Periodontal (gum) disease is an infectious disease that progressively weakens the attachment of supporting tissues to the teeth, including gums, ligaments and bone. If not stopped, the loss of attachment will eventually lead to bone and tooth loss.
A thin layer of plaque that builds up on teeth (mainly due to poor oral hygiene habits) is the main breeding ground for the bacteria that cause gum disease. Our main treatment goal is to remove as much of this plaque as possible from tooth and gum surfaces. Much of the plaque can be removed using special hand or ultrasonic instruments that deep clean dental surfaces, including the roots. But while effective, these manual techniques may not address the full extent of infection, especially if the disease is well advanced.
If severe bone loss has already occurred, deep pockets of infection may have developed. As bone loss progresses, teeth with multiple roots may also develop an anatomical problem known as furcation invasions where the roots of the tooth branch off. If there continues to be signs of disease, like gum inflammation, bleeding or pus formation, it’s these hard to reach areas that may still be a problem even after extensive treatment. If so, we may need to take a different approach with antimicrobial or antibiotic products.
The most effective antimicrobial substance for reducing bacteria in biofilm is a chlorhexidine mouthrinse. The typical 0.12% solution is only available by prescription — if taken for a prolonged time it can result in tooth staining, affected taste or mouth irritation. To assure the solution reaches below the gum line, it will need to be applied by us in the office, followed up flushing irrigation of the affected area.
Another alternative is topically applied antibiotics that can stop or even reverse the progression of gum disease. There’s evidence that topical applications can penetrate into these deeper areas of infection. A common antibiotic used in this way is tetracycline, which has been shown to stop inflammation and infection.
These treatments don’t eliminate the need for mechanical cleaning, and the prolonged use of antibacterial products can have a detrimental effect on “good” bacteria (needed, for example, to complete the digestive process). It will depend on the extent of the gum disease to determine how successful conservative treatment may be. It’s also important that you contribute to your own dental health with a renewed daily oral hygiene habit.
If you would like more information on treatments for gum disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Treating Difficult Areas of Periodontal Disease.”
If you’re in the habit of making New Year’s resolutions, perhaps you’ve made familiar promises like losing weight, running a 5k race or joining a gym. How about this one: “I resolve this year to take better care of my teeth.” Better yet, you needn’t wait for the next January 1st — you can begin better oral hygiene habits today.
Although maybe not as glamorous as other self-improvement habits, oral hygiene still promises huge benefits not only for your teeth and gums, but also for your general health and possibly your wallet. Daily brushing and flossing reduces your risk of tooth decay and periodontal (gum) disease, which can in turn reduce your long-term dental care costs. Besides, clean teeth just look better!
If brushing your teeth hasn’t been a regular habit for you, here are a few tips to get you on the right track:
Pick the right brush. For most people, a soft bristled, multi-tufted toothbrush is the best choice. If you’re not sure what kind of brush to use, ask us for recommendations.
Look for the basics in toothpaste. Store shelves are filled with toothpastes promising everything from teeth whitening to tartar control. Just be sure of two things: that the product contains fluoride (proven to reduce the risk of tooth decay) and it has the American Dental Association’s Seal of Approval. If you have sensitive teeth, ask us about toothpaste options that address this or other special situations.
Easy does it with the technique. Over-vigorous brushing can harm your teeth’s enamel and cause gum recession. Hold the brush handle between your fingertips with no more pressure than you would hold a pencil. Position the brush-head at the gum line at about a 45-degree angle and gently clean all your tooth surfaces. If you’re trying this approach for the first time, the task should take about two minutes.
Visit your dentist twice a year to keep on track. Think of your dental healthcare team as your “personal trainers” in oral hygiene. Besides monitoring your overall dental health and removing hard to reach plaque through semi-annual cleanings, they’ll also coach you on your new lifetime habit of better oral hygiene.
If you would like more information on oral hygiene, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Oral Hygiene.”
Dental implants are a popular and effective restoration for lost teeth, if there’s enough bone present to support the implant. That might not be the case, however, because without the stimulation of the lost tooth, the bone may dissolve (resorb) over time. It’s possible, however, that you may need to re-grow bone in the back area of the upper jaw where your upper (maxillary) sinus is located.
Sinuses are air space cavities located throughout the skull. This feature allows your head to be light enough to be supported by your neck muscles. Inside each sinus is a membrane that lines your sinus cavities, nasal passages and other spaces. The maxillary sinus is located on each side of the face just below the eyes. Pyramidal in shape, the floor of the pyramid lies just above the upper back teeth.
A surgeon approaches the sinus through the mouth, with the objective of moving the sinus membrane up from the floor of the sinus. This is accomplished by placing bone-grafting material in the area. Over time the body uses the grafting material as a scaffold to produce new bone that then replaces the grafting material. The resulting new bone becomes the support for the implant.
If enough bone exists to stabilize an implant but not anchor it, then the surgeon can approach the sinus from the same opening that’s used for the intended implant site, insert the grafting material, and install the implant during the same procedure. If not, the surgeon creates a small “window” laterally over the teeth to access the sinus and insert the graft. The implant is installed a few months later after the new bone is created.
The procedure usually requires only a local anesthetic, although some patients may require additional sedation or anti-anxiety medication. After the surgery, you normally experience mild to moderate swelling and discomfort, about the same as having a tooth removed. All these symptoms can be managed with non-steroidal, anti-inflammatory pain medication and a decongestant for minor congestion in the sinus. We might also prescribe an antibiotic to help prevent infection.
Although this procedure adds another step and possibly more waiting time to implantation, it gives you an option you wouldn’t otherwise have — a life-like, effective replacement of your back teeth with dental implants.
If you would like more information on bone regeneration for implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Sinus Surgery.”
They work hard, and put in lots of time on the field and at home. They learn the rules of the game — as well as the unwritten rules of sportsmanship and teamwork. They receive the proper training, and wear appropriate protective equipment. But sometimes, in spite of everything, kids who participate in sports can be subject to injury. Fortunately, in today's dentistry there are a variety of treatments, as well as preventive measures, which can help.
When faced with serious dental injury, time is of the essence in saving teeth. So, don't delay — come in to see us immediately! If treated promptly, it's possible for teeth which have been dislodged — or even knocked out of the mouth — to be put back in position and stabilized. Afterwards, follow-up treatment will ensure that the tooth has the best chance of recovery.
The treatment of kids' dental injuries is sometimes different than that of adults. For example, in adults, a root canal would generally be necessary, followed by a tooth restoration (crown). But some kids may not need this treatment, since their teeth are still developing. Also, replacing a missing primary (baby) tooth may not be recommended, since it may hinder development of the permanent teeth. Based on his or her individual circumstances, we can develop an appropriate treatment plan for your child.
Luckily, the most common dental injuries aren't nearly as serious — they typically involve chipped or cracked teeth. Most can be repaired by reattaching the broken piece, or using a tooth-colored restoration. If a large part of the structure of a permanent tooth is missing, a crown or “cap” may be placed on the visible part, above the gum line. Smaller chips, even in primary teeth, can be successfully repaired by cosmetic bonding with composite resin materials.
Finally, if your child is involved in athletic activities — or if you are — consider obtaining a custom-made mouthguard. Numerous studies have shown that this protective gear can help prevent many dental injuries. Unlike the off-the-shelf types found in some sporting-goods stores, the ones we provide are individually fabricated from an exact model of the teeth. They're strong, fit comfortably, and offer superior protection at a reasonable cost.
If you have questions about the treatment of sports-related dental injuries, or about mouthguards, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Trauma & Nerve Damage to Teeth” and “Mouthguards.”
Tooth wear, especially on biting surfaces, is a normal part of aging — we all lose some of our tooth enamel as we grow older. Even primary (“baby”) teeth may show some wear before they’re lost. But there’s also excessive, premature tooth wear caused by disease or abnormal biting habits. This type of wear is cause for concern and action before it leads to tooth loss.
Normal tooth wear occurs because of what teeth naturally do — bite and chew. When teeth come together as we eat they generate a modest amount of force: between 13 and 23 pounds. Our teeth also make brief contacts hundreds to thousands times a day. Again, this produces force, though not to the extent we see with biting and chewing: somewhere between 0.75 and 7.5 pounds. These glancing contacts are actually good for dental health because they provide needed stimulation to the teeth and jaws that help the body maintain healthy bone and tooth attachments.
But parafunctional (outside the normal function) habits like teeth grinding or foreign object chewing can greatly increase the generated force, up to 230 pounds. These may result in noticeable symptoms like fractures or loose teeth, but not always — the damage may not be noticeable until much later in the form of excessive tooth wear.
These parafunctional habits aren’t the only cause for excessive tooth wear; tooth decay can weaken the tooth structure, making it more susceptible to wear. And, some restorative materials used for fillings may also affect the rate of wear.
Because excessive tooth wear may or may not present with immediate symptoms, it’s important to maintain regular dental checkups to monitor the condition of your teeth. Our training and experience helps us identify signs of excessive tooth wear and, depending on the extent of damage, work with you on a treatment plan. You should also keep us informed about oral habits, especially teeth grinding, thumb sucking or foreign object chewing (toys, nails, pencils, etc.).
Your teeth will wear as you grow older. By keeping a close eye on your teeth, we’ll help you keep that wear at a normal rate.
If you would like more information on preventing excessive tooth wear, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “When Children Grind Their Teeth.”
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