A:

Periodontal disease is a bacterial infection that starts with the germs attaching and growing on the roots of the teeth then spreading below the gum line. This develops inflammation of the gums or Gingivitis and if left untreated the infection progresses to cause destruction and loss of the bone supporting and holding the teeth (Periodontitis). In most cases periodontal disease is slow and chronic like for example, hardening of the arteries, there is little or no pain to warn you. 

The most common signs and symptoms of periodontal disease are bleeding gums, puffy discolored gums, receding gum line, loose teeth and shifting of teeth.

Periodontal disease is a progressive condition and the leading cause of tooth loss among adults in the developed world.  It is often said that the real tragedy of periodontal disease is not the eventual loss of teeth but the severe loss of bone that results in deformity of the face and jaws. 

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What is a Periodontist?

A periodontist is a dentist who specializes in the soft tissues of the mouth and the underlying jawbone which supports the teeth.  A dentist must first graduate from an accredited dental school before undertaking an additional three years of study within a periodontology residency training program, in order to qualify as a periodontist.

The primary focus of this residency training is on both surgical and non surgical management of periodontal disease and the placement of dental implants.

Conditions Treated by a Periodontist

The periodontist is mainly concerned with preventing the onset of gum disease (periodontal disease), diagnosing conditions affecting the gums and jawbone, and treating gingivitis, periodontitis and bone loss.  Periodontal disease is a progressive condition and the leading cause of tooth loss among adults in the developed world.

The periodontist is able to treat mild, moderate and advanced gum disease by first addressing the bacterial infection at the root of the problem, providing periodontal treatment, then providing information and education on good oral hygiene and the effective cleaning of the teeth.

The most common conditions treated by the periodontist are:

• Gingivitis – This is the mild inflammation of the gums which may or may not be signified by pain and bleeding.

 

• Mild/moderate periodontitis – When the pockets between the teeth and the soft tissues are measured to be between 4-6mm it is classified as moderate periodontitis (gum disease).

 

• Advanced periodontitis – When the pockets between the teeth and the soft tissues in general exceed 6mm in depth, significant bone loss may occur; causing shifting or loss of teeth.

 

• Missing teeth – When teeth are missing as a result of bone loss, the periodontist can implant prosthetic teeth.  These teeth are anchored to the jawbone and restore functionality to the mouth.

Treatments Performed by a Periodontist

The periodontist is able to perform a wide range of treatments to halt the progression of gum disease, replace missing teeth and make the appearance of the smile more aesthetically pleasing.

Here are some of the treatments commonly performed by the periodontist:

• Implant placement – When a tooth or several teeth are missing, the periodontist is able to create a natural-looking replacement by anchoring a prosthetic tooth to the jawbone.

 

• Osteoplasty (hard tissue recontouring) – Once periodontitis has been treated, the periodontist can recontour the hard tissue to make the smile both natural-looking and aesthetically pleasing.

 

• Gingivoplasty (soft tissue recontouring) – As gums recede due to periodontitis, the teeth may appear longer; causing a “toothy" smile.  The periodontist can remove tissues or straighten the gum line to make the teeth look more even.

 

• Bone grafting – Dental implants can only be positioned if there is sufficient bone to attach the prosthetic tooth to.  If bone loss has occurred, bone grafting is an excellent way to add or “grow” bone so that an implant may be properly secured.

 

• Deep pocket cleanings – As gingivitis and periodontitis progress, it becomes more difficult to cleanse the pockets between the soft tissues and the teeth.  The periodontist can scale and root plane the teeth (sometimes under local anesthetic) to remove debris and infection-causing bacteria.

 

• Crown lengthening – In order to expose more of the natural tooth, the periodontist can remove some of the surrounding gingival tissue.

The periodontist is a highly skilled dental health professional who is able to diagnose and treat many commonly occurring soft tissue and bone problems in the oral cavity.

Be sure to ask your periodontist if you have any questions or concerns.

