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Peridontal Disease and Overall Health
During your routine check up appointments over the past few years you may have noticed an increased emphasis by us on your periodontal health. Periodontal health refers to status of health of your gingiva ("gums") and the bony support systems of the teeth. Research in the causes, diagnosis and treatment of periodontal disease as well as other health related diseases associated with uncontrolled periodontal disease have led us to focus with more awareness on the health status of your periodontium.
Exactly what is periodontal disease?
In the simplest terms, periodontal disease is an infectious disease caused by toxins and other by-products of microorganisms (bacteria mostly) that are able to accumulate below the gums. These toxins poison the surrounding tissues, including the gingiva and bone supporting the teeth, and cause, among other things, infection and the destruction of the bone that supports the teeth. If the disease is not controlled, at the very least, tooth loss from periodontal disease ("gum disease") will occur. Fortunately, for most people, periodontal disease is a slowly progressing disease and, for the most part, not painful in the early stages.
While there is a genetic basis for periodontal disease in many people, it is truly a preventable disease. Certain other diseases, such as diabetes and some cancers (and their treatments!) can severely hamper periodontal health. The good news is that even in the presence of other diseases or if a patient is genetically predisposed to periodontal disease, with proper periodontal therapy and meticulous home care, the disease progression can be controlled in most cases.
The most recent research shows that periodontal disease, even in its earliest stages, may be associated with other major health risks, including heart disease. Studies from the American College of Cardiology, University of Minnesota, Brigham & Women's Hospital in Boston, Harvard's School of Dental Medicine and the University of North Carolina have shown a positive association between periodontal disease and an increased risk of heart attacks.
Other published studies have shown other associated health risks including premature births and a decreased birth weight in children born to mothers with uncontrolled periodontal disease.
Additionally, periodontal disease has been linked to chronic fatigue, an increased risk for contracting other diseases (colds and the flu typically) and overall malaise.
What are the signs and symptoms of periodontal disease?
Generally, red and swollen gingiva that bleeds easily when probed or flossed are often signs of gingivits, the earliest stage of gum disease. During the oral and periodontal examination of your cleaning and check up appointment, we examine the overall health of your periodontium. This examination includes a visual look to see if the gingiva is firm and pink, which is the appearance of healthy gingiva or if the gingiva is red and puffy or swollen which indicates unhealthy gingiva.
Additionally, we will measure at least four individual points around each of your teeth with a periodontal probe. This millimeter probe will show how far below the surface of your gingiva the bone support for the tooth begins. In a healthy state, the measurement is less than three millimeters (3mm) and there is no bleeding when the site on the tooth is probed. Measurements of 3mm with bleeding when the gingiva is probed lead to a diagnosis of gingivitis, which can easily progress to full blown periodontal disease.
The treatment for gingivitis is simply better home care: thorough brushing and daily dental flossing. Regular 6 month cleaning and check up appointments are suggested.
When the pockets measure 4-5mm with bleeding when probed, early periodontal disease is diagnosed. The infected gingiva at this stage of the disease usually has little or no discomfort but the toxins are already poisoning and destroying the gingiva and bone supporting the adjacent tooth. As this painless infection progresses, often unknown to the patient, it may already be challenging their overall health. Because the active disease is present, we will routinely take considerable time to emphasize more diligent and thorough home care and, often, more frequent cleaning and check up appointments.
The treatment of early periodontal disease is emphasized home care, including thorough brushing, especially with an electric tooth brush, diligent daily flossing and, sometimes the use of a Water Pik. Cleaning and check up appointment intervals are reduces to every three or four months to establish that the home care is effective in stopping the disease. (We typically recommend the Braun/Oral B electric toothbrush because of the clinical success we have seen with patients that have used it, but many other similar toothbrushes on the market will work as well.)
Pockets that measure 5-6mm, especially with spontaneous hemorrhage and, often a suppurative (pus) discharge, are diagnosed as moderate periodontal disease. This active and destructive stage of the disease is shown clinically with accumulating levels of the toxins below the gum line causing an acute or chronic local and progressing disease state. If the active disease at this stage is not controlled, the certain loss of teeth and an increased risk of potentially more serious health problems exists. This disease state needs rapid treatment, including the disinfecting of the pockets around the teeth that are teeming with the microbes (again, usually bacteria) and their poison by-products with an ultrasonic dental scaler, an antibiotic rinse administered below the gum lines and, often, a prescription antibiotic. Frequent office visits to ensure the disease has been arrested are necessary.
Treatment for moderate periodontal disease is multifaceted. Of course, meticulous home care is essential to stop the active disease. Equally important, non-surgical periodontal therapy is initiated in the affected areas. This usually involves dividing the mouth into four quadrants and using the therapy to treat each of the four quadrants. Local anesthesia is used to be certain the patient is comfortable while the therapy disinfects and cleanses the toxins and microbes from below the gum line. Upon completion of the therapy, the patient returns to the office for a 12 week follow up check up to evaluate both how effective the periodontal therapy was in cleansing and to see how well the home care is progressing.
A patient that has had active periodontal disease, as is the case with those affected with diseases such as heart disease, never completely gets rid of the disease because of the destruction to the gingiva and bone around the teeth. Therefore, frequent periodontal maintenance appointments are necessary to be absolutely certain the periodontal disease is in remission and stays in remission. These appointments can range from two to four month intervals, often depending on how meticulous the home care regimen is.
Advanced periodontal disease is characterized as diseased pockets that measure 6mm or more and remain inflammed, infected and extremely unhealthy. This advanced stage of disease is more difficult to treat due primarily to the extensive destruction of bone around the teeth as well as the chronic infection. Advanced periodontal disease can cause significant pain as well as swelling, fever and potential serious systemic infections. Periodontal surgery is the last resort in attempting to arrest the active disease and save the teeth. At this stage of the disease, little else can be done.
After the surgery, the patient is followed at 2-4 month intervals for life. There can be no further periodontal destruction without serious tooth loss and other associated health risks.
Treatment for advanced periodontal disease is an open, full flap-osseous periodontal surgery, followed by a three month healing phase and then periodontal maintenance appointments at two to four month intervals for life. Antibiotic and anti-inflammatory medicines and prescription mouth rinses are prescribed.
Gingivitis and its associated symptoms are reversible with little or no long term consequences. Early periodontal disease can be reverted to health if caught early enough and if meticulous home care is maintained. Moderate and advanced periodontal disease require definitive specialized treatment to attempt to put the active disease in remission. At these stages, the disease is always there and cannot be "cured" but it can be maintained in remission if the therapy is successful and the home care regimen followed.
As you can see, we place great value on keeping you disease free, working with you to be sure that you are able to enjoy a lifetime with your natural teeth. Equally important to us, we do not want to put you at risk for other health problems associated with a poorly maintained periodontium. Knowing that periodontal disease is both preventable and treatable, we hope you will support us in our efforts to keep you healthy, both orally and systemically. Now you know the rest of the story!! Keep brushing and flossing!
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Making Your Smile All You Ever Wanted!
With advances in dental science over the past decade, huge strides have been made in the ability of dentistry to esthetically enhance the smile. We are proud to apply these conservative and time proven techniques in our practice.
There are basically three main systems to enhance the smile. These include tooth bleaching, the use of porcelain veneers and full coverage porcelain crowns, or "caps" as they are sometimes known.
The single most conservative and remarkable treatment to enhance the smile is tooth bleaching. This safe and effective method of brightening the color of the teeth has been used for a number of years with simple astounding results. Because the teeth are not physically altered in any fashion, the smile is enhanced by lightening the color of the teeth and, thus, warming the smile. While the bleaching results are not a permanent change, they are long lasting. Once the initial bleaching procedure has been completed, a one or two day maintenance bleaching is recommended every 18-36 months.
Teeth that are more yellow in color, usually as a result of the aging process, bleach with the best results. Gray colored teeth, teeth swirled with multiple colors, intrinsically stained teeth, such as those stained with tetracycline or fluoride will bleach to a certain degree but may not brighten up as much as other tooth discolorations. (Click here to see our special bleaching section)
Veneers offer a more conservative tooth alteration than full coverage crowns. Tooth preparation (a light roughening of the tooth surface with the dental drill) is required for porcelain veneers. While the tooth structure is altered, most of the natural enamel remains on the tooth, which very nearly keeps the tooth in its natural state. The before and after results of porcelain veneers is striking, rendering a durable and long lasting improvement of the smile! Often times, we will bleach the teeth first and then veneer them to get the brightest and most natural final appearance possible. While veneers may be made of plastics, either in a direct or indirect technique or in porcelain, we only use porcelain because of the final esthetics and durability. (Click here to see our special veneer section)
For any number of reasons, it may not be possible to use veneers or bleaching to improve the smile. In these instances, it may be necessary to crown the teeth using porcelain to metal, porcelain to gold or all porcelain crowns. This technique usually involves reshaping the teeth in such a way that most, if not all, of the natural enamel is removed during the preparation of the teeth and the final crown cemented to the prepared tooth. While this technique is time proven and very esthetic, it is not as conservative as either bleaching or the use of veneers.
Sometimes it is necessary to use a combination of bleaching, veneers and crowns to get the smile that you have always wanted. If you are not happy with your smile- including the shade, shape or alignment of the teeth, ask us about ways to make you happier with your smile!!
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Athletic Mouthguards
For many years, certain contact sports have required the use of athletic soft rubber mouthguards. The purpose of the mouthguards is to minimize damage to the lips, teeth and adjacent oral structures. Countless numbers of athletes have successfully completed their athletic careers with all of their teeth intact because of the mouthguards.
Probably the biggest source of athletic mouthguards are those purchased at sporting goods stores. These types of mouthguards are formed to the user's teeth by dipping them in hot water to soften them, molding them and then letting them cool. When the teeth bite into the mouthguard, the softened rubber spreads out to not only cover the teeth but also the roof of the mouth and partially obscure the airway, making some athletes feel like they could not breath well. Because of this "overflow" feeling when they are formed, many athletes cut the back portion of the dipped mouthguard off and only used it to cover the front teeth.
While this "cut down" mouthguard will protect the front teeth, it creates a significant deficiency in the protection afforded by the use of an athletic mouthguard. Research has conclusively shown that athletic mouthguards provide another significant protection, one that is lost with the "cut down" mouthguards. This protection involves lessening the risk and severity of brain concussions as well as protecting the teeth. The research showed that, by placing the molded rubber mouthguard between the teeth, especially the back teeth, when there was a blunt blow to the head, the teeth could not "smack" together from the impact, which in turn prevented a compression of the brain onto the bone of the skull. The impact of the brain on the skull is the process of "bruising" the brain, more commonly known as a "concussion". By cutting off the back part of the mouthguard, the back teeth can, once again, smack together on impact and act to cause a concussion, even though the front teeth remain protected. For that reason, the athletic mouthguard should not be "cut down".
A research study from Arizona showed that in women's high school basketball, the frequency of players sustaining concussions from contact with other players or the basketball floor was the leading of cause of all head injuries in the sport. The frequency and severity of the concussion type injures significantly decreased when athletic mouthguards were used.
We are pleased to continue our in-office program of supporting the use of athletic mouthguards by making custom mouthguards for our patients to use in athletics, including, but not confined to, football (mandatory), basketball, soccer, wrestling, baseball and karate. We make the custom mouthguards at NO CHARGE to our patients. (If the first mouthguard is lost, there may be a small charge to re-make a new one). Custom mouthguards fit precisely to the teeth and are much less uncomfortable and cumbersome than those made from purchases at the local sporting good stores, negating the need to "cut down" the mouthguard. To have one made for you or your athlete(s), give the office a call to schedule an appointment! Help us to help you!!
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