A:

Periodontists have advanced training in the treatment of periodontal disease and dental implants.  Patients with periodontal disease have lowered resistance to the bacteria that cause the infection.  This causes a chronic gum infection that can grow in cycles.  Some of the factors that can lead to periodontal disease include poor oral hygiene, smoking, stress, genetic factors, diet, age, illness and lack of regular cleanings and checkups.

Your dentist knows your dental history and the condition of your teeth so if they make an initial diagnosis or notice any changes, they will then refer you to a periodontist.  In many cases, your general dentist may do your preliminary periodontal treatment and a portion of your periodontal maintenance afterwards.  No matter what treatment is needed, we will work closely with him or her to ensure you receive the best possible dental care.

 

A:

The word periodontal means “around the tooth”.  Periodontal disease attacks the gums and the bone that support the teeth.   Periodontal disease is characterized by red, swollen, and bleeding gums.  Periodontal disease begins when plaque, a sticky, colorless, film of bacteria, food debris, and saliva, is left on the teeth and gums.  If plaque is not removed, it turns into calculus (tartar).  The bacteria in the plaque and tartar 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.

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.

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.

A: Gum disease may be passed from parents to children and between couples, according to an article in the September 1997 issue of the Journal of the American Dental Association.  Researchers suggest that bacteria causing periodontal disease are passed though saliva.  This means that when a family or couple comes into contact with each other's saliva, they're at risk for contracting the gum disease of another family member.  Based on this research, the American Academy of Periodontology recognizes that treatment of gum disease may involve entire families. If one family member has gum disease, the AAP recommends that all family members see a dental professional for a periodontal disease screening.

A: A family history of periodontal disease is just one factor but an important one to consider.  Studies suggest that up to 30% of the population may be genetically susceptible to developing severe periodontal disease, according to a study published in the Journal of Clinical Periodontology.  Despite aggressive oral care habits, these people may be six times more likely to develop periodontal disease. These findings could result in the early identification and treatment of at-risk patients. 

 

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 your overall health.

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 or increase a woman’s risk of having a preterm, low-birth weight baby.

Heart Disease

Several theories exist to explain the link between periodontal disease and heart disease.  One theory is that oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in the coronary arteries (blood vessels of the heart) and contributing to clot formation.  Coronary artery disease is characterized by a thickening of the walls of the coronary arteries due to the buildup of fatty proteins.  Blood clots can obstruct normal blood flow, restricting the amount of oxygen and nutrients needed for the heart to function properly, possibly leading to heart attacks.

Another possibility is that the inflammation caused by periodontal disease increases plaque build up, which may contribute to swelling of the arteries.  Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease.

Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.

Stroke

Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.

Diabetes

People with diabetes are more likely to have periodontal disease than people without diabetes, probably because diabetics are more susceptible to contracting infections. In fact, periodontal disease is often considered the sixth complication of diabetes. Those people who don't have their diabetes under control are especially at risk.

A study in the Journal of Periodontology found that poorly controlled type 2 diabetic patients are more likely to develop periodontal disease than well-controlled diabetics are.

Research has emerged that suggests that the relationship between periodontal disease and diabetes goes both ways - periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.

Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts diabetics at increased risk for diabetic complications. Thus, diabetics who have periodontal disease should be treated to eliminate the periodontal infection.

This recommendation is supported by a study reported in the Journal of Periodontology in 1997 involving 113 Pima Indians with both diabetes and periodontal disease. The study found that when their periodontal infections were treated, the management of their diabetes markedly improved.

Respiratory Disease

Bacterial respiratory infections are thought to be acquired through the inhaling of fine droplets from the mouth and throat into the lungs.  These droplets contain germs that can breed and multiply within the lungs to cause damage.  According to the American Dental Association, recent research suggests that bacteria found in the throat, as well as bacteria found in the mouth, can be drawn into the lower respiratory tract.  This can cause infections or worsen existing lung conditions.  People with respiratory diseases, such as chronic obstructive pulmonary disease, typically suffer from reduced protective systems, making it difficult to eliminate bacteria from the lungs.

Scientists have found that bacteria that grow in the oral cavity can be aspirated into the lung to cause respiratory diseases such as pneumonia, especially in people with periodontal disease. This discovery leads researchers to believe that these respiratory bacteria can travel from the oral cavity into the lungs to cause infection.

