Periodontal (gum) disease, which is also known as periodontal disease and periodontitis, is a progressive disease which if left untreated may result in tooth loss. Gum disease begins with the inflammation and irritation of the gingival tissues which surround and support the teeth. The cause of this inflammation is the toxins found in plaque which cause an ongoing bacterial infection.

The bacterial infection colonizes in the gingival tissue and deep pockets form between the teeth and the gums. If treated promptly by a periodontist, the effects of mild inflammation (known as gingivitis) are completely reversible. However, if the bacterial infection is allowed to progress, periodontal disease begins to destroy the gums and the underlying jawbone; promoting tooth loss. In some cases, the bacteria from this infection can travel to other areas of the body via the bloodstream.

Common Causes of Gum Disease

There are genetic and environmental factors involved in the onset of gum disease, and in many cases the risk of developing periodontitis can be significantly lowered by taking preventative measures. Here are some of the most common causes of gum disease:

• Poor dental hygiene: Preventing dental disease starts at home with good oral hygiene and a balanced diet. Prevention also includes regular dental visits which include exams, cleanings, and x-rays. A combination of excellent home care and professional dental care will ensure and preserve the natural dentition and supporting bony structures. When bacteria and calculus (tartar) are not removed, the gums and bone around the teeth become affected by bacteria toxins and can cause gingivitis or periodontitis, which can lead to tooth loss.
• Tobacco use: Research has indicated that smoking and tobacco use is one of the most significant factors in the development and progression of gum disease. In addition to smokers experiencing a slower recovery and healing rate, smokers are far more likely to suffer from calculus (tartar) build up on teeth, deep pockets in the gingival tissue and significant bone loss.
• Genetic predisposition: Despite practicing rigorous oral hygiene routines, as much as 30% of the population may have a strong genetic predisposition to gum disease. These individuals are six times more likely to develop periodontal disease than individuals with no genetic predisposition. Genetic tests can be used to determine susceptibility and early intervention can be performed to keep the oral cavity healthy.
• Pregnancy and menopause: During pregnancy, regular brushing and flossing is critical. Hormonal changes experienced by the body can cause the gum tissue to become more sensitive, rendering them more susceptible to gum disease.
• Chronic stress and poor diet: Stress lowers the ability of the immune system to fight off disease, which means bacterial infections may possibly beat the body’s defense system. Poor diet or malnutrition can also lower the body’s ability to fight periodontal infections, as well as negatively affecting the health of the gums.
• Diabetes and underlying medical issues: Many medical conditions can intensify or accelerate the onset and progression of gum disease including respiratory disease, heart disease, arthritis and osteoporosis.
• Grinding teeth: The clenching or grinding of the teeth can significantly damage the supporting tissue surrounding the teeth. Grinding one’s teeth is usually associated with a “bad bite” or the misalignment of the teeth. When an individual is suffering from gum disease, the additional destruction of gingival tissue due to grinding can accelerate the progression of the disease.
• Medication: Many drugs including oral contraceptive pills, heart medicines, anti-depressants and steroids affect the overall condition of teeth and gums; making them more susceptible to gum disease. Steroid use promotes gingival overgrowth, which makes swelling more commonplace and allows bacteria to colonize more readily in the gum tissue.

Treatment of Gum Disease

Periodontists specialize in the treatment of gum disease and the placement of dental implants. A periodontist can perform effective cleaning procedures in deep pockets such as scaling and root planing, and also prescribe antibiotic and antifungal medications to treat infection and halt the progression of the disease.

In the case of tooth loss, the periodontist is able to perform tissue grafts to promote natural tissue regeneration, and insert dental implants if a tooth or several teeth are missing. Where gum recession causes a “toothy” looking smile, the periodontist can recontour the gingival tissue to create an even and aesthetically pleasing appearance.

Preventing periodontal disease is critical in preserving the natural dentition. Addressing the causes of gum disease and discussing them with your dentist will help prevent the onset, progression, and recurrence of periodontal disease. If you have any questions or concerns about the causes or treatments pertaining to gum disease, please ask your dentist.

It is well documented that people who suffer from diabetes are more susceptible to developing infections than non-diabetes sufferers. It is not widely known that t periodontal disease is often considered the sixth complication of diabetes; particularly when the diabetes is not under proper control. Periodontal disease (often called periodontitis and gum disease) is a progressive condition that often leads to tooth loss if treatment is not promptly sought. Periodontal disease begins with a bacterial infection in the gingival tissue which surrounds the teeth. As the bacteria colonize, the gum pockets become deeper, the gums recede as tissue is destroyed and the periodontitis eventually attacks the underlying bone tissue.

