Posts for category: Dental Procedures
As your dental provider, we're always alert for signs of tooth decay or periodontal (gum) disease, the two leading causes of tooth loss. But we're also watching for less common conditions that could be just as devastating.
Root resorption falls into this latter category: it occurs when a tooth's root structure begins to break down and dissolve (or resorb). It's a normal process in primary ("baby") teeth to allow them to loosen and give way when permanent teeth are ready to erupt.
It's not normal, though, for permanent teeth. Something internally or—more commonly—externally causes the root structure to break down. External resorption usually occurs at the neck-like or cervical area of a tooth around the gum line. Known as external cervical resorption (ECR), it can first appear as small, pinkish spots on the enamel. These spots contain abnormal cells that cause the actual damage to the root.
We don't fully understand how root resorption occurs, but we have identified certain factors that favor its development. For example, it may develop if a person has experienced too much force against the teeth during orthodontic treatment. Injury to the periodontal ligaments, teeth-grinding habits or some dental procedures like internal bleaching may also contribute to later root resorption.
Early diagnosis is a major part of effective treatment for root resorption. Because it's usually painless and easily overlooked, resorption is often too difficult to detect in its early stages without x-rays—a good reason for regular dental exams. Beginning spots or lesions are usually small enough to surgically remove the tissue cells causing the damage and then filled with a tooth-colored filling material. If it has advanced further, we may also need to perform a root canal treatment.
At some point, the damage from root resorption can be too great, in which case it might be best to remove the tooth and replace it with a dental implant or similar restoration. That's why catching root resorption early through regular dental exams can give you the edge for saving your tooth.
If you would like more information on diagnosing and treating root resorption, 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 Resorption: An Unusual Phenomenon.”
If you smoke, you know better than anyone how a hard a habit it is to kick. If you want to quit, it helps to have a motivating reason—like lowering your risk for cancer, cardiovascular disease or similar conditions.
Here’s another reason for quitting tobacco: it could be making your teeth and gums less healthy. And, if you’re facing a restoration like dental implants, smoking can make that process harder or even increase the risk of failure.
So, to give your willpower some needed pep talk material, here are 3 reasons why smoking doesn’t mix with dental implants.
Inhaled smoke damages mouth tissues. Though you may not realize it, the smoke from your cigarette or cigar is hot enough to burn the top layer of skin cells in your mouth, which then thickens them. This could affect your salivary glands causing them to produce less saliva, which in turn could set off a chain of events that increases your risk of tooth decay or periodontal (gum) disease. The end result might be bone loss, which could make installing dental implants difficult if not impossible.
Nicotine restricts healthy blood flow. Nicotine, the chemical tobacco users crave, can restrict blood flow in the tiny vessels that course through the mouth membranes and gums. With less blood flow, these tissues may not receive enough antibodies to fight infection and fully facilitate healing, which could interfere with the integration of bone and implants that create their durable hold. Slower healing, as well as the increased chances of infection, could interrupt this integration process.
Smoking contributes to other diseases that impact oral health. Smoking’s direct effect on the mouth isn’t the only impact it could have on your oral health. As is well known, tobacco use can increase the risk of systemic conditions like cardiovascular and lung disease, and cancer. These conditions may also trigger inflammation—and a number of studies are showing this triggered inflammatory response could also affect your body’s ability to fight bacterial infections in the mouth. Less healthy teeth, gums and underlying bone work against your chances of long-term success with implants.
If you would like more information on dental implants, 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 Implants & Smoking: What are the Risks?”
Installing dental implants involves more than the mechanics of placing them into the jawbone. Ultimate success — a natural and beautiful smile — requires painstaking attention to detail and artistry.
Here are a few of the factors we must consider to achieve a smile with dental implants you’ll be proud to display.
The amount of available bone. For the permanent crown to appear natural, it’s crucial to position the implant precisely. To achieve this precision requires an adequate amount of bone to be present. Unfortunately, bone loss is quite common after tooth loss; to minimize this we place bone grafts in the empty socket if at all possible after extraction to encourage bone growth. It’s also possible in some cases to perform bone grafting surgery before implants to build up bone volume.
Your genetic gum tissue type. There are basically two types of gum tissue people are born with: thin or thick. Thin tissues are more subject to wear, difficult to work with during surgery and can make it difficult to hide the metal components of an implant. Thicker tissues are easier to work with, but can have a tendency to overgrow.
Achieving a natural “emergence profile.” To look natural, the implant crown must appear to seamlessly emerge from the surrounding gum tissue. To achieve this, we must carefully plan and place the implant in the precise location in the bone, taking into account the implant shape and how far it should be placed within the bone to match the position and height of adjacent teeth and gum tissues.