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Four out of five people have periodontal disease and don’t know it!  Most people are not aware of it because the disease is usually painless in the early stages.  Unlike tooth decay, which often causes discomfort, it is possible to have periodontal disease without noticeable symptoms.  Having regular dental check-ups and periodontal examinations are very important and will help detect if periodontal problems exist.

Periodontal disease begins when plaque, a sticky, colorless, film of bacteria, food debris, and saliva, is left on the teeth and gums.  The bacteria produce toxins (acids) that inflame the gums and slowly destroy the bone.  Brushing and flossing regularly and properly will ensure that plaque is not left behind to do its damage.

Other than poor oral hygiene, there are several other factors that may increase the risk of developing periodontal disease:

• Smoking or chewing tobacco – Tobacco users are more likely than nonusers to form plaque and tartar on their teeth.

• Certain tooth or appliance conditions – Bridges that no longer fit properly, crowded teeth, or defective fillings that may trap plaque and bacteria.

• Many medications – Steroids, cancer therapy drugs, blood pressure meds, oral contraceptives.  Some medications have side affects that reduce saliva, making the mouth dry and plaque easier to adhere to the teeth and gums.

• Pregnancy, oral contraceptives, and puberty – Can cause changes in hormone levels, causing gum tissue to become more sensitive to bacteria toxins.

• Systemic diseases – Diabetes, blood cell disorders, HIV / AIDS, etc.

• Genetics may play role – Some patients may be predisposed to a more aggressive type of periodontitis.  Patients with a family history of tooth loss should pay particular attention to their gums.

Signs and Symptoms of Periodontal Disease

• Red and puffy gums – Gums should never be red or swollen.

• Bleeding gums – Gums should never bleed, even when you brush vigorously or use dental floss.

• Persistent bad breath – Caused by bacteria in the mouth.

• New spacing between teeth – Caused by bone loss.

• Loose teeth – Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone).

• Pus around the teeth and gums – Sign that there is an infection present.

• Receding gums – Loss of gum around a tooth.

• Tenderness or Discomfort – Plaque, calculus, and bacteria irritate the gums and teeth.

Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease.

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A dental implant is a small titanium screw that serves as the replacement for the root portion of a missing tooth. The dental implant is stable and comfortable.  No adjustment is needed after placement.  Normally it will serve its owner for life. Anyone who is missing one or more teeth due to injury, disease, or tooth decay, may be a candidate for dental implants.

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Many patients have this question on their minds.  While many dentists want to place implants today, Periodontists are uniquely.....

• Trained to comprehensively diagnose and treatment plan for optimal dental health

• Extensively trained in all gum and bone surgery procedures to eliminate and prevent periodontal disease around your implants particularly...

• laser therapy  

• bone development procedures to improve bone form and shape for proper location and alignment of your implant 

• soft tissue (gum) procedures to provide a "gum seal" around your implants

• Trained to...

• understand your bite (the way teeth fit together and function) for proper alignment and positioning of implants

• understand the effect of bite stress on disease in the mouth on implants

• Able to assist you to maintain healthy gums and bone around your implants

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Brushing our teeth removes food particles, plaque, and bacteria from all tooth surfaces, except in between the teeth.  Unfortunately, our toothbrush can’t reach these areas that are highly susceptible to decay and periodontal (gum) disease.

Daily flossing is the best way to clean between the teeth and under the gumline.  Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

Plaque is a sticky, almost invisible film that forms on the teeth.  It is a growing colony of living bacteria, food debris, and saliva.  The bacteria produce toxins (acids) that cause cavities and irritate and inflame the gums.  Also, when plaque is not removed above and below the gumline, it hardens and turns into calculus (tartar).  This will further irritate and inflame the gums and also slowly destroy the bone.  This is the beginning of periodontal disease.

How to floss properly:

• Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
• Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
• Curve the floss into a “C” shape around each tooth and under the gumline.  Gently move the floss up and down, cleaning the side of each tooth.

