Periodontics

Reasons for periodontal treatment

Periodontal disease is a progressive condition which begins with mild gum inflammation called gingivitis. It is the leading cause of tooth loss in adults living in the developed world, and should be taken very seriously. Periodontal disease (often called gum disease) is typically signified by red, swollen, painful, or bleeding gums, but in some cases has no noticeable symptoms.

Periodontal disease generally begins when the bacteria living in plaque cause an infection in the surrounding tissues of the teeth, causing them to become irritated and painful. Eventually, this infection will cause the jawbone to recede and the tooth to become loose.

There are several reasons why periodontal treatment may be necessary:

  • Moderate/advanced gum disease – This occurs when the gums are bleeding, swollen or red around most teeth and the jawbone has begun to recede.
  • Localized gum recession – The infection which propagates moderate or advanced gum disease often begins in one area. Gum recession may also be caused due to over brushing with a hard bristle brush, or due to a tooth that is not positioned properly. Immediate treatment is required to prevent further spreading.
  • Before crown lengthening – The periodontist may lengthen the crown of the tooth by removing surrounding soft tissue to provide more tooth exposure.
  • Ridge augmentation – This procedure, often called “recontouring” may be required to correct an uneven gum line. Before embarking on treatment, a periodontist needs to treat any bacterial infections and periodontitis.

In the case of mild/moderate periodontal problems, the focus of the periodontist will be on curing the underlying bacterial infection and then providing advice on the most appropriate home cleaning methods.

Sometimes a deep scaling is needed to remove the bacterial plaque and calculus (tartar) from the teeth and tissues. Where periodontal disease is advanced and the jawbone has regressed significantly, more intensive cleaning may be recommended and loose teeth that cannot be saved will be removed.

The periodontist is trained in all aspects of dental implant procedures, which can restore functionality to the mouth when teeth have been affected by periodontitis.

Because periodontal disease is progressive, it is essential to remove the bacteria and calculus build up to halt the spread of the infection. Your dentist will be happy to advise you on effective cleaning methods and treatment options.

When to See a Periodontist

Periodontal disease begins when the toxins found in plaque start to attack the soft or gingival tissue surrounding the teeth. This bacterium embeds itself in the gum and rapidly breeds, causing a bacterial infection. As the infection progresses, it starts to burrow deeper into the tissue causing inflammation or irritation between the teeth and gums. The response of the body is to destroy the infected tissue, which is why the gums appear to recede. The resulting pockets between the teeth deepen and if no treatment is sought, the tissue which makes up the jawbone also recedes causing unstable teeth and tooth loss.

Diagnosis and Treatment

Before initiating any dental treatment, the periodontist must extensively examine the gums, jawbone and general condition of the teeth. When gingivitis or periodontal disease is officially diagnosed, the periodontist has a number of surgical and non-surgical options available to treat the underlying infection, halt the recession of the soft tissue, and restructure or replace teeth that may be missing.

Gingivitis/mild periodontal disease – When the gum pockets exceed 4mm in depth, the periodontist or hygienist may perform scaling and root planing to remove debris from the pockets and allow them to heal. Education and advice will be provided on an effective cleaning regime thereafter.

Moderate periodontal disease – If the gum pockets reach 4-6mm in length, a more extensive scaling and root planing cleaning might be required. This cleaning is usually performed under local anesthetic.

Advanced periodontal disease – Gum pockets in excess of 6-7mm are usually accompanied by bone loss and gum recession. Scaling and root planing will always be performed as the initial nonsurgical treatment. In addition to those nonsurgical treatments, the periodontist may recommend surgical treatment to reduce pocket depth.

Tooth loss – Where one or several teeth are missing due to periodontal disease, dental implants are an effective option. If the bone is strong enough to provide a suitable anchor for the prosthetic tooth, the implant can be placed. However, if the bone is severely eroded, bone grafts may be performed by the periodontist to provide a suitable anchor for the new tooth/teeth.

Ask us if you have questions about periodontal disease, periodontal treatment, or dental implants.