Chronic obstructive pulmonary diseases (COPD) cause persistent obstruction of the airways. The main cause of this disease is thought to be long-term smoking. Chemicals from smoke or air pollution irritate the airways to cause obstruction. Further damage to the tissue and working function of the lungs can be prevented, but already damaged tissue cannot be restored - untreated or undetected COPD can result in irreversible damage. Scientists believe that through the aspiration process, bacteria cam cause frequent bouts of infection in patients with COPD. Studies are now in progress to learn to what extent oral hygiene and periodontal disease may be associated with more frequents bouts of respiratory disease in COPD patients.

Pregnancy

For a long time we've known that risk factors such as smoking, alcohol use, and drug use contribute to mothers having babies that are born prematurely at a low birth weight.

Now evidence is mounting that suggests a new risk factor – periodontal disease. Pregnant women who have periodontal disease may be seven times more likely to have a baby that is born too early and too small.

More research is needed to confirm how periodontal disease may affect pregnancy outcomes. It appears that periodontal disease triggers increased levels of biological fluids that induce labor. Furthermore, data suggests that women whose periodontal condition worsens during pregnancy have an even higher risk of having a premature baby.

All infections are cause for concern among pregnant women because they pose a risk to the health of the baby. The Academy recommends that women considering pregnancy have a periodontal evaluation.

Be Aware of Your Overall Health

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: Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.  How does smoking increase your risk for periodontal disease?  Smokers are much more likely than non-smokers to have calculus form on their teeth, have deeper pockets between the teeth and gums and lose more of the bone and tissue that support the teeth.  In addition, after periodontal treatment or any type of oral surgery, the chemicals in tobacco can slow down the healing process and make the treatment results less predictable.

If the calculus is not removed during a professional cleaning, and it remains below your gum line, the bacteria in the calculus can destroy your gum tissue and cause your gums to pull away from your teeth. When this happens, periodontal pockets form and fill with disease-causing bacteria.

If left untreated, periodontal disease will progress. The pockets between your teeth and gums can grow deeper, allowing in more bacteria that destroy tissue and supporting bone. As a result, the gums may shrink away from the teeth making them look longer. Without treatment, your teeth may become loose, painful and even fall out.

Please Save Your Smile

Research shows that smokers loose more teeth than nonsmokers do.  According to data from the Centers for Disease Control and Prevention, only about 20 percent of people over age 65 who have never smoked are toothless, while a whopping 41.3 percent of daily smokers over age 65 are toothless.

In addition, research shows that current smokers don't heal as well after periodontal treatment as former smokers or nonsmokers.  But these effects are mainly reversible if the smokers kick the habit before beginning treatment.

It's Not Just Cigarettes

Other tobacco products are also harmful to your periodontal health. Smokeless tobacco also can cause gums to recede and increase the chance of losing the bone and fibers that hold your teeth in place.

And, a study of cigar and pipe smokers published in the January 1999 issue of the Journal of the American Dental Association revealed that cigar smokers experience tooth loss and alveolar bone loss at rates equivalent to those of cigarette smokers.  Pipe smokers experience tooth loss at a rate similar to cigarette smokers.

Other Oral Problems

Researches also have found that the following problems occur more often in people who use tobacco products:

• Oral cancer
• Bad breath
• Stained teeth
• Tooth loss
• Bone loss
• Loss of taste
• Less success with periodontal treatment
• Less success with dental implants
• Gum recession
• Mouth sores
• Facial wrinkling

A:

According to information gathered from the American Academy of Periodontology, researchers have suggested a link between osteoporosis and bone loss in the jaw.  Studies suggest that osteoporosis may lead to tooth loss because the density of the bone that supports teeth may be decreased, which weakens their foundation.  However, hormone replacement therapy may offer some protection.

One study published in the June 2007 Journal of Periodontology (JOP) examined 1,256 postmenopausal women and looked for a potential association between periodontal bacteria and bone loss in the oral cavity.  The study results showed that women with periodontal bacteria in their mouths were also more likely to have bone loss in the oral cavity, which can lead to tooth loss if not treated.  A follow-up study of 106 postmenopausal women over more than 10 years concluded they could significantly reduce tooth loss by controlling their periodontal disease.

Another JOP study from August 1999 concludes that estrogen supplementation in women within five years of menopause slows the progression of periodontal disease.  Researchers have suspected that estrogen deficiency and osteopenia/osteoporosis speed the progression of oral bone loss following menopause, which could lead to tooth loss. The study concluded that estrogen supplementation may lower gum inflammation and the rate of attachment loss (destruction of the fibers and bone that support the teeth) in women with signs of osteoporosis, thus helping to protect the teeth.

What about Bisphosphonates?