Floss holders are recommended if you have difficulty using conventional floss.

Daily flossing will help you keep a healthy, beautiful smile for life!

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Bad breath (halitosis) can be an unpleasant and embarrassing condition.  Many of us may not realize that we have bad breath, but everyone has it from time to time, especially in the morning.

There are various reasons one may have bad breath, but in healthy people, the major reason is due to microbial deposits on the tongue, especially the back of the tongue.  Some studies have shown that simply brushing the tongue reduced bad breath by as much as 70 percent.

What may cause bad breath?

• Morning time – Saliva flow almost stops during sleep and its reduced cleansing action allows bacteria to grow, causing bad breath.
• Certain foods – Garlic, onions, etc.  Foods containing odor-causing compounds enter the blood stream; they are transferred to the lungs, where they are exhaled.
• Poor oral hygiene habits – Food particles remaining in the mouth promote bacterial growth.
• Periodontal (gum) disease – Colonies of bacteria and food debris residing under inflamed gums.
• Dental cavities and improperly fitted dental appliances – May also contribute to bad breath.
• Dry mouth (Xerostomia) – May be caused by certain medications, salivary gland problems, or continuous mouth breathing.
• Tobacco products – Dry the mouth, causing bad breath.
• Dieting – Certain chemicals called ketones are released in the breath as the body burns fat.
• Dehydration, hunger, and missed meals – Drinking water and chewing food increases saliva flow and washes bacteria away.
• Certain medical conditions and illnesses – Diabetes, liver and kidney problems, chronic sinus infections, bronchitis, and pneumonia are several conditions that may contribute to bad breath.

Keeping a record of what you eat may help identify the cause of bad breath.  Also, review your current medications, recent surgeries, or illnesses with your dentist.

What can I do to prevent bad breath?

• Practice good oral hygiene – Brush at least twice a day with an ADA approved fluoride toothpaste and toothbrush.  Floss daily to remove food debris and plaque from in between the teeth and under the gumline.  Brush or use a tongue scraper to clean the tongue and reach the back areas.  Replace your toothbrush every 2 to 3 months.  If you wear dentures or removable bridges, clean them thoroughly and place them back in your mouth in the morning.
• See your dentist regularly – Get a check-up and cleaning at least twice a year.  If you have or have had periodontal disease, your dentist will recommend more frequent visits.
• Stop smoking/chewing tobacco – Ask your dentist what they recommend to help break the habit.
• Drink water frequently – Water will help keep your mouth moist and wash away bacteria.
• Use mouthwash/rinses – Some over-the-counter products only provide a temporary solution to mask unpleasant mouth odor.  Ask your dentist about antiseptic rinses that not only alleviate bad breath, but also kill the germs that cause the problem.

In most cases, your dentist can treat the cause of bad breath.  If it is determined that your mouth is healthy, but bad breath is persistent, your dentist may refer you to your physician to determine the cause of the odor and an appropriate treatment plan.

A:

Brushing and flossing help control the plaque and bacteria that cause dental disease.

Plaque is a film of food debris, bacteria, and saliva that sticks to the teeth and gums.  The bacteria in plaque convert certain food particles into acids that cause tooth decay.  Also, if plaque is not removed, it turns into calculus (tartar).  If plaque and calculus are not removed, they begin to destroy the gums and bone, causing periodontal (gum) disease.

Plaque formation and growth is continuous and can only be controlled by regular brushing, flossing, and the use of other dental aids.

Toothbrushing – Brush your teeth at least twice a day (especially before going to bed at night) with an ADA approved soft bristle brush and toothpaste.

• Brush at a 45 degree angle to the gums, gently using a small, circular motion, ensuring that you always feel the bristles on the gums.
• Brush the outer, inner, and biting surfaces of each tooth.
• Use the tip of the brush head to clean the inside front teeth.
• Brush your tongue to remove bacteria and freshen your breath.