Periodontal Scaling & Root Planing

The objective of scaling and root planing is to remove etiologic agents that cause inflammation to the gingival (gum) tissue and surrounding bone. Common etiologic agents removed by this conventional periodontal therapy include dental plaque and tartar (calculus).

These non-surgical procedures which completely cleanse the periodontium, work very effectively for individuals suffering from gingivitis (mild gum inflammation) and moderate/severe periodontal disease.

Reasons for scaling and root planing

Scaling and root planing can be used both as a preventative measure and as a stand-alone treatment. These procedures are performed as a preventative measure for a periodontitis sufferer.

Here are some reasons why these dental procedures may be necessary:

  • Disease prevention – The oral bacteria which cause periodontal infections can travel via the bloodstream to other parts of the body. Research has shown that lung infections and heart disease have been linked to periodontal bacteria. Scaling and root planing remove bacteria and halts periodontal disease from progressing, thus preventing the bacteria from traveling to other parts of the body.
  • Tooth protection – When gum pockets exceed 3mm in depth, there is a greater risk of periodontal disease. As pockets deepen, they tend to house more colonies of dangerous bacteria. Eventually, a chronic inflammatory response by the body begins to destroy gingival and bone tissue which may lead to tooth loss. Periodontal disease is the number one cause of tooth loss in the developed world.
  • Aesthetic effects – Scaling and root planing help remove tartar and plaque from the teeth and below the gumline. As an added bonus, if superficial stains are present on the teeth, they will be removed in the process of the scaling and root planing procedure.
  • Better breath – One of the most common signs of periodontal disease is halitosis (bad breath). Food particles and bacteria can cause a persistent bad odor in the oral cavity which is alleviated with cleaning procedures such as scaling and root planing.

What do scaling and root planing treatments involve?

Scaling and root planing treatments are only performed after a thorough examination of the mouth. The dentist will take X-rays, conduct visual examinations and make a diagnosis before recommending or beginning these procedures.

Depending on the current condition of the gums, the amount of calculus (tartar) present, the depth of the pockets and the progression of the periodontitis, local anesthetic may be used.

Scaling – This procedure is usually performed with special dental instruments and may include an ultrasonic scaling tool. The scaling tool removes calculus and plaque from the surface of the crown and root surfaces. In many cases, the scaling tool includes an irrigation process that can also be used to deliver an antimicrobial agent below the gums that can help reduce oral bacteria.

Root Planing – This procedure is a specific treatment which serves to remove cementum and surface dentin that is embedded with unwanted microorganisms, toxins and tartar. The root of the tooth is literally smoothed in order to promote good healing. Having clean, smooth root surfaces helps bacteria from easily colonizing in future.

Following these deep cleaning procedures, the gum pockets may be treated with antibiotics. This will soothe irritation and help the gum tissues to heal quickly.

During the next appointment, the dentist or hygienist will thoroughly examine the gums again to see how well the pockets have healed. If the gum pockets still measure more than 3mm in depth, additional and more intensive treatments may be recommended.

If you have any concerns or questions about scaling and root planing, or periodontal disease, please ask your dentist.

Pocket Irrigation

Periodontal disease is a progressive condition that leads to gum inflammation, the recession of bone and gum tissue, and tooth loss if left untreated. There are a variety of effective treatments and procedures available, including pocket irrigation, which can assist in treating the progression of the disease.

Pocket irrigation aims to cleanse plaque from the interdental (between teeth) and subgingival (under the gumline) regions of the mouth in order to prevent the colonization of harmful oral bacteria. This procedure is also used to deliver antibacterials to the subgingival areas.

Reasons for pocket irrigation

Pocket irrigation, which is also known as oral irrigation, is a versatile dental treatment used for several different preventative purposes. Pocket irrigation may be performed as part of a professional dental cleaning, or at home with a specially modified oral irrigator.