Recently, there has been information in the news about taking bisphosphonates and the implications on your periodontal health.  Below are some questions and answers about taking bisphosphonates, osteoporosis, and osteonecrosis of the jaw (the condition associated with taking bisphosphonates).

What are bisphosphonates?

Bisphosphonates, also known as bone-sparing drugs, are commonly used in the treatment of osteoporosis and cancer that has spread to the bone.  Some bisphosphonates are taken orally (such as Fosamax, Actonel, Boniva) to help prevent or treat osteoporosis and Paget's disease of the bone. Others, such as Aredia, Bonefos, Didronel or Zometa, are administered intravenously (injected into a vein) as part of cancer therapy to reduce bone pain and hypercalcemia of malignancy (abnormally high calcium levels in the blood), associated with metastatic breast cancer, prostate cancer and multiple myeloma. 

In rare instances, some individuals receiving intravenous bisphosphonates for cancer treatment have developed osteonecrosis of the jaw, a rare but serious condition that involves severe loss, or destruction, of the jawbone.  The risk of osteonecrosis of the jaw in patients using oral bisphosphonates following dental surgery appears to be very low.

What is osteonecrosis of the jaw (ONJ)?

This condition has been observed in individuals with cancer who undergo invasive dental procedures such as dental implants or tooth extractions while receiving treatment with intravenous bisphosphonates.  ONJ can cause severe, irreversible and often debilitating damage to the jaw.

Because osteonecrosis of the jaw is rare, researchers can not yet predict who, among users, will develop it.  To diagnose osteonecrosis of the jaw, doctors may use x-rays or test for infection (taking microbial cultures).  Treatments for osteonecrosis of the jaw may include antibiotics, oral rinses and removable mouth appliances. Minor dental work may be necessary to remove injured tissue and reduce sharp edges of damaged bone. Surgery is typically avoided because it may make the condition worse. The consensus is that good oral hygiene along with regular dental care is the best way to lower your risk of developing osteonecrosis.

Who can develop ONJ?

The FDA recognizes additional risk factors associated with the development of osteonecrosis (not limited to the jaw) in cancer patients, such as female sex, advanced age, edentulous regions, combination cancer therapy, blood dyscrasias/metastatic disease, anemia coagulopathy, surgical dental procedures, and prior infection.

While on treatment, patients taking IV bisphosphonates should avoid invasive dental procedures if possible.  For patients who develop ONJ while on bisphosphonate therapy, dental surgery may exacerbate the condition.  For patients requiring dental procedures, there are no data available to suggest whether discontinuation of bisphosphonate treatment reduces the risk of ONJ.  Clinical judgment of the treating physician should guide the management plan of each patient based on individual benefit/risk assessment.

What is osteoporosis?

People diagnosed with osteoporosis have low or decreasing bone mass and must take extra care in performing day-to-day activities because they are at increased risk for bone fractures.  Because bone loss is associated with both osteoporosis and periodontal disease, it is questioned whether the two are related.  The association has been difficult to prove because of the many similar risk factors for these two diseases, including smoking, age, medications, and systemic diseases.

A:

In the past, periodontal surgery was considered an ordeal.  Things have changed!

Today there should be NO pain involved during surgery, and the postoperative discomfort is minimal.  At our office, we use conscious sedation to better help our patients relax.  New and sophisticated medications help to ensure you a smooth procedure.

  

Postoperative discomfort has been dramatically reduced with the use of NSAIDS (non-steroid anti-inflammatory drugs). These pain prevention drugs, such as Naprosyn and Motrin, stop the formation of the chemicals the body normally produces that cause elevated pain.  NSAIDS are not narcotics, so you can function normally when taking them. Generally, NSAIDS are started the morning before surgery, and taken for three to five days postoperatively. After this time no prescription medications are normally needed. In addition to the NSAIDS, a narcotic may be recommended for the first or second day.

 

Patients are occasionally given antibiotics to take after surgery.  Even if you feel okay, it is important to take the prescribed antibiotics until they are all taken, to optimize healing.

 

A prescription mouthwash is often prescribed after surgery, and may be used for about 3-4 weeks. It is much more effective than any over-the-counter mouthwash, and kills bacteria throughout the mouth.  During the first 7 days there is sometimes a periodontal dressing over the operated area (similar to silly putty), and using the mouthwash helps to keep the dressing clean.

 

At 7-10 days any dressing is removed, along with sutures which may not have dissolved. The area is cleaned, and postoperative care of the area is reviewed.  This appointment generally lasts 15-30 minutes, and should not cause discomfort.