Electric toothbrushes are also recommended.  They are easy to use and can remove plaque efficiently.  Simply place the bristles of the electric brush on your gums and teeth and allow the brush to do its job, several teeth at a time.

Flossing – Daily flossing is the best way to clean between the teeth and under the gumline.  Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

• Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
• Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
• Curve the floss into a “C” shape around each tooth and under the gumline.  Gently move the floss up and down, cleaning the side of each tooth.

Floss holders are recommended if you have difficulty using conventional floss.

Rinsing – It is important to rinse your mouth with water after brushing, and also after meals if you are unable to brush.  If you are using an over-the-counter product for rinsing, it’s a good idea to consult with your dentist or dental hygienist on its appropriateness for you.

A: No.  Many patients seek out a periodontist on their own based on their own research or they may be referred by another patient or family member who has previously had periodontal treatment and is familiar with the signs and symptoms.

A:

You should have your teeth checked and cleaned at least twice a year, though your dentist or dental hygienist may recommend more frequent visits.

Regular dental exams and cleaning visits are essential in preventing dental problems and maintaining the health of your teeth and gums.  At these visits, your teeth are cleaned and checked for cavities.  Additionally, there are many other things that are checked and monitored to help detect, prevent, and maintain your dental health.  These include:

• Medical history review: Knowing the status of any current medical conditions, new medications, and illnesses, gives us insight to your overall health and also your dental health.
• Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss.  X-rays also help determine tooth and root positions.
• Oral cancer screening: Check the face, neck, lips, tongue, throat, tissues, and gums for any signs of oral cancer.
• Gum disease evaluation: Check the gums and bone around the teeth for any signs of periodontal disease.
• Examination of tooth decay: All tooth surfaces will be checked for decay with special dental instruments.
• Examination of existing restorations: Check current fillings, crowns, etc.
• Removal of calculus (tartar): Calculus is hardened plaque that has been left on the tooth for sometime and is now firmly attached to the tooth surface.  Calculus forms above and below the gum line, and can only be removed with special dental instruments.
• Removal of plaque: Plaque is a sticky, almost invisible film that forms on the teeth.  It is a growing colony of living bacteria, food debris, and saliva.  The bacteria produce toxins (poisons) that inflame the gums.  This inflammation is the start of periodontal disease!
• Teeth polishing: Removes stain and plaque that is not otherwise removed during toothbrushing and scaling.
• Oral hygiene recommendations: Review and recommend oral hygiene aids as needed (electric dental toothbrushes, special cleaning aids, fluorides, rinses, etc.).
• Review dietary habits: Your eating habits play a very important role in your dental health.

As you can see, a good dental exam and cleaning involves quite a lot more than just checking for cavities and polishing your teeth.  We are committed to providing you with the best possible care, and to do so will require regular check-ups and cleanings.

A:

With many state-of-the-art dental treatments and prevention options available in dentistry today, there are fewer reasons for having to extract (remove) teeth.  When something does go wrong with a tooth, we try to do everything possible to restore the tooth to its original function.  Removing a tooth is the last option because we know that removal may lead to severe and costly dental and cosmetic problems if the tooth is not replaced.

Losing a tooth can be a very traumatic experience and it’s very unfortunate when it does happen.  Injury, accident, fracture, severe dental decay, and gum disease are the major reasons for having to remove a tooth.  If teeth are lost due to injury or have to be removed, it is imperative that they be replaced to avoid cosmetic and dental problems in the future.

When a tooth is lost, the jaw bone that helped to support that tooth begins to atrophy, causing the teeth on either side to shift or tip into the open space of the lost tooth.  Also, the tooth above or below the open space will start to move towards the open space because there is no opposing tooth to bite on.  These movements may create problems such as decay, gum disease, excessive wear on certain teeth, and TMJ (jaw joint) problems.  These problems and movements do not result immediately, but will eventually appear, compromising your chewing abilities, the health of your bite, and the beauty of your smile.