Here are the main ways in which pocket irrigation can be beneficial:

  • Interdental cleaning – Pocket irrigators blast plaque, food particles, and other debris from between the teeth. The removal of harmful materials and bacteria keep the gum pockets cleaner and shallower, helping the gum tissue remain healthy.
  • Halitosis prevention – Halitosis (or bad breath) is generally a result of old food particles between the teeth and tooth decay. A toothbrush or dental scraper alone may not be able to reach into the depths of the gum pockets, but water jets can flush out food particles and help clean above and below the gumline.
  • Subgingival cleaning – Pocket irrigators have a rounded tip which eliminates the risk of tissue damage while cleaning under the gumline. The side port opening facilitates extensive cleansing by flushing out bacteria, particles and toxins from below the gumline.
  • Antimicrobial application – Antimicrobial substances have proven effective for eliminating and preventing some strains of harmful oral bacteria. Antimicrobial substances can be combined with water, or used as a stand-alone treatment for successful pocket irrigation.

What does pocket irrigation treatment involve?

Pocket irrigation is generally performed in combination with other dental treatments, such as professional dental cleaning or pocket reduction surgery.

In the case of a pocket reduction surgery, the tartar and subgingival plaque will be removed with special scaling and root planing instruments. When the pockets are free of debris, an antimicrobial agent may be applied using an oral irrigator. This will help reduce harmful oral bacteria which still remain in the pockets.

During a deep cleaning procedure, a pocket irrigator may be used after scaling and root planing to cleanse the pockets. Again, an antimicrobial agent may be applied to help reduce subgingival oral bacteria.

Pocket irrigation can be performed at home as part of the daily oral routine using a water jet or water pick. Flushing the interdental area with water is less harmful to soft tissue than dental floss, but should not be used as a substitute for professional dental cleaning.

If you have any questions about pocket irrigation, cleaning your teeth, periodontal disease and treatment, please contact our practice.

Antibiotic Treatment

Periodontal disease is a progressive condition that leads to severe inflammation and tooth loss if left untreated. Antibiotic treatments can be used in combination with scaling and root planing, curettage, surgery, or as a stand-alone treatment to help reduce bacteria before and/or after many common periodontal procedures.

Antibiotic treatments come in several different types, including oral forms and topical gels which are applied directly into the gum pockets. Research has shown that in the case of acute periodontal infection, refractory periodontal disease, prepubertal periodontal disease and juvenile periodontal disease, antibiotic treatments have been incredibly effective.

Antibiotics can be prescribed at a low dose for longer term use or as a short term medication to deter bacteria from re-colonizing.

Oral Antibiotics

Oral antibiotics tend to affect the whole body and are less commonly prescribed than topical gel.

Here are some specific details about several different types of oral antibiotics:
Tetracycline antibiotics – Antibiotics which include tetracycline hydrochloride, doxycycline, and minocycline are the primary drugs used in periodontal treatment. They have antibacterial properties, reduce inflammation and block collagenase (a protein which destroys the connective tissue).
Macrolide antibiotics – This group of antibiotics has proven effective at reducing inflammation and can also reduce bacterial growth associated with periodontitis.
Metronidazole – This antibiotic is generally used in combination with amoxicillin or tetracycline to combat inflammation and bacterial growth in severe or chronic periodontitis.

Topical Gels and Strips

The biggest advantage of directly delivering antibiotics to the surface of the gums is not affecting the entire body. Topical gels and direct delivery methods tend to be preferred over their oral counterparts and are extremely effective when used after scaling and root planing procedures. Here are some of the most commonly used direct delivery antibiotics:

Atridox® – This doxycycline gel conforms to the contours of gum surfaces and solidifies over them. Over several days, this gel gradually releases the antibiotic medication.
PerioChip® – This chip is placed into the actual gum pocket after a root planing procedure. PerioChip® slowly releases Chlorhexidine, a powerful antibacterial antiseptic. PerioChip® reduces pocket depth in most periodontitis cases.
Actisite® – This thin strip is similar to dental floss and contains tetracycline hydrochloride. The thread is temporarily placed between the tooth and gum to kill bacteria and reduce pocket depth. Several threads are sometimes placed for around 10 days to enhance the antibiotic effect.