Reasons for the Connection

Experts suggest the relationship between diabetes and periodontal disease can worsen both conditions if either condition is not properly controlled. Here are ways in which diabetes and periodontal disease are linked:

• Increased blood sugar: Moderate and severe periodontal disease elevates sugar levels in the body, increasing the amount of time the body has to function with high blood sugar. This is why diabetics with periodontitis have difficulty keeping control of their blood sugar. In addition, the higher sugar levels found in the mouth of diabetics provide food for the very bacteria that worsen periodontal infections.
• Blood vessel thickening: The thickening of the blood vessels is one of the other major concerns for diabetes sufferers. The blood vessels normally serve a vital function for tissues by delivering nutrients and removing waste products. With diabetes, the blood vessels become too thick for these exchanges to occur. This means that harmful waste is left in the mouth and can weaken the resistance of gum tissue, which can lead to infection and gum disease.
• Smoking: Tobacco use does a great deal of damage in the oral region. Not only does tobacco use slow the healing process, it also vastly increases the chances of an individual developing periodontal disease. For diabetics who smoke, the risk is exponentially greater. In fact, diabetic smokers aged 45 and over are twenty times more likely to develop periodontal disease.
• Poor oral hygiene:  It is essential for diabetics to maintain excellent levels of oral health. When daily brushing and flossing does not occur, the harmful oral bacteria can ingest the excess sugar between the teeth and colonize more freely below the gum line. This exacerbates the metabolic problems that diabetes sufferers experience.

Diagnosis and Treatment

It is of paramount importance for people suffering from any type of diabetes to see the dentist at least twice yearly for checkups and professional cleanings. Studies have shown that simple non-surgical periodontal treatments can lower the HbA1c (hemoglobin molecule blood test) count by as much as 20% in a six month period.

The dentist will use medical history, family history and dental X-rays to assess the risk factors for periodontal disease and determine the exact condition of the gums, teeth and underlying jawbone. If necessary the dentist will work in conjunction with other doctors to ensure that both the diabetes and the gum disease are being managed and controlled as effectively as possible.

Non-surgical procedures performed by the dentist and dental hygienist include deep scaling, where calculus (tartar) will be removed from the teeth above and below the gumline, and root planing, where the root of the tooth is smoothed down to eliminate any remaining bacteria. Antibiotics may be applied to the gum pockets to promote healing. Before and after periodontal treatment, the dentist and hygienist will recommend proper home care and oral maintenance as well as prescribing prescription mouthwashes which serve to deter further bacteria colonization. If you have questions or concerns about diabetes or periodontal disease, please ask your dentist.

Teeth whitening (or bleaching) is a simple, non-invasive dental treatment used to change the color of natural tooth enamel and is an ideal way to enhance the beauty of your smile. Because having whiter teeth has now become the number one aesthetic concern of most patients, there are a number of ways to whiten teeth. The most popular method is using a home teeth whitening system that will whiten teeth dramatically. Since teeth whitening only works on natural tooth enamel, it is important to evaluate replacement of any old fillings, crowns, etc. Replacement of any restorations will be done after bleaching so they will match the newly bleached teeth.

Teeth whitening is not permanent. A touch-up maybe needed every several years, and more often if you smoke, drink coffee, tea, or wine.Reasons for teeth whitening:

• Fluorosis (excessive fluoridation during tooth development)
• Normal wear of outer tooth layer
• Stained teeth due to medications
• Yellow, brown stained teeth

What does teeth whitening involve?

This type of teeth whitening usually requires two visits. At the first appointment, impressions (molds) will be made of your teeth to fabricate custom, clear plastic, trays.

At your second appointment, you will try on the trays for proper fit, and adjustments will be made if necessary. The trays are worn with special whitening solution either twice a day for 30 minutes or overnight for a couple of weeks depending on the degree of staining and desired level of whitening. It is normal to experience tooth sensitivity during the time you are whitening your teeth, but it will subside shortly after you have stopped bleaching. You will receive care instructions for your teeth and trays, and be encouraged to visit your dentist regularly to help maintain a beautiful, healthy, white smile.

Bruxism refers to an oral parafunctional activity which occurs in most humans at some point in their lives. The grinding of the teeth and the clenching of the jaw are the two main characteristics of this condition, which can occur either during the day or at night.

Bruxism is one of the most common known sleep disorders and causes most of its damage during sleeping hours. The clenching and grinding which accompanies bruxism is symptomatic of a malfunctioning chewing reflex, which is turned off in non-sufferers when sleeping. For sufferers, deep sleep or even naps, cause the reflex nerve control center in the brain to turn off, and the reflex pathways to become active.

Typically, the incisors and canines (front 6 upper and lower teeth) of opposing arches grind against each other laterally. This side to side action puts undue strain on the medial pterygoid muscles and the temporomandibular joints. Earache, depression, headaches, eating disorders and anxiety are amongst the most common symptoms of bruxism; which often accompanies chronic stress, Alzheimer’s disease and alcohol abuse.