Options for replacement of missing teeth:

Removable bridges - This type of bridge is a good solution for replacing one or more missing teeth, especially in complex dental situations where other replacement options are not possible. They are usually made of tooth-colored, artificial teeth combined with metal clasps that hook onto adjacent natural teeth. Removable bridges are the most economical option for replacing missing teeth, but may be the least aesthetically pleasing. This is because the metal clasps on the appliances are often impossible to completely conceal.

Fixed bridges - This type of bridge is generally made of porcelain or composite material and is anchored (cemented) permanently to a natural teeth adjacent to the missing tooth site. The benefit of this type of bridge is that it is fixed (not removable) and it is very sturdy. The disadvantage is that in order to create a fixed appliance, two healthy, natural teeth will have to be crowned (capped) to hold the bridge in place.

Dentures - This type of tooth replacement is used when most or all of the natural teeth are missing in one dental arch. Dentures are removable artificial teeth that are made to closely resemble the patients’ original teeth.

Implants - Are a great way to replace one or more missing teeth. They may also be great to support ill fitting dentures. A dental implant is an artificial root that is surgically placed into the jaw bone to replace a missing tooth. An artificial tooth is placed on the implant, giving the appearance and feel of a natural tooth. Implants are very stable, durable, and are the most aesthetically pleasing tooth replacement option.

If you are missing teeth, ask us if they need replacement and what options are available to you. Together we will select the best replacement option for your particular case. Prevention and early treatment is always less involved and less costly than delaying treatment and allowing a serious problem to develop.

A:

Many people are unaware that having periodontal disease (the destruction of gum tissue and bone that hold our teeth in place) can affect your overall health.  Periodontal disease is one of the most common infections; often more prevalent than the common cold!  Periodontal disease is not only the number one reason people lose teeth; it can also affect the health of your body!

Periodontal disease is a bacterial infection, and in its earliest stages, it’s called gingivitis.  It starts when an accumulation of plaque (a colony of bacteria, food debris, and saliva) is NOT regularly removed from the gums and teeth.  The bacteria in plaque produce toxins/acids that irritate and infect the gums and eventually destroy the jaw bone that supports the teeth.  When periodontal disease is not treated it can eventually lead to tooth loss!

There are numerous studies that have looked into the correlation between gum disease and major medical conditions.  These studies suggest people with periodontal disease are at a greater risk of systemic disease and indicate that periodontal disease may cause oral bacteria to enter the bloodstream and travel to major organs and begin new infections.  Research suggests that periodontal bacteria in the blood stream may:

• Contribute to the development of heart disease
• Increase the risk of stroke
• Compromise the health of those that have diabetes or respiratory diseases
• Increase a woman’s risk of having a preterm, low-birth weight baby

Researchers conclude there is still much research to be done to understand the link between periodontal disease and systemic diseases, but enough research has been done to support that infections in the mouth can play havoc elsewhere in the body.

To ensure a healthy, disease-free mouth, we recommend the importance of regular dental check-ups and cleanings, which include a periodontal evaluation.  Also, diligent home care and a proper diet can help reduce the plaque and bacteria in the mouth.

Remember….the mouth body connection!  Taking care of your oral health may contribute to your overall medical health!

A:

Straighter teeth perform chewing, biting and speaking functions more effectively than crooked teeth.  In addition, a straight smile boosts confidence, is aesthetically pleasing to look at, and can help stave off a wide variety of dental ailments.

There are several types of malocclusion including overbite, underbite, crossbite, and overcrowding.  Each of these alignment problems negatively impacts the functionality and cosmetic appearance of the teeth.

Here is a brief overview of some of the main disorders associated with crooked teeth:

Periodontitis – Periodontitis or gum disease begins with a bacterial infection.  The bacterial infection is caused by inadequate oral hygiene.  Crooked teeth are hard to clean effectively, which means that debris, plaque and bacteria can build up in hard-to-reach areas.  Straight teeth are much easier to clean and are at less risk of contracting gum disease.

