PERIODONTICS

 

1. PERIODONTAL GUM DISEASE

To view a detailed interactive video about Symptoms of Periodontal Disease.

It is extremely important to note that periodontal disease can progress without any signs or symptoms such as pain. This is why regular dental checkups are exceptionally important. Described below are some of the most common signs and symptoms of periodontal disease.

If you have any of these signs or symptoms, the advice of a general dentist or periodontist should be sought as soon as possible:

  • Bleeding Gums.
    Bleeding (when brushing, flossing or eating food) is one of the most common symptoms of a periodontal infection. The toxins in plaque cause a bacterial infection that makes the tissues prone to bleeding. Gums should never bleed, even when you brush vigorously or use dental floss.
  • Pain, redness or swelling.
    Plaque, calculus and bacteria irritate the gums and teeth. A periodontal infection may be present if the gums are swollen, red or painful for no apparent reason. It is essential to halt the progression of the infection before the gum tissue and jawbone have been affected. It is also critical to treat the infection before it is carried into the bloodstream to other areas of the body. Gums should never be red or swollen.
  • Receding Gums.
    New spacing between teeth or longer-looking teeth can be caused by periodontal disease due to gum recession and bone loss. The toxins produced by bacteria can destroy the supporting tissue and bones, thus making the teeth look longer and the smile appear more “toothy”.
  • Bad breath/halitosis.
    Although breath odor can originate from back of the tongue, the lungs and stomach, from the food we consume, or from tobacco use, bad breath may be caused by old food particles that sit between the teeth and underneath the gum line. The deeper gum pockets are able to house more debris and bacteria, causing a foul odor.
  • Loose teeth or change in bite pattern.
    A sign of rapidly progressing periodontal disease is the loosening or shifting of the teeth in the affected area. As the bone tissue gets destroyed, or periodontal fibers weakened (fibers that support the tooth to the bone), teeth that were once firmly attached to the jawbone become loose or may shift in position.
  • Pus.
    Pus oozing from between the teeth is a definitive sign that a periodontal infection is in progress. The pus is a result of the body trying to fight the bacterial infection.
Diagnosis of Periodontal Disease

Periodontal disease is diagnosed by your dentist during a periodontal examination. This type of exam should always be part of your regular dental check-up. A periodontal probe (small dental instrument) is gently used to measure the sulcus (pocket or space) between the tooth and the gums. The depth of a healthy sulcus measures three millimeters or less and does not bleed. The periodontal probe helps indicate if pockets are deeper than three millimeters. As periodontal disease progresses, the pockets usually get deeper. Your dentist or hygienist will use pocket depths, amount of bleeding, inflammation, tooth mobility, etc., to make a diagnosis that will determine the type of periodontal disease you have.

To view a detailed interactive video about common causes of Periodontal Disease.

There are genetic and environmental factors involved in the onset of periodontal disease, and in many cases, the risk of developing periodontal disease can be significantly lowered by taking preventative measures.

Here are some of the most common causes of periodontal disease:

  • Poor Dental Hygiene.
    Preventing dental disease starts at home with good oral hygiene and a balanced diet. Prevention also includes regular dental visits that include exams, cleanings and x-rays. A combination of excellent home care and professional dental care will ensure and preserve the natural dentition and supporting bony structures. If bacteria and calculus (tartar) are not removed, the gums and bone around the teeth become affected by bacteria toxin, that can cause gingivitis or periodontal disease, which can lead to tooth loss.
  • Tobacco Use.
    Research has indicated that smoking and tobacco use is one of the most significant factors in the development and progression of gum disease. In addition to smokers experiencing a slower recovery and healing rate, smokers are far more likely to suffer from calculus (tartar) build up on teeth, deep pockets in the gingival tissue and significant bone loss.
  • Genetic Predisposition.
    Despite practicing rigorous oral hygiene routines, as much as 30% of the population may have a strong genetic predisposition to gum disease. These individuals are six times more likely to develop periodontal disease than individuals with no genetic predisposition. Genetic tests can be used to determine susceptibility and early intervention can be performed to keep the oral cavity healthy.
  • Pregnancy and Menopause.
    During pregnancy, regular brushing and flossing is critical. Hormonal changes experienced by the body can cause the gum tissue to become more sensitive, rendering them more susceptible to gum disease.
  • Chronic Stress and Poor Diet.
    Stress lowers the ability of the immune system to fight off disease, which means bacterial infections may possibly beat the body’s defense system. Poor diet or malnutrition can also lower the body’s ability to fight periodontal infections, as well as negatively affecting the health of the gums.
  • Diabetes and Underlying Medical Issues.
    Many medical conditions can intensify or accelerate the onset and progression of gum disease including respiratory disease, heart disease, arthritis and osteoporosis. Diabetes hinders the body’s ability to utilize insulin, which makes the bacterial infection in the gums more difficult to control, and cure.
  • Grinding Teeth.
    The clenching or grinding of the teeth can significantly damage the supporting tissue surrounding the teeth. Grinding one’s teeth is usually associated with a "bad bite" or the misalignment of the teeth. When an individual is suffering from gum disease, the additional destruction of gingival tissue due to grinding can accelerate the progression of the disease.
  • Medication.
    Many drugs including oral contraceptive pills, heart medicines, anti-depressants and steroids affect the overall condition of teeth and gums; making them more susceptible to gum disease. Steroid use promotes gingival overgrowth, which makes swelling more commonplace and allows bacteria to colonize more readily in the gum tissue.
  • Lack of Selenium.
    A contributing cause may be low selenium in the diet. Studies have shown that selenium has the strongest association with gum disease, with low levels increasing the risk by 13 fold.

Daily oral hygiene measures to prevent periodontal disease include:

  • Brushing. Brushing properly on a regular basis (at least twice daily), with the patient attempting to direct the toothbrush bristles underneath the gum-line, to help disrupt the bacterial growth and formation of subgingival plaque. To view a short informative video about brushing.
  • Soft Toothbrush. Using a soft toothbrush to prevent damage to tooth enamel and sensitive gums.
  • Flossing. Flossing daily and using interdental brushes (if there is a sufficiently large space between teeth), as well as cleaning behind the last tooth, the third molar, in each quarter. To view a short informative video about Flossing.
  • Antiseptic Mouthwash. Chlorhexidine gluconate based mouthwash in combination with careful oral hygiene may cure gingivitis, although they cannot reverse any attachment loss due to periodontal disease.
  • Medication. Using periodontal trays to maintain dentist-prescribed medications at the source of the disease. The use of trays allows the medication to stay in place long enough to penetrate the biofilms where the bacteria are found.
  • Check-Ups. Regular dental check-ups and professional teeth cleaning at least 2-4 times per year. Dental check-ups serve to monitor the person’s oral hygiene methods and levels of attachment around teeth, identify any early signs of periodontal disease, and monitor response to treatment. To view a short informative video about what to expect during a new patient dental exam.

2. BONE GRAFTING

Bone grafting is often closely associated with dental restorations such as dental implants. In the majority of cases, the success of a restoration procedure can hinge on the height, depth, and width of the jawbone at the implant site. When the jawbone has receded or sustained significant damage, the implant(s) cannot be supported on this unstable foundation and bone grafting is usually recommended for the ensuing restoration.

There are several major factors that affect jaw bone volume:

  • Periodontal Disease.
    Periodontal disease can affect and permanently damage the jaw bone that supports the teeth. Affected areas progressively worsen until the teeth become unstable.
  • Tooth Extraction.
    Studies have shown that patients who have experienced a tooth extraction subsequently lose 40-60% of the bone surrounding the extraction site during the following three years. Loss of bone results in what is called a "bone defect".
  • Injuries and Infections.
    Dental injuries and other physical injuries resulting from a blow to the jaw can cause the bone to recede. Infections can also cause the jaw bone to recede in a similar way.
Reasons for bone grafts

Bone grafting is a highly successful procedure in most cases. It is also a preferable alternative to having missing teeth, diseased teeth, or tooth deformities. Bone grafting can increase the height or width of the jawbone and fill in voids and defects in the bone.