Bruxism is frequently misdiagnosed or not diagnosed at all, because it is only one of several potential causes of tooth wear. Only a trained professional can tell the difference between bruxing wear and wear caused by overly aggressive brushing, acidic soft drinks and abrasive foods.

A BiteStrip® is an economical device used to diagnose bruxism at home. The device itself is a small electromyography which senses and monitors any activity in the jaw muscles during sleep. The frequency and severity of the condition can then be assessed and the best treatment plan can be formulated.

Reasons for the treatment of bruxism

Here are some of the main reasons why bruxism should be promptly treated:

• Gum recession and tooth loss – Bruxism is one of the leading causes of gum recession and tooth loss; firstly because it damages the soft tissue directly, and secondly because it leads to loose teeth and deep pockets where bacteria can colonize and destroy the supporting bone.
• Occlusal trauma – The abnormal wear patterns on the occlusal (chewing) surfaces can lead to fractures in the teeth, which may require restorative treatment.
• Arthritis – In severe and chronic cases, bruxing can eventually lead to painful arthritis in the temporomandibular (TMJ) joints (the joints that allow the jaw to open smoothly).
• Myofascial pain – The grinding associated with bruxism can eventually shorten and blunt the teeth. This can lead to muscle pain in the myofascial region and debilitating headaches.

Treatment options for bruxism

There is no single cure for bruxism, though a variety of helpful devices and tools are available. Here are some common ways in which bruxism is treated:

• • Mouthguards – An acrylic mouthguard can be designed from tooth impressions to minimize the abrasive action of tooth surfaces during normal sleep. Mouthguards should be worn on a long-term basis to help prevent tooth damage, damage to the temporomandibular joint and help to stabilize the occlusion.
  • NTI-tss device – This device is fitted by a health professional and only covers the front teeth. The goal of the NTI-tss is to prevent the grinding of the rear molars by limiting the contraction of the temporalis muscle.

Other methods of treatment include relaxation exercises, stress management education and biofeedback mechanisms. When the bruxing is under control, there are a variety of dental procedures such as crowns, gum grafts and crown lengthening that can restore a pleasant aesthetic appearance to the smile. If you have questions or concerns about bruxism, please ask your dentist.

Soft tissue grafting is often necessary to combat gum recession. Periodontal disease, trauma, aging, over brushing, and poor tooth positioning are the leading causes of gum recession which can lead to tooth-root exposure in severe cases.

When the roots of the teeth become exposed, eating hot and cold foods can be uncomfortable, decay is more prevalent and the aesthetic appearance of the smile is altered. The main goal of soft tissue grafting is to either cover the exposed root or to thicken the existing gum tissue in order to halt further tissue loss. The three different types of common soft tissue grafts include:

• Free gingival graft – A strip of tissue is removed from the roof of the mouth and stitched to the grafting site in order to promote natural growth. This type of graft is most commonly used for thickening existing tissue.
• Connective tissue graft – For larger areas or root exposure, subepithelial tissue is needed to remedy the problem. This subepithelial connective tissue is removed from a small flap in the mouth and sutured to the grafting site. This is the most common treatment for root exposure.
• Pedicle graft – This type of graft involves the “sharing” of soft tissue between the affected site and adjacent gum. A flap of tissue is partially cut away and moved sideways to cover the root. The results of this type of graft are excellent because the tissue that is moved to the adjacent area includes blood vessels that are left in place.

Reasons for soft tissue grafting

Soft tissue grafting is an extremely versatile procedure that has many uses. Recent developments in dental technology have made soft tissue grafting more predictable and less intrusive. Here are some of the main benefits associated with soft tissue grafting treatment:

• Increased comfort – Root exposure can cause substantial pain and discomfort. Eating hot, cold or even warm foods can cause severe discomfort. Soft tissue grafts cover the exposed root, decreases sensitivity and restore good health to the gum area.
• Improved aesthetics – Gum recession due to periodontal disease can cause the smile to look “toothy” or the teeth to appear uneven in size. Soft tissue grafting can be used as a cosmetic procedure to re-augment the gums, and make the smile appear more symmetrical.
• Improved gum health – Periodontal disease is a progressive condition that can destroy soft tissue very rapidly. When used in combination with deep cleaning procedures, soft tissue grafting can halt tissue and bone loss, and protect exposed roots from further complications.

What does soft tissue grafting treatment involve?

Initially, deep cleaning will be performed both above and below the gum line to clear the teeth and roots of calculus (tartar). The grafting procedure itself will generally be performed under local anesthetic, but this will depend on the size of the areas receiving grafts. A small incision will be made at the recipient site in order to create a small pocket. A split thickness incision is made in this pocket and the donor tissue is placed between the two sections of this area. The donor tissue strip is generally larger than the incision, so some excess will be apparent.