 

With most cases it is important to keep all bacteria away from the surgical site for 8-10 weeks.  To help ensure optimal plaque control, a polish appointment is often scheduled about 4 weeks afterwards.  We have found that careful control of plaque during the healing phase greatly enhances surgical results.

 

SURGICAL POST-OPERATIVE INSTRUCTIONS

 

The post-operative instructions listed below should be followed accurately in order to speed your recovery.

SWELLING - The first 24 hours is the most critical phase for swelling control. Most swelling does not visibly appear until 24-48 hours after surgery.  It is therefore important to apply (on and off) ice at 15-20 minutes intervals.  Ice application after 48 hours is not helpful, as it actually slows healing and prevents swelling reduction.

EATING - The rule of thumb is "cool and soft".  Avoid spicy or hot foods.  Any food that is cool, easy to chew, and soft is O.K. to eat (ie. Jello, yogurt, sliced soft fruit, cereal, potato, fish, eggs, applesauce, etc.). DO NOT eat or drink anything hot during the first 24 hours.

EXERCISING - Aerobic activities and heavy lifting should be avoided for the first 72 hours. Let common sense prevail.

SMOKING - The less you smoke, the faster things heal and few complications arise. A better result will also be obtained.

CLEANING - Areas not included in the surgery can be cleaned as normal.  Warm salt rinses (1/2 tsp. salt per 8 oz. glass of water) can be used after eating for the first week. NO brushing of surgical site until directed to do so.

PAIN CONTROL - Pain management begins immediately after surgery. The medication MUST be taken whether you experience pain or not. Proper blood levels are necessary in order to reduce pain and swelling.

MEDICATIONS - Use only the medications below that your doctor has checked.
(Prescriptions will vary depending upon the circumstance warranting medication. Please follow you doctor's orders for each medication as they were discussed with you).  Examples of medication regimens are listed below.  Please consult your individual prescription instructions prior to taking ordered medications.

Decadron 1.5 mg: one pill taken after 6 pm the first day of surgery. Then one pill twice daily until entire amount is used.

Peridex: The day after surgery, begin twice daily oral rinses until the bottle is used up (approximately 2 weeks). A 30 second rinse in the morning and again in the evening will control bacteria that can delay healing. In special situations, extended use of Peridex may be suggested. Apply Peridex topically with a Q tip to surgical site beginning on second day.

Motrin 600 mg and 1000 mg Extra Strength Tylenol. Alternate every 2 hours for the first day. Then take as needed for discomfort.

Other medications, as listed.

BLEEDING - Normally there will be some bleeding following surgery.  The application of pressure from a damp, cool cloth or ice in these areas will usually hasten clotting.  Continued bleeding can be controlled by firm pressure on a dampened tea bag placed directly on the area.  However, should you become concerned about excess bleeding, please call the office for further instructions.

PERIODONTAL DRESSING (If used):  The pinkish casts, when applied to the surgical area, should remain until your next appointment.  These were applied to provide greater comfort.  Should they loosen, do not force them back to place.  If you have any questions, please call the office.

When NO PERIODONTAL DRESSING is used, the following precautions should be observed:

No vigorous rinsing or spitting for the first 24 hours. This tends to promote bleeding.

Floss may be used to remove food should it collect between teeth.

Begin twice daily rinses with Peridex until the bottle is used up.

Avoid cold & hot beverages since the teeth may be sensitive to thermal stimuli.

If sutures become loose or stringy, do not pull on them.

If you are uncertain as to what to do, please call our office.

Sinus Augmentation/Sinus Lift - In addition to the general post surgical instructions that should be followed (described in detail above), there are specific instructions that need to be followed for those patients who have had sinus lift surgery. The following post surgical instructions are in addition to those which should be followed for routine periodontal surgery/dental implant related surgery and include:

POST-OPERATIVE PHASE:

Continue the antibiotics until the entire prescription is completed.

Please use a nasal decongestant for the first 72 hours after surgery (e.g. Afrin nasal spray). Follow the pharmaceutical manufacturer instructions.

Do not hold your sneeze or blow your nose. The associated increase in pressure can damage the surgical site.

Nasal bleeding after surgery is common for the first 24 hours. Excessive bleeding should be reported to our office.

Any discharge, which smells or is discolored should be reported promptly.

Please note that smoking interferes with post-surgical healing.

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:

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 (Partials) - 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 or more 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 your dentist what options for replacement are available to you. Together we can discuss your options and help you 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.