Blending color shades with adjacent natural teeth. When it comes to color, everyone has subtle differences in tooth shades and hues. In fact, there are slight color variations within individual teeth, from the root to the tip of the crown. To make sure the implant blends in with adjacent teeth, it’s important to match the color incorporated into the porcelain crown with the natural crowns beside them.
These and other factors require both technical expertise and a sense of artistry. Carefully considering all of them will help ensure your dental implants result in the smile you want.
If you would like more information on smile transformations with dental implants, 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 “Matching Teeth & Implants.”
Gum recession — when the gum tissue covering teeth wears away — is a serious matter. If the roots become exposed you'll not only have increased sensitivity and possible discomfort, your teeth can become more susceptible to decay.
There are a number of reasons for gum recession, including overaggressive brushing and flossing, poor fitting appliances like dentures or braces, or genetics (inheriting a thin gum tissue type or poor tooth position). Perhaps the most common reason, though, is periodontal (gum) disease. Caused by bacterial plaque, a thin film of food particles that builds up on tooth surfaces, the disease weakens the gum tissues around teeth, causing them ultimately to detach and “roll up” toward the roots.
Treating the gum infection by removing the built-up plaque and calculus (hardened plaque deposits) will help stop recession or even reverse it. Â As we remove plaque the infection subsides and the gums cease to be inflamed. If they haven't receded too far they may re-grow and renew their attachment to the teeth.
In other cases, though, the recession may have progressed too far and too rapidly toward root exposure. Gums in this condition may require tissue grafts to the recessed area to create or regenerate new tissue.
Most grafting techniques fall into one of two categories. The first is known as free gingival grafting where a thin layer of skin is removed or "freed" from the roof of the patient's mouth (the palate), shaped and then stitched to the recession site.
The second category is called connective tissue grafting, most often used to cover exposed roots. In this case the donor material is transplanted from the donor site to the recipient site, but the recipient site's tissue covers the donor connective tissue graft as it still maintains a physical attachment to the original location. The recipient site can thus maintain a blood supply, which can result in quicker, more comfortable healing than with free gingival grafting.
Connective tissue grafting does, however, require sophisticated microsurgical techniques, along with the surgeon's in-depth skill and art, to prepare both the donor and recipient sites. Allografts (donor skin from another person) may also be used as a donor tissue and placed beneath the recipient site tissue thereby avoiding a second surgical site.
Gum tissue grafting can be an intense undertaking, but the results can be astounding. Not only will restoring recessed gum tissues give your teeth a new lease on life, it will revitalize your smile.
If you would like more information on treatment for gum recession, 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 “Periodontal Plastic Surgery.”
Periodontal (gum) disease is potentially devastating to your teeth, gums and bone. To fight it we have to remove the substance that causes and sustains the disease from all oral surfaces — a thin layer of bacteria and food particles known as plaque.
To accomplish this task, we use a variety of hand instruments called scalers to mechanically remove plaque and calculus (hardened plaque deposits), as well as ultrasonic equipment to vibrate plaque loose and flush it away with water. If we detect plaque deposits well below the gum line and around the tooth roots, we may need to use other techniques like root planing or surgery to access these deeper areas.
Â While gum disease is persistent and aggressive, these traditional techniques have proven quite effective in controlling the infection and restoring health to diseased gums. Yet like other aspects of medicine and dentistry, technological advances have created a new option for gum disease treatment: the Nd:YAG laser.
The Nd:YAG laser is named for the crystal it uses to produce a narrow and intense beam of light on a specific frequency. In recent years it's become an important surgical tool because it can distinguish between diseased and healthy tissue, destroying the former while not affecting the latter.Â It's being used now on a limited basis for treating gum disease, especially for removing infected tissue in deep pockets that can form below the gum line, and for removing plaque and calculus from root surfaces.
Â Because of its precision, early evidence of effectiveness is encouraging: minimal tissue damage and swelling, less bleeding and reduced patient discomfort after treatment. The heat from the laser has also been shown to kill bacteria and essentially sterilize the area.
Still, the findings aren't conclusive enough as to whether lasers are superior in most circumstances to traditional scaling methods. For the time being, we'll continue to use the tried and true methods for removing plaque and calculus. But as laser technology advances, the time may come when this new approach to gum disease treatment will become a more prominent and beneficial option for patients.
If you would like more information on your treatment options for 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 magazine article “Lasers Versus Traditional Cleanings for Treating Gum Disease.”