Platelet rich growth factors which stimulate natural tissue growth and promote good healing may be applied to the site before suturing. In addition, tissue-stimulating proteins may be added to encourage quicker tissue growth. Finally, the wound site will be sutured to prevent shifting, and surgical material will be placed to protect the sensitive area. Gum uniformity and substantial healing will take place in the first six weeks after the procedure.

If you have any questions about soft tissue grafting, please ask your dentist.

A dental implant is essentially an artificial tooth root which is attached to the jaw bone. Eventually, a replacement tooth or bridge will be firmly fixed to this root, restoring complete function to the tooth. The key to a successful and long-lasting implant is the quality and quantity of jawbone to which the implant will be attached. If bone has been lost due to injury or periodontal disease, a sinus augmentation can raise the sinus floor to allow for new bone formation.

In the most common sinus augmentation technique, a tiny incision is made near the upper premolar or molar region to expose the jawbone. A small opening is cut into the bone and the membrane lining the sinus on the other side of the opening is gently pushed upward. The underlying space is filled with bone graft material and the incision is closed. The bone which is used for this procedure may be from your own body or from a cadaver. Sometimes the dentist might use synthetic materials which can also stimulate bone formation. The implants are placed after healing has occurred; this will depend on the individual case. Sinus augmentation has been shown to increase the success of dental implant procedures.

Periodontal disease is an extremely serious progressive condition which can lead to tooth loss if left untreated. Periodontal disease occurs when a bacterial infection in the gum pockets causes the bone and gum tissue to recede away from the teeth. The quality and quantity of bone and gum tissue is greatly reduced as the gum pockets continue to deepen. Fortunately, prompt diagnosis combined with effective regenerative procedures can halt the progression of the disease and save the teeth. There are many regenerative dental procedures available to restore health to the gums, bone and teeth. The following are the most commonly used regenerative procedures.

Bone Regeneration

Dental implants and other restorative procedures depend on the jawbone being sufficiently strong and thick. When periodontal disease has taken hold, the jawbone may have become too thin to successfully support an implant. Natural bone regeneration (or bone grafting) is one of the best ways to promote growth and thicken the jawbone.

Initially, bone grafting material is obtained from elsewhere on the body or from a bone bank. The gums are gently pulled back, and an opening is made in the jawbone where the grafting material will be packed in tightly. A membrane is used to maintain the shape of the new bone, and tissue stimulating proteins and a platelet-rich growth factor may be applied to promote faster healing. The surgical site will be sutured and packed with protective material. The bone will naturally regenerate and become strong enough to eventually support an implant.

Gum Tissue Regeneration

Gum tissue regeneration is usually performed by way of gum grafting. When gum tissue has been lost as a result of periodontal disease, the smile may appear discolored, toothy or unpleasant. A gum graft aims to symmetrically contour the gum line, cover any exposed tooth roots and restore health to the gums. Initially, a small strip of tissue will be removed from the roof of the mouth and placed in the middle of a split-thickness incision at the recipient site. The surgical site will be covered with a protective membrane which promotes tissue regeneration, covered in platelet-rich growth factor and tissue stimulating proteins, and then sutured closed. The soft tissue surrounding the teeth will naturally regenerate, producing a healthy, smile.

Pocket Reduction Surgery

The aim of pocket reduction surgery is to reduce the depth of the gum pockets and make it much harder for bacteria to invade the gum tissue. Initially, the gum tissue is pulled back from the teeth and the subgingival area is thoroughly cleansed under local anesthesia. Extensive scraping may be required to fully remove the plaque, debris and tartar from below the gum line. An antimicrobial agent may then be applied to the affected area to kill any remaining bacteria, and the surgical site will be sutured closed. Pocket reduction surgery is very effective for halting tissue loss and promoting the natural healing of the gums.

Scaling and Root Planing

The term “scaling” refers to the removal of plaque and calculus (tartar) from the supragingival region (above the gum line). This treatment is usually conducted in the course of a routine professional cleaning, and performed under local anesthetic. Root planing usually accompanies scaling and is performed in the subgingival region (below the gum line). Tartar and toxins are initially removed, and then the tooth root is smoothed down to promote good healing in the gum tissue. The planing of the tooth root provides a smooth area which prevents bacteria from recolonizing. If these procedures do not completely eradicate the infection, surgical measures may be required.

If you have any questions about regenerative procedures or periodontal disease, please ask your dentist.

A dental prophylaxis is a cleaning procedure performed to thoroughly clean the teeth. Prophylaxis is an important dental treatment for halting the progression of periodontal disease and gingivitis.

Periodontal disease and gingivitis occur when bacteria from plaque colonize on the gingival (gum) tissue, either above or below the gum line. These bacteria colonies cause serious inflammation and irritation which in turn produce a chronic inflammatory response in the body. As a result, the body begins to systematically destroy gum and bone tissue, making the teeth shift, become unstable, or