There are essentially two basic ways in which bone grafting can positively impact the health and stability of the teeth:

  • Jaw Stabilization.
    Bone grafting stabilizes and helps restore the jaw foundation for restorative or implant surgery. Deformities can also be corrected and the restructuring of the bone can provide added support.
  • Preservation.
    Bone grafting can be used to limit or prevent bone recession following a tooth extraction, periodontal disease, or other invasive processes.
Oral Examination

Initially, the dentist will thoroughly examine the affected area in order to assess the general condition of the teeth and gums. If periodontal disease is present or the adjacent teeth are in poor condition, these factors will be fully addressed before the bone grafting procedure can begin. The dentist will also recommend panoramic x-rays in order to assess the precise depth and width of the existing bone. On occasion, a CAT scan may be recommended to determine the bone condition. Depending on these results, the dentist may also anesthetize the area and explore into the gum in order to determine what kind and how much bone is required.

What Does Bone Grafting Involve?

There are several types of bone grafts. Your dentist will determine the best type for your particular condition.

  • Autogenous Bone Graft.
    Harvested from the patient’s own body (usually from the posterior part of the lower jaw or the chin). This method is usually preferred because it produces the most predictable results.
  • Allograft Bone Graft.
    Cadaver or synthetic bone is used in this type of graft.
  • Xenograft.
    Cow bone is used in this type of graft.

The bone grafting procedure can often take several months to complete. Bone is typically harvested from your own body (or on rare occasions obtained from a “bone bank”) and added to the affected site. This bone will fuse with the existing bone and the migration of cells will cause firm adhesion and cell growth. Supplementing the jaw with bone will result in greater bone mass to help support and anchor the implant(s).

During the surgery, the dentist will numb the grafting and extraction sites using local anesthetic. A small incision will be made to prepare the site for the new bone and it will be anchored into place. On occasion, a synthetic membrane may be used to cover the new bone. This membrane prevents soft tissue and bacterial invasions, and encourages new bone growth. The surgery does not require an overnight stay, and you will be provided with comprehensive instructions for your post-operative care. The dentist will prescribe medications to help manage infection, discomfort and swelling.

3. CROWN LENGTHENING

Crown lengthening exposes more of the natural tooth by reshaping or recontouring bone and gum tissue. It is generally performed in order to improve the health of the gum tissue, or to prepare the mouth for restorative or cosmetic procedures. In addition, crown lengthening procedures can also be used to correct a “gummy” smile, where teeth are covered with excess gum tissue. This treatment can be performed on a single tooth, many teeth or the entire gum line, to expose a pleasant, aesthetically pleasing smile.

Reasons for crown lengthening

Crown lengthening is a versatile and common procedure that has many effective uses and benefits. The vast majority of patients who have undergone this type of surgery are highly delighted with the results.

Here are some of the most common reasons for crown lengthening:

  • Restoration of damaged teeth.
    Periodontal disease can cause severe damage to the teeth, as can trauma and decay. Where teeth have been broken beneath the gum line, crown lengthening can be used to prepare the area for a new restoration to correct the damaged teeth.
  • Cosmetic uses.
    Extra gum tissue can make teeth look unnaturally short, and also increase susceptibility to periodontal infections. Removing excess gum tissue can restore a balanced, healthy look and thus improve the aesthetic appearance of the smile.
  • Dental crowns.
    Crown lengthening serves to provide more space between the supporting jawbone and dental crown. This prevents the new crown from damaging gum tissues and bone once it is in place.
What does crown lengthening involve?

Crown lengthening is normally performed under local anesthetic. The amount of time this procedure takes will largely depend in how many teeth are involved and whether a small amount of bone needs to be removed, in addition to the soft tissue. Any existing dental crowns will be removed prior to the procedure, and replaced immediately afterwards.

