Posts for: September, 2014
Without effective treatment, periodontal (gum) disease can eventually lead to tooth loss. That’s why it’s imperative to remove bacterial plaque and calculus — the main cause of the disease — from all teeth and gum surfaces. For moderate to advanced gum disease, this could require a procedure known as flap surgery to gain access to deeper infected areas.
This type of procedure involves making scalpel incisions into the gum tissue to create a flap opening. Through this opening we’re able to gain access to the deeper pockets that have formed because of the tissue detachment that occurs following bone loss. The flap opening allows for better access to the root surfaces for removal of plaque and calculus (tartar). Once we’ve finished, we then suture the flap back into place to reduce the pockets and allow the area to heal.
While effective, flap surgery is considered moderately invasive and may produce mild post-procedural discomfort. Recently, however, a specially designed laser for periodontal therapy shows promise of less invasiveness and patient discomfort than traditional flap surgery.
A laser is an intense and narrow beam of light of a single wavelength. A periodontal laser can pass without effect through healthy cell tissue (like sunlight through a window pane) but interacts and “vaporizes” the darkly pigmented bacteria in diseased tissue. The laser energy is delivered in pulses to minimize any heat-related damage to healthy cells.
The periodontal laser can precisely remove diseased tissue, even where it mingles with healthy tissue. Once it’s removed, the root surfaces can be cleaned with ultrasonic scalers and/or hand instruments. And because a medical laser seals the tissue it cuts, it doesn’t produce open incisions as with flap surgery that require suturing afterward.
Studies of post-operative recovery after laser surgery showed similar infection reduction and renewed bone and tissue growth as with traditional surgery. Patients, however, reported much less discomfort after the laser procedure. Although more research is needed, it initially appears periodontal laser treatments can effectively treat gum disease with minimal interference with healthy tissue and greater comfort for patients.
You may not realize it, but the simple act of eating can generate a tremendous amount of force on teeth and jaws. Fortunately, your teeth can absorb much of this biting force — but within limits. If the force exceeds normal limits on a continual basis, you may begin to notice aching teeth or sore jaws, and we may begin to notice unusual tooth wear during your dental checkups.
The most common cause for this is a chronic habit of grinding or clenching the teeth, also known as bruxism. It can manifest itself by teeth grinding against each other, teeth pressing against soft tissue (as with thumb-sucking) or biting or chewing on hard objects such as pencils or nails. We commonly see bruxism with patients who are experiencing excessive stress, sleep-related problems or as a result of lifestyle habits such as smoking or excessive alcohol consumption. You may not even be consciously aware of it as in the case of bruxism that occurs while you sleep, but your sore jaws in the morning (as well as your sleeping partner’s complaints of noise) may be evidence of it.
Treatment involves a two-part approach. First, we want to relieve the pain symptoms and stop the damage. To relieve pain we’ll often prescribe mild, anti-inflammatory or muscle-relaxant drugs, or perhaps medication to help you sleep better. We may also design a bite guard for wear on your upper teeth at night: the lower teeth will tend to glide or skate on the wear-resistant plastic and prevents them from placing excessive forces on your teeth.
The other part is to address the underlying cause for long-term results. If the habit arises from severe stress or other lifestyle issues, we may recommend biofeedback therapy or psychotherapy to improve your coping mechanisms. If an abnormality like a bad bite (malocclusion) is an underlying factor, we may recommend a minor bite adjustment by reshaping the teeth to lessen the bite impact.
The right course of action depends on a thorough dental examination to determine the exact nature of your clenching or grinding habit. From there we can discuss your options on how to relieve the soreness and pain, as well as prevent problems in the future.
If you would like more information on bruxism and its effects, 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 “Stress & Tooth Habits.”
Tooth decay (dental caries) is one of the world’s most common infectious diseases. Left untreated, it can lead to tooth loss. The best treatment strategy, of course, is to prevent it from occurring in the first place with a long-term approach that begins in early childhood and continues throughout our lifetime.
Here are some basic components for just such a prevention strategy.
Know your risk. We each don’t share the same level of risk for tooth decay, so it’s important to come to terms with any factors that raise your personal risk for the disease — your dental history, inadequate oral hygiene, absence of fluoride use, and lifestyle habits like smoking. Coming to terms with these and other factors — and altering those you can change — can lower your risk.
Reduce acid-producing bacteria in your mouth. Tooth decay usually arises from elevated acidic levels in the mouth caused by certain strains of oral bacteria. You can reduce these bacteria by removing plaque, a thin film of food particles that collect on tooth surfaces, with daily oral hygiene and regular cleanings in our office. In some cases, we may also recommend antibacterial mouthrinses like chlorhexidine to further lower the bacterial population.
Apply protective measures to teeth. Fluoride, a naturally occurring chemical, has been proven effective in strengthening tooth enamel and reducing tooth decay. In addition to fluoride found in many oral hygiene products and public water systems, children can also benefit from a direct application of fluoride to the enamel surface just after the teeth have erupted in the mouth. Many clinical studies have shown 99% cavity free results in over a thousand teeth receiving a fluoride application with sealants.
Control your diet. Bacteria ferment leftover sugars and other carbohydrates in the mouth; this creates acid, which can soften tooth enamel and lead to decay. You can limit this effect by eating more fresh fruits and vegetables and reducing your consumption of refined sugar. You should also limit between meal snacking — constant snacking prevents saliva, the mouth’s natural acid neutralizer, from effectively restoring the mouth’s pH balance.
A prevention strategy for tooth decay will help you avoid unnecessary pain and problems — physically and financially. You’ll also reap the rewards that come from a lifetime of good dental health.
If you would like more information on preventing tooth decay, 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 “Tooth Decay.”
Now that celebrities can communicate directly with their fans through social media, we’ve started to see dispatches from some surprising locations — the dental chair, for example! Take singer Kelly Clarkson, who was the first winner of American Idol, and perhaps one of the first to seek moral support via social media before having an emergency root canal procedure.
“Emergency root canal — I’ve had better days,” Kelly posted on her Facebook page, along with a photo of herself looking… well, pretty nervous. But is a root canal procedure really something to be scared about? It’s time to clear up some misconceptions about this very common dental procedure.
First of all, root canal treatment is done to save a tooth that might otherwise be lost to an infection deep inside it. So while it’s often looked upon with apprehension, it’s a very positive step to take if you want to keep your teeth as long as possible. Secondly, tooth infections can be painful — but it’s the root canal procedure that stops the pain. What, actually, is done during this tooth-saving treatment?
First, a local anesthetic is administered to keep you from feeling any pain. Then, a small opening is made through the chewing surface of the infected tooth, giving access to the central space inside, which is called the “pulp chamber.” A set of tiny instruments is used to remove the diseased pulp (nerve) tissue in the chamber, and to clean out the root canals: branching tunnel-like spaces that run from the pulp chamber through the root (or roots) of the tooth. The cleared canals are then filled and sealed.
At a later appointment, we will give you a more permanent filling or, more likely, a crown, to restore your tooth’s full function and protect it from further injury. A tooth that has had a root canal followed by a proper restoration can last as long as any other natural tooth — a very long time indeed.
If you have any questions about root canal treatment, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine article “A Step by Step Guide to Root Canal Treatment.”
Your braces have finally been removed and you’ve unveiled your new smile to the world. You’re finished with orthodontics — right?
Not quite. If you want to “retain” your new smile you’ll need to wear a retainer appliance: depending on your age and which teeth were moved, that could be for several months or even indefinitely.
Retainers are necessary because of how teeth naturally move within the mouth. Although your teeth may seem rigidly set in bone, they’re actually held in place by an elastic tissue called the periodontal ligament. This tissue is quite dynamic in response to biting forces or even normal tooth wear. When forces are applied to a tooth, it’s the ligament that transmits pressure against the teeth to gradually move them to a more accommodating position. In response, the bone resorbs (dissolves) on the side of the tooth moving toward the new position while laying down new growth on the other side. This bone growth will help anchor the tooth in the new position.
Braces use this natural process to gradually move teeth; both the ligament and bone will reform as needed. But this reforming process takes time. Furthermore, there’s a natural balance between the teeth, the tongue and the lips and cheeks. Although the new position created by orthodontics may be more aesthetically pleasing, it may disrupt the natural balance of these surrounding muscles. The influence of habits like clenching or grinding of your teeth may also disturb the new tooth position. The natural tendency is to revert back to the original tooth position.
We use retainers to prevent this reversal. Nearly all orthodontic patients will initially wear them all the time, and for younger patients this may be reduced to wear only during sleep time. Total wear time usually lasts a minimum of eighteen months, until the bone and ligament have fully reformed.
For older patients, though, retainer wear may need to continue indefinitely to prevent “relapse.” In these long-term cases another option to a removable retainer is to permanently bond thin retainer wires to the inside surfaces of the front teeth. The wires can remain in place for several years and are much less noticeable than a removable retainer.
While retainers are often considered inconvenient, they’re absolutely necessary for preserving the results of orthodontic treatment. In the end they’ll help you keep the form and function of your new smile.
If you would like more information on orthodontic retainers, 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 “Why Orthodontic Retainers?”