James Van Sicklen, Jr. DDS | Stockton, CA Dentist

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Periodontics

Periodontics

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:

  • 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.

Bone Grafting

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:

  • Autogenous bone graft – In this type of graft the bone is removed from elsewhere in the body and implanted in the mouth.  Common donor sites for bone grafting include the iliac section of the pelvis, the chin and the posterior third molar areas of the jaw.  If large amounts of bone need to be harvested, the hip or the shin bone (tibia) is generally used.
  • Allograft – Synthetic bone (manmade) can be created in the laboratory and used in the bone grafting procedure.  Bone can also be obtained from a bone bank (cadaver bone).
  • Xenograft – This is the implantation of bovine (cow) bone. A xenograft is perfectly safe and has been used successfully; ample bone can be obtained, and a secondary donor site is not necessary.

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:

  • Gum/bone tissue regeneration – A thin barrier (membrane) is placed below the gum line over the grafting material.  This barrier creates enough space for healthy tissue to grow and separates the faster growing gum tissue from the slower growing fibers.  This means that bone cells can migrate to the protected area and grow naturally.
  • Tissue stimulating proteins – Enamel matrix proteins occur during natural tooth development.  Emdogain is a matrix protein product which is usually placed on the affected site before the gum is sutured.  It mediates the formation of accellular cementum on the tooth which provides a foundation to allow periodontal attachment to occur.  Tissue stimulating proteins help create lost support in areas affected by periodontal defects.
  • Platelet-rich growth factors – A high platelet concentration liquid can be used to create a blood clot at the site of a wound.  It has recently been discovered that PRGF also stimulates bone growth – meaning a denser graft in a shorter time period.

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

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 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.

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 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:

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

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.

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.

 
 
 

Periodontal Scaling & Root Planning

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:

  • 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.

Prophylaxis (Teeth Cleaning)

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:

  • Tartar removal – Tartar (calculus) and plaque buildup, both above and below the gum line, can cause serious periodontal problems if left untreated.  Even using the best brushing and flossing homecare techniques, it can be impossible to remove debris, bacteria and deposits from gum pockets.  The experienced eye of a dentist using specialized dental equipment is needed in order to spot and treat problems such as tartar and plaque buildup.
  • Aesthetics – It’s hard to feel confident about a smile marred by yellowing, stained teeth.  Prophylaxis can rid the teeth of unsightly stains and return the smile to its former glory.
  • Fresher breath – Periodontal disease is often signified by persistent bad breath (halitosis).  Bad breath is generally caused by a combination of rotting food particles below the gum line, possible gangrene stemming from gum infection, and periodontal problems.  The removal of plaque, calculus and bacteria noticeably improves breath and alleviates irritation.
  • Identification of health issues – Many health problems first present themselves to the dentist.  Since prophylaxis involves a thorough examination of the entire oral cavity, the dentist is able to screen for oral cancer, evaluate the risk of periodontitis and often spot signs of medical problems like diabetes and kidney problems.  Recommendations can also be provided for altering the home care regimen.

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:

  1. Supragingival cleaning – The dentist will thoroughly clean the area above the gum line with scaling tools to rid them of plaque and calculus.
  2. Subgingival cleaning – This is the most important step for patients with periodontal disease because the dentist is able to remove calculus from the gum pockets and beneath the gum line.
  3. Root planing – This is the smoothing of the tooth root by the dentist to eliminate any remaining bacteria.  These bacteria are extremely dangerous to periodontitis sufferers, so eliminating them is one of the top priorities of the dentist.
  4. Medication – Following scaling and root planing, an antibiotic or antimicrobial cream is often placed in the gum pockets.  These creams promote fast and healthy healing in the pockets and help ease discomfort.
  5. X-ray and examination – Routine X-rays can be extremely revealing when it comes to periodontal disease.  X-rays show the extent of bone and gum recession, and also aid the dentist in identifying areas which may need future attention.

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

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.

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