The dentist will make a series of small incisions around the soft tissue in order to separate the gums away from the teeth. Even if only one tooth requires the re-contour, neighboring teeth are usually treated to provide a more even reshaping. Separating the gums provides the dentist with access to the roots of the teeth and the underlying bone.

In some cases, the removal of a small amount of tissue will provide enough tooth exposure to place a crown. In other cases, the dentist will also need to remove a small amount of bone from around the teeth. The bone is usually removed using a combination of special hand instruments, and rotary instruments. The rotary instruments roughly resemble the drill that is used in cavity treatment.

When the dentist is satisfied the teeth have sufficient exposure, the wound will be cleaned with sterile water and the gum tissue will be sutured with small stitches. The teeth will look noticeably longer immediately after surgery because the gums have now been repositioned.

The dentist will secure the surgical site using an intraoral (periodontal) bandage, which serves to prevent infection. Prescriptions may be provided for pain medication, and a chlorhexidine (antimicrobial) mouth rinse may be given to help reduce any bacteria attempting to re-colonize. The surgical site will be completely healed in approximately two to three months.

4. DENTAL IMPLANTS

Despite improvements in dental care, dental implants are replacement tooth roots. Implants provide a strong foundation for fixed (permanent) or removable replacement teeth that are made to match your natural teeth.

Dental implants offer a natural solution to replace teeth lost due to trauma, decay, disease or old age. Replacing missing teeth improves the oral health as well as the functionality of the teeth, enhances smile and self-esteem. A dental implant is a small titanium screw root, which is fitted into the socket of the missing teeth that looks and functions like the real ones and can be used to replace a single tooth or several teeth.

The missing teeth can be replaced immediately by placing the implants directly into the available bone. With the use of angled, and/or max implant technology, is less likely to require bone grafting.

What Are the Advantages of Dental Implants?

There are many advantages to dental implants, including:

  • Improved appearance:
    Dental implants look and feel like your own teeth. And because they are designed to fuse with bone, they become permanent.
  • Improved speech:
    With poor-fitting dentures, the teeth can slip within the mouth causing you to mumble or slur your words. Dental implants allow you to speak without the worry that teeth might slip.
  • Improved comfort:
    Because they become part of you, implants eliminate the discomfort of removable dentures.
  • Easier eating:
    Sliding dentures can make chewing difficult. Dental implants function like your own teeth, allowing you to eat your favorite foods with confidence and without pain.
  • Improved self-esteem:
    Dental implants can give you back your smile and help you feel better about yourself.
  • Improved oral health:
    Dental implants don’t require reducing other teeth, as a tooth-supported bridge does. Because nearby teeth are not altered to support the implant, more of your own teeth are left intact, improving long-term oral health. Individual implants also allow easier access between teeth, improving oral hygiene.
  • Durability:
    Implants are very durable and will last many years. With good care, many implants last a lifetime.
  • Convenience:
    Removable dentures are just that; removable. Dental implants eliminate the embarrassing inconvenience of removing dentures, as well as the need for messy adhesives to keep them in place.
How Successful Are Dental Implants?

Success rates of dental implants vary, depending on where in the jaw the implants are placed but, in general, dental implants have a success rate of up to 98%. With proper care (see below), implants can last a lifetime.

Can Anyone Get Dental Implants?

In most cases, anyone healthy enough to undergo a routine dental extraction or oral surgery can be considered for a dental implant. Patients should have healthy gums and enough bone to hold the implant. They also must be committed to good oral hygiene and regular dental visits. Heavy smokers, people suffering from uncontrolled chronic disorders-such as diabetes or heart disease- or patients who have had radiation therapy to the head/neck area need to be evaluated on an individual basis. If you are considering implants, talk to your dentist to see if they are right for you.

Our Implants are the clear choice for patients seeking fast, efficient and high quality dental implant services, performed only by highly trained and experienced dentist.

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