Periodontal (gum) disease is a bacterial infection, which if left untreated could cause gum recession, bone loss and eventually tooth loss. Caused mainly by plaque left on tooth surfaces from poor hygiene practices, the deeper the infection spreads below the gum line, the more difficult it is to treat.
One possible scenario involves parts of a tooth’s root structure known as furcations. These are branching forks formed during the early development of teeth with multiple roots where they take different paths from the base of the crown. As gum disease spreads around the root it may cause different degrees of bone loss at the point of the branch.
It’s imperative when treating gum disease to uncover and remove any bacterial plaque or calculus (hardened plaque deposits) found, including below the gum line. To address bacterial plaque at the root level, it’s important to first determine if bone loss has involved the furcations (where the roots separate, also referred to as a “furcation invasion”) and to what degree.
We usually classify this degree of involvement in three classes: Class I, the invasion has created a groove in the furcation, but minimal significant bone loss; Class II, the bone loss has extended into the furcation by at least two millimeters; or Class III, the bone loss extends completely from one end of the furcation to the other (or “through and through”).
Depending on the class, cleaning plaque and calculus from furcations and then maintaining them thereafter can be quite challenging. We may need to use specially shaped hand instruments known as scalers or curettes to reach and clean root surfaces, or ultrasonic scalers that use high-frequency vibrations and streaming water to loosen and flush away plaque debris. It may also prove helpful, though limited, to apply antimicrobials or antibiotics to the area to help limit the levels of bacteria.
Disease damage around furcations may also require surgical treatment to encourage new tissue and bone growth in the area. Surgery can also help make the area more accessible to future cleaning and maintenance, both for you and us. Renewed hygiene practices on your part and regular cleaning and checkups with us will help ensure that the situation involving your tooth roots can be kept under control and your tooth preserved for many years to come.
Undergoing regular dental cleanings is an essential part of periodontal (gum) disease prevention. While a daily habit of brushing and flossing cleans bacterial plaque from most tooth surfaces, it’s difficult to remove from places your brush or floss can’t access well. That, as well as hardened plaque deposits known as calculus, must be removed by a hygienist or dentist with a technique known as scaling.
Scaling is traditionally performed manually using specialized hand instruments known as scalers. Although hand scalers are quite effective, they must be used carefully to avoid damage to gum tissue or, during deeper cleaning known as root planing, the tooth roots. A different method for plaque removal known as ultrasonic scaling has grown in popularity as an alternative to manual scaling.
Ultrasonic scaling uses equipment emitting vibrational energy that crushes and loosens plaque and calculus, and disrupts growing bacterial colonies in biofilm. Plaque particles are then washed away using water irrigation. The most recent models of ultrasonic scalers have matched the effectiveness of hand scaling in removing plaque and calculus in shallow gum pockets, and surpassed the manual technique in cleaning out pockets greater than 4 mm. In experienced hands, they’re kinder to tooth structure and other tissues. Water irrigation also improves healing by removing bacteria and scaling by-products, which also makes the area easier to view by the hygienist.
On the other hand, any type of power scaler must be used with caution with patients who have pacemakers, and are not recommended for those with hypersensitive teeth or teeth that are in the early stages of de-mineralization. The technique may also produce an aerosol of finely misted particles (with possible contamination) that requires added measures to contain them.
For most patients, though, ultrasonic scalers are an effective tool for plaque and calculus removal. As ultrasonic devices continue to evolve, patients will ultimately benefit from greater comfort and reduced treatment times.
If you would like more information on plaque removal with ultrasonic scalers, 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 “Dental Cleanings Using Ultrasonic Scalers.”
Dental implants are by far the best way to replace missing teeth. But they do more than improve your smile: they can restore your ability to eat, chew and talk properly, especially if the teeth replaced are in the back of your mouth. What’s more, they can improve the entire look of your face by restoring facial height and cheek support lost because of the missing teeth.
There is, however, one obstacle to overcome before receiving dental implants — a lack of sufficient bone at the implant site. Bone loss usually occurs when teeth have been missing for some time. This is because when we chew the forces generated by the teeth stimulate continual bone growth to make up for older bone that has dissolved (resorbed). This stimulation doesn’t occur after teeth are lost, which slows the rate of bone growth. Over time the amount of healthy bone diminishes.
Without enough bone for support, implants can’t be placed properly. Fortunately, some of the bone can be regenerated through techniques that place bone grafting material at the site to stimulate and serve as a scaffold for new bone.Â The new bone will eventually replace the graft.
For missing upper back teeth with bone loss, we can take advantage of facial anatomy to grow the bone needed for implants. This area of the face is where the maxillary sinuses, air spaces lined with a tissue membrane, are located on either side just above the upper jaw. After determining their exact size and location through detailed x-ray imaging, we can surgically access the area inside the mouth just above the missing teeth.