Elyzol® – This metronidazole antibiotic comes in gel and strip form. It is unique because it is able to destroy parasites as well as oral bacteria.
Arestin® – This Minocycline antibiotic comes in mini capsules which are delivered into the gums after scaling and root planing.

Noticeable periodontal improvements are usually seen after systemic or oral antibiotic treatment. We will incorporate antibiotic treatments as necessary for the healing of your periodontal condition.

If you have any questions about periodontal disease or antibiotic treatments, contact our practice at your convenience.

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Bruxism

Bruxism refers to an oral parafunctional activity that occurs in most humans at some point in their lives. Grinding of the teeth and clenching of the jaw are the two main characteristics of this condition, which can occur during the day or at night.

Bruxism is one of the most common known sleep disorders and causes most of its damage during sleeping hours. The clenching and grinding which accompanies bruxism is symptomatic of a malfunctioning chewing reflex, which is turned off in non-sufferers when sleeping. For sufferers, deep sleep or even naps cause the reflex nerve control center in the brain to turn off and the reflex pathways to become active.

Typically, the incisors and canines (front 6 upper and lower teeth) of opposing arches grind against each other laterally. This side to side action puts undue strain on the medial pterygoid muscles and the temporomandibular joints. Earache, depression, headaches, eating disorders, and anxiety are among the most common symptoms of bruxism; these symptoms also accompany health issues such as chronic stress, Alzheimer’s disease, and alcohol abuse.

Bruxism is frequently misdiagnosed or not diagnosed at all, because it is only one of several potential causes of tooth wear. Only a trained professional can tell the difference between bruxing wear and wear caused by overly aggressive brushing, acidic soft drinks, and abrasive foods.

A BiteStrip® is an economical device used to diagnose bruxism at home. The device itself is a small electromyography which senses and monitors any activity in the jaw muscles during sleep. The frequency and severity of the condition can then be assessed and the best treatment plan can be formulated.

Reasons for the treatment of bruxism

Here are some of the main reasons why bruxism should be promptly treated:

  • Gum recession and tooth loss – Bruxism is one of the leading causes of gum recession and tooth loss. It damages the soft tissue directly and leads to loose teeth and deep pockets, where bacteria can colonize and destroy the supporting bone.
  • Occlusal trauma – The abnormal wear patterns on the occlusal (chewing) surfaces can lead to fractures in the teeth, which may require restorative treatment.
  • Arthritis – In severe and chronic cases, bruxing can eventually lead to painful arthritis in the temporomandibular (TMJ) joints (the joints that allow the jaw to open smoothly).
  • Myofascial pain – The grinding associated with bruxism can eventually shorten and blunt the teeth. This can lead to debilitating headaches and muscle pain in the myofascial region.

Treatment options for bruxism

There is no single cure for bruxism, though a variety of helpful devices and tools are available.

Here are some common ways in which bruxism is treated:

  • Mouthguards – An acrylic mouthguard can be designed from tooth impressions to minimize the abrasive action of tooth surfaces during normal sleep. Mouthguards should be worn on a long-term basis to help to stabilize the occlusion as well as prevent damage to teeth and to the temporomandibular joint.
  • NTI-tss device – This device is fitted by a health professional and only covers the front teeth. The goal of the NTI-tss is to prevent the grinding of the rear molars by limiting the contraction of the temporalis muscle.
  • Botox® – Botox® can be injected into the muscles to relax and weaken them. Botox® is an excellent treatment for bruxism because it weakens the muscles enough to prevent grinding but not enough to interfere with everyday functions like chewing and speaking.
  • Other methods of treatment include relaxation exercises, stress management education, and biofeedback mechanisms. When the bruxing is under control, there are a variety of dental procedures such as crowns, gum grafts, and crown lengthening that can restore a pleasant aesthetic appearance to the smile.

If you have questions or concerns about bruxism, please contact our office.