Temporomandibular Disorder (TMJ) - Crooked teeth can lead to improper jaw alignment, which in turn causes a painful condition known as TMJ.  Severe headaches, jaw pain, lockjaw and the grinding of teeth characterize this debilitating disorder.

Tooth injury – Straight teeth creates a strong wall, which means injuries are less likely to occur.  Crooked teeth are weaker and often protrude, making them far more vulnerable to external injury.

Uneven wear – Crooked teeth cause some of the teeth to work harder than others when biting and chewing.  Straight teeth share the workload evenly, meaning less risk of injury and better aesthetics.

Teeth can be straightened using either orthodontic braces or customized aligning trays.  Orthodontic braces are usually affixed to the teeth for a set duration.  The brackets and archwires are tightened regularly by the orthodontist and removed when treatment is complete.  Fixed braces can be placed on the front side or back side of the teeth and are effective for most types of malocclusion.

Aligning trays are fully removable and are used where the malocclusion is less severe, and the teeth need to move a shorter distance.  These trays are replaced every few weeks for the duration of the treatment, and have proven to be equally effective for straightening teeth.

If you have questions about orthodontics and straightening teeth, please ask your orthodontist.

A:

If you’re feeling somewhat self-conscious about your teeth, or just want to improve your smile, cosmetic dental treatments may be the answer to a more beautiful, confident smile.

Cosmetic dentistry has become very popular in the last several years, not only due to the many advances in cosmetic dental procedures and materials available today, but also because patients are becoming more and more focused on improving their overall health.  This includes dental prevention and having a healthier, whiter, more radiant smile.

There are many cosmetic dental procedures available to improve your teeth and enhance your smile.  Depending on your particular needs, cosmetic dental treatments can change your smile dramatically, from restoring a single tooth to having a full mouth make-over.  Ask your dentist how you can improve the health and beauty of your smile with cosmetic dentistry.

Cosmetic Procedures:

Teeth Whitening: Bleaching lightens teeth that have been stained or discolored by age, food, drink, and smoking.  Teeth darkened as a result of injury or taking certain medications can also be bleached, but the effectiveness depends on the degree of staining present.

Composite (tooth-colored) Fillings: Also known as “bonding”, composite fillings are now widely used instead of amalgam (silver) fillings to repair teeth with cavities, and also to replace old defective fillings.  Tooth-colored fillings are also used to repair chipped, broken, or discolored teeth.  This type of filling is also very useful to fill in gaps and to protect sensitive, exposed root surfaces caused by gum recession.

Porcelain Veneers: Veneers are thin custom-made, tooth-colored shells that are bonded onto the fronts of teeth to create a beautiful individual smile.  They can help restore or camouflage damaged, discolored, poorly shaped, or misaligned teeth.  Unlike crowns, veneers require minimal tooth structure to be removed from the surface of the tooth.

Porcelain Crowns (caps): A crown is a tooth-colored, custom-made covering that encases the entire tooth surface restoring it to its original shape and size.  Crowns protect and strengthen teeth that cannot be restored with fillings or other types of restorations.  They are ideal for teeth that have large, fractured or broken fillings and also for those that are badly decayed.

Dental Implants: Dental implants are artificial roots that are surgically placed into the jaw to replace one or more missing teeth.  Porcelain crowns, bridges, and dentures can be made specifically to fit and attach to implants, giving a patient a strong, stable, and durable solution to removable dental appliances.

Orthodontics: Less visible and more effective brackets and wires are making straightening teeth with orthodontics much more appealing to adult patients.  Also, in some cases, teeth may be straightened with custom-made, clear, removable aligners that require no braces.

Thanks to the advances in modern dentistry, cosmetic treatments can make a difference in making your smile shine!