The sinus cavity is an area where bone growth can occur by placing a bone graft between the floor of the sinus and the sinus membrane. Sometimes bone growth enhancers are used to stimulate and speed up regeneration. The procedure can usually be performed with local anesthesia (much like a routine tooth filling), with only mild discomfort afterward for a few days managed by an anti-inflammatory drug like ibuprofen and a decongestant for sinus swelling.
After six to seven months, we re-evaluate the area to see if sufficient bone has returned for implant surgery. If so, you will be well on your way to achieving a new look and better function through dental implants.
If you would like more information on building new bone through sinus surgery, 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 “Sinus Surgery.”
The movie Bohemian Rhapsody celebrates the iconic rock band Queen and its legendary lead vocalist, Freddie Mercury. But when we see pictures of the flamboyant singer, many fans both old and new may wonder—what made Freddie’s toothy smile look the way it did? Here’s the answer: The singer was born with four extra teeth at the back of his mouth, which caused his front teeth to be pushed forward, giving him a noticeable overbite.
The presence of extra teeth—more than 20 primary (baby) teeth or 32 adult teeth—is a relatively rare condition called hyperdontia. Sometimes this condition causes no trouble, and an extra tooth (or two) isn’t even recognized until the person has an oral examination. In other situations, hyperdontia can create problems in the mouth such as crowding, malocclusion (bad bite) and periodontal disease. That’s when treatment may be recommended.
Exactly what kind of treatment is needed? There’s a different answer for each individual, but in many cases the problem can be successfully resolved with tooth extraction (removal) and orthodontic treatment (such as braces). Some people may be concerned about having teeth removed, whether it’s for this problem or another issue. But in skilled hands, this procedure is routine and relatively painless.
Teeth aren’t set rigidly in the jawbone like posts in cement—they are actually held in place dynamically by a fibrous membrane called the periodontal ligament. With careful manipulation of the tooth, these fibers can be dislodged and the tooth can be easily extracted. Of course, you won’t feel this happening because extraction is done under anesthesia (often via a numbing shot). In addition, you may be given a sedative or anti-anxiety medication to help you relax during the procedure.
After extraction, some bone grafting material may be placed in the tooth socket and gauze may be applied to control bleeding; sutures (stitches) are sometimes used as well. You’ll receive instructions on medication and post-extraction care before you go home. While you will probably feel discomfort in the area right after the procedure, in a week or so the healing process will be well underway.
Sometimes, dental problems like hyperdontia need immediate treatment because they can negatively affect your overall health; at other times, the issue may be mainly cosmetic. Freddie Mercury declined treatment because he was afraid dental work might interfere with his vocal range. But the decision to change the way your smile looks is up to you; after an examination, we can help you determine what treatment options are appropriate for your own situation.
If you have questions about tooth extraction or orthodontics, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Simple Tooth Extraction” and “The Magic of Orthodontics.”
If you’re over age 30 there’s a fifty percent chance you have periodontal (gum) disease—and you may not even know it. Without treatment this often “silent” bacterial infection could cause you to lose gum coverage, supporting bone volume or eventually your teeth.
That’s not to say there can’t be noticeable symptoms like swollen, red, bleeding or painful gums. But the surest way to know if you have gum disease, as well as how advanced it is, is to have us examine your gums with manual probing below the gum line.
Using a long metal device called a periodontal probe, we can detect if you’ve developed periodontal pockets. These are gaps created when the diseased gum’s attachment to teeth has weakened and begun to pull away. The increased void may become inflamed (swollen) and filled with infection.
During an exam we insert the probe, which has markings indicating depths in millimeters, into the naturally occurring space between tooth and gums called the sulcus. Normally, the sulcus extends only about 1-3 mm deep, so being able to probe deeper is a sign of a periodontal pocket. How deep we can probe can also tell us about the extent of the infection: if we can probe to 5 mm, you may have early to mild gum disease; 5-7 mm indicates moderate gum disease; and anything deeper is a sign of advanced disease.
Knowing periodontal pocket depth helps guide our treatment strategy. Our main goal is to remove bacterial plaque, a thin film of food particles that collects on teeth and is the main cause and continuing fuel for the infection. In mild to moderate cases this may only require the use of hand instruments called scalers to manually remove plaque from tooth surfaces.
If, however, our periodontal probing indicates deeper, advanced gum disease, we may need to include surgical procedures to access these infected areas through the gum tissue. By knowing the depth and extent of any periodontal pockets, we can determine whether or not to use these more invasive techniques.
Like many other health conditions, discovering gum disease early could help you avoid these more advanced procedures and limit the damage caused by the infection. Besides daily brushing and flossing to remove plaque and regular dental checkups, keep watch for signs of swollen or bleeding gums and contact us for an appointment as soon as possible. And be aware that if you smoke, your gums will not likely bleed or swell—that could make diagnosis more difficult.
If you would like more information on treating gum disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor article “Understanding Periodontal Pockets.”
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