Crown Lengthening

Crown lengthening is generally performed 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. Crown lengthening exposes more of the natural tooth by reshaping or recontouring bone and gum tissue. This treatment can be performed on a single tooth, many teeth, or the entire gum line, exposing an 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 can also increase susceptibility to periodontal infections. Removing excess gum tissue can restore a balanced, healthy look and improve the aesthetic appearance of the smile.
  • Dental crowns – Crown lengthening provides 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 on how many teeth are involved and whether a small amount of bone needs to be removed along with the soft tissue. Any existing dental crowns will be removed prior to the procedure and replaced immediately afterward.

Your 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 your 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, your 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.

The teeth will look noticeably longer immediately after surgery because the gums have now been repositioned.

Your 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.

If you have any questions about crown lengthening, please contact our office.

Oral Cancer Exam

According to research conducted by the American Cancer Society, more than 30,000 cases of oral cancer are diagnosed each year. More than 7,000 of these cases result in the death of the patient. The good news is that oral cancer can easily be diagnosed with an annual oral cancer exam, and effectively treated when caught in its earliest stages.

Oral cancer is a pathologic process that begins with an asymptomatic stage during which the usual cancer signs may not be readily noticeable. This makes the oral cancer examinations performed by the dentist critically important. Oral cancers can be of varied histologic types such as teratoma, adenocarcinoma, and melanoma. The most common type of oral cancer is the malignant squamous cell carcinoma. This oral cancer type usually originates in lip and mouth tissues.

There are many different places in the oral cavity and maxillofacial region in which oral cancers commonly occur, including:

  • Lips
  • Mouth
  • Tongue
  • Salivary Glands
  • Oropharyngeal Region (throat)
  • Gums
  • Face

Oral cancer exams, diagnosis and treatment

The oral cancer examination is a completely painless process. During the visual part of the examination, the dentist will look for abnormality and feel the face, glands and neck for unusual bumps. Lasers which can highlight pathologic changes are also a wonderful tool for oral cancer checks. The laser can “look” below the surface for abnormal signs and lesions which would be invisible to the naked eye.

If abnormalities, lesions, leukoplakia or lumps are apparent, the dentist will implement a diagnostic impression and treatment plan. In the event that the initial treatment plan is ineffective, a biopsy of the area will be performed. The biopsy includes a clinical evaluation which will identify the precise stage and grade of the oral lesion.

Oral cancer is deemed to be present when the basement membrane of the epithelium has been broken. Malignant types of cancer can readily spread to other places in the oral and maxillofacial regions, posing additional secondary threats. Treatment methods vary according to the precise diagnosis but may include excision, radiation therapy and chemotherapy.

During bi-annual check-ups, the dentist and hygienist will thoroughly look for changes and lesions in the mouth, but a dedicated comprehensive oral cancer screening should be performed at least once each year.

If you have any questions or concerns about oral cancer, please contact our practice.

Reasons for oral cancer examinations

It is important to note that around 75 percent of oral cancers are linked with modifiable behaviors such as smoking, tobacco use and excessive alcohol consumption. Your dentist can provide literature and education on making lifestyle changes and smoking cessation.

When oral cancer is diagnosed in its earliest stages, treatment is generally very effective. Any noticeable abnormalities in the tongue, gums, mouth or surrounding area should be evaluated by a health professional as quickly as possible. During the oral cancer exam, the dentist and dental hygienist will be scrutinizing the maxillofacial and oral regions carefully for signs of pathologic changes.

The following signs will be investigated during a routine oral cancer exam:

  • Red patches and sores – Red patches on the floor of the mouth, the front and sides of the tongue, white or pink patches which fail to heal and slow healing sores that bleed easily can be indicative of pathologic (cancerous) changes.
  • Leukoplakia – This is a hardened white or gray, slightly raised lesion that can appear anywhere inside the mouth. Leukoplakia can be cancerous or may become cancerous if treatment is not sought.
  • Lumps – Soreness, lumps or the general thickening of tissue anywhere in the throat or mouth can signal pathological problems.