are well worth it. You’ll have less dental expense, a beautiful smile, and fresh breath that will keep you eminently kissable all year round.

Wisdom Teeth

Wisdom Teeth are the third and final set of molars that most people get in their late teens and early twenties. When these teeth are aligned correctly and healthy, they can be a part of a healthy mouth. However, most wisdom teeth are misaligned and need to be removed.

Your dentist may recommend removal of your wisdom teeth if there are signs of pain, infections, damage to adjacent teeth, gum disease, tooth decay or cysts. Your dentist may also recommend removing your wisdom teeth without any of these systems in order to avoid a more difficult procedure later on.

A typical surgery to remove wisdom teeth requires sedation and may lead to facial swelling and bleeding for a few days afterwards. There are two potential complications that can happen after surgery: dry socket and paresthesia.


Teeth Whitening

Getting a beautiful smile is easier than you think
Do your teeth have more of a yellow tint now? All the coffee, cigarettes or red wine you may have enjoyed took a toll, and that big smile you use to flash is gone. Well, did you know that you can have those stains almost magically erased in the same amount of time it takes to get your haircut, a manicure or even lunch with your friends? Yes, in just a short time you can have a teeth whitening session and bring back that shiny, bright smile again.

Using the latest in tooth whitening technology, a visit to your dental office can make your smile brighter than ever before. Tooth whitening can correct tooth discolorations caused by staining, aging, or even chemical damage to teeth. In cases of extreme tooth discoloration, whitening isn’t always enough and crowns or veneers may be the only choice. But because of the low cost of tooth whitening treatments, it’s usually worth a try.

Teeth whitening methods
Two effective teeth whitening techniques are available today: in-office laser teeth whitening and at-home teeth whitening with custom-fit trays. Both teeth whitening techniques are best performed under your dentist’s supervision to ensure the safest and most dependable results.

  • In-Office Tooth Whitening methods are performed with bleaching gel and laser light. This is a good method of teeth whitening for sensitive teeth, as the process may be closely monitored by the cosmetic dentist. The teeth are carefully isolated from the lips and gums, and then a bleaching gel is applied to them. A laser is used in conjunction with the gel to accelerate and amplify the tooth whitening process.
  • At-Home Tooth Whitening are available in a variety of “flavors” for those who are interested in giving whitening a go in the privacy of their home. Your cosmetic dentist can take imprints of your teeth and then make custom-fitted trays for you to take home to complete the tooth whitening process. There are also teeth bleaching kits and other over-the-counter teeth whitening products available to brighten your smile.

Some key benefits of whitening are:

  • Corrects brown, yellow, and mottled tooth staining
  • Works on people of all ages
  • Restores brightness and life to “dull” smiles

Tooth Decay

Tooth Decay is a result of bacteria in the mouth that makes acids that eat away at the tooth. When sugar and starches are consumed on a regular basis and plaque is left on the teeth, it produces acids and destroys tooth enamel over a period of time.  Tooth decay will often lead to cavities if left untreated.

Most tooth decay can be treated by using fluoride, a filling, or, in more extreme cases, through a root canal or a crown.

You can prevent tooth decay by regularly brushing and flossing your teeth, regularly scheduling hygiene checkups with your dentist, and limiting foods that are high in sugar.