Posts for: April, 2018
There’s more to teeth than meets the eye. Hidden beneath the visible crown are the tooth’s roots set within the jawbone, secured and protected by the gums from bacteria and infection. But if the gums shrink back (recede), the roots become exposed and susceptible to disease, especially at the points where multiple roots branch from each other, areas called furcations.
It all begins with periodontal (gum) disease caused by built-up bacterial plaque from insufficient brushing and flossing. The infection triggers inflammation that over time weakens gum tissues. They begin to detach from the teeth, which can eventually lead to gum recession and root exposure.
This also causes bone loss, especially at the furcations. We can detect any loss (known as a furcation invasion) and how far along it may be with x-ray imaging or by manually probing with an instrument called a periodontal probe.
There are three general classes measuring furcation invasions. In the earliest, Class I, we can feel the invasion as a slight groove; in Class II, it increases to two or more millimeters across. In Class III the bone loss extends from one side of the root all the way to the other (a “through and through”).
At this stage a patient is in danger of losing the tooth, so we’ll have to act promptly. This means first removing accumulated dental plaque and calculus (tartar) to stop the infection and allow the gums to heal. With severe damage, we may need to assist healing with bone and gum tissue grafting, in which we place donor grafts to serve as scaffolding for the appropriate tissue to grow upon.
You can help prevent this situation by practicing effective daily hygiene and visiting your dentist for thorough cleanings at least twice a year (or more if recommended). And at the first signs of a gum infection—swollen, reddened or bleeding gums—make an appointment as soon as possible to have it checked. The sooner we can detect and treat gum disease, the less likely a furcation invasion or worse will be in your future.
If we could go back in time, we all probably have a few things we wish we could change. Recently, Dr. Travis Stork, emergency room physician and host of the syndicated TV show The Doctors, shared one of his do-over dreams with Dear Doctor magazine: “If I [could have] gone back and told myself as a teenager what to do, I would have worn a mouthguard, not only to protect my teeth but also to help potentially reduce risk of concussion.”
What prompted this wish? The fact that as a teenage basketball player, Stork received an elbow to the mouth that caused his two front teeth to be knocked out of place. The teeth were put back in position, but they soon became darker and began to hurt. Eventually, both were successfully restored with dental crowns. Still, it was a painful (and costly) injury — and one that could have been avoided.
You might not realize it, but when it comes to dental injuries, basketball ranks among the riskier sports. Yet it’s far from the only one. In fact, according to the American Dental Association (ADA), there are some two dozen others — including baseball, hockey, surfing and bicycling — that carry a heightened risk of dental injury. Whenever you’re playing those sports, the ADA recommends you wear a high-quality mouth guard.
Mouthguards have come a long way since they were introduced as protective equipment for boxers in the early 1900’s. Today, three different types are widely available: stock “off-the-shelf” types that come in just a few sizes; mouth-formed “boil-and-bite” types that you adapt to the general contours of your mouth; and custom-made high-quality mouthguards that are made just for you at the dental office.
Of all three types, the dentist-made mouthguards are consistently found to be the most comfortable and best-fitting, and the ones that offer your teeth the greatest protection. What’s more, recent studies suggest that custom-fabricated mouthguards can provide an additional defense against concussion — in fact, they are twice as effective as the other types. That’s why you’ll see more and more professional athletes (and plenty of amateurs as well) sporting custom-made mouthguards at games and practices.
“I would have saved myself a lot of dental heartache if I had worn a mouthguard,” noted Dr. Stork. So take his advice: Wear a mouthguard whenever you play sports — unless you’d like to meet him (or one of his medical colleagues) in a professional capacity…
Your teen is about to embark on an orthodontic journey to a straighter, more attractive smile. But although you're excited about the outcome, you both may be steeling yourselves for a few years of "life with braces."
But maybe not—your teen may be able to take advantage of a different kind of corrective appliance: clear aligners. This 21st Century teeth movement method has a number of advantages over braces. For teens, though, there's one big one that could have a huge impact on their social life—clear aligners are nearly invisible to other people.
Clear aligners consist of a series of clear, removable, computer-generated trays based on photographs, models and x-rays of an individual patient's teeth and bite. Each of the trays is slightly different from the previous one in the series, and by wearing each one for about two weeks before moving on to the next, the aligners gradually move the teeth to the desired new positions.
Besides reducing embarrassment often associated with wearing metal braces, clear aligners have other benefits. Unlike braces, they can be removed for eating, easier oral hygiene or for rare special occasions (although for best effectiveness, they should be worn for 20 to 22 hours each day). Recent developments like added elements that help target certain teeth for movement or "power ridges" for more controlled and efficient force have increased the range of bite problems they can be used to correct.
While this means clear aligners can be used for many bite problems, in some severe cases braces and other orthodontic treatments might still be necessary. And because they're not fixed like braces (only the orthodontist can remove them) the patient must have the maturity and self-discipline to wear them consistently.
Your teen will need to undergo a thorough orthodontic examination to see if clear aligners are a viable option for them. If so, it could make the next few treatment years less stressful for both of you.
If you would like more information on clear aligners, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Clear Aligners for Teens: User-Friendly Orthodontics.”
Periodontal (gum) disease is an aggressive bacterial infection caused by built-up plaque on tooth surfaces. Gum disease results in bone loss and causes loss of attachment from the teeth, leading to eventual tooth loss.
The goal of any gum disease treatment is to remove as much plaque and calculus (hardened deposits of plaque) from the gums and teeth as possible. Scaling with special hand instruments or ultrasonic equipment is the basic technique for plaque and calculus removal above and below the gum line. As the infection spreads below the gum line, it can widen the natural gap between teeth and gums to form voids known as periodontal pockets that fill with infection. Accessing and cleaning these pockets, which can occur as deep as the tooth roots, will require more invasive procedures.
Pockets that form at a depth greater than 5 mm below the gum line will most likely require surgical access through the gum tissue. But for pockets not quite that deep there’s an intermediary technique called root planing without surgical intervention. As the name suggests, the roots are physically “planed,” much like shaving a wooden board to remove minute layers of wood.
Using similar instruments as with scaling, root planing removes calculus, bacteria and other infected matter adhering to the root surfaces. It’s best to perform the procedure with local anesthesia to numb the gum tissues, which may be quite sensitive depending on the degree of infection. Working in a pain-free environment also helps us to be as thorough as possible in detecting and removing every bit of plaque and calculus we can find.
In advanced cases, it may be necessary to perform this procedure during multiple visits. As plaque and calculus are removed the inflammation in affected tissues will begin to subside, revealing more deposits of plaque and calculus. It’s also important to begin and maintain a daily habit of effective brushing and flossing to lessen the chances of a recurring infection.
Treating gum disease is an ongoing effort that requires constant monitoring and sustained efforts to remove plaque and calculus, including root planing. Saving your teeth, however, is well worth the effort.
If you would like more information on treating periodontal disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Root Planing.”