The term “periodontics” refers to the dental specialty that pertains to the prevention, diagnosis and treatment of periodontal disease that affects the gums and jawbone. The gum tissues serve to surround and support the teeth and the underlying jawbone anchors teeth firmly in place. Periodontists have completed several years of extra dental training and are concerned with maintaining the function, health and aesthetics of the jawbone and tissues.
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:
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.
Periodontal disease is the leading cause of bone loss in the oral cavity, though there are others such as ill-fitting dentures and facial trauma. The bone grafting procedure is an excellent way to replace lost bone tissue and encourage natural bone growth. Bone grafting is a versatile and predictable procedure which fulfills a wide variety of functions.
A bone graft may be required to create a stable base for dental implant placement, to halt the progression of gum disease, or to make the smile appear more aesthetically pleasing.
There are several types of dental bone grafts. The following are the most common:
Reasons for bone grafting
There are a wide variety of reasons why bone grafting may be the best option for restoring the jaw bone.
Dental implants – Implants are the preferred replacement method for missing teeth because they restore full functionality to the mouth; however, implants need to be firmly anchored to the jawbone to be effective. If the jawbone lacks the necessary quality or quantity of bone, bone grafting can strengthen and thicken the implant site.
Sinus lift – A sinus lift entails elevating the sinus membrane and grafting bone onto the sinus floor so that implants can be securely placed.
Ridge augmentation – Ridges in the bone can occur due to trauma, injury, birth defects, or severe periodontal disease. The bone graft is used to fill in the ridge and make the jawbone a uniform shape.
Nerve repositioning – If the inferior alveolar nerve requires movement to allow for the placement of implants, a bone grafting procedure may be required. The inferior alveolar nerve allows feeling and sensation in the lower chin and lip.
What does bone grafting treatment involve?
Bone grafting is a fairly simple procedure that can be performed under local anesthetic; however, if large amounts of bone area need to be grafted, general anesthetic may be required.
Initially, the grafting material needs to either be harvested or prepared for insertion. A small incision is made in the gum tissue and then gently separated from the bone. The bone grafting material is then placed at the affected site.
The bone regeneration process may be aided by:
The gum is sutured in place and a follow-up appointment will need to be made within 10 days to assess progress. Bone grafting is a highly successful treatment and a good base for further periodontal restorations.
If you have any questions about bone grafting, please ask your dentist.
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:
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:
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 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:
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 afterwards.
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 will have been repositioned. 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.
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 which 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:
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:
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.
The objective of scaling and root planing is to remove etiologic agents which 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:
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.
A dental prophylaxis is a cleaning procedure performed to thoroughly clean the teeth. Prophylaxis is an important dental treatment for halting the progression of periodontal disease and gingivitis.
Periodontal disease and gingivitis occur when bacteria from plaque colonize on the gingival (gum) tissue – either above or below the gum line. These bacteria colonies cause serious inflammation and irritation which in turn produce a chronic inflammatory response in the body. As a result, the body begins to systematically destroy gum and bone tissue, making the teeth shift, become unstable, or completely fall out. The pockets between the gums and teeth become deeper and house more bacteria which may travel via the bloodstream and infect other parts of the body.
Reasons for prophylaxis/teeth cleaning
Prophylaxis is an excellent procedure to help keep the oral cavity in good health and also halt the progression of gum disease.
Here are some of the benefits of prophylaxis:
What does prophylaxis treatment involve?
Prophylaxis can either be performed in the course of a regular dental visit or, if necessary, under general anesthetic. The latter is particularly common where severe periodontal disease is suspected or has been diagnosed by the dentist. An endotracheal tube is sometimes placed in the throat to protect the lungs from harmful bacteria which will be removed from the mouth.
Prophylaxis is generally performed in several stages:
Prophylaxis is recommended twice annually as a preventative measure, but should be performed every 3-4 months on periodontitis sufferers. Though gum disease cannot be completely reversed, prophylaxis is one of the tools the dentist can use to effectively halt its destructive progress.
If you have questions or concerns about prophylaxis or periodontal disease, please contact our practice.
Ridge modification is an effective procedure for treating deformities in the upper and lower jaws. These deformities can occur as a result of periodontal disease, trauma, injury, wearing dentures, or developmental problems. Such defects can leave insufficient bone for the placement of dental implants and an additional unattractive indentation in the jaw line adjacent to the missing teeth.
During the ridge modification procedure, the gum is lifted away from the ridge to fully expose the defect in the bone. The bony defect can be filled with bone graft material that can help regenerate lost bone or a bone substitute. Finally, the incision is closed and several months of healing will be required. Depending on the case and type of implant and procedure, the dental implant might be placed during the ridge modification procedure or when healing is complete; this all depends on the condition of the bone. Ridge modification improves the cosmetic appearance, functionality of the mouth, and the chance of enjoying dental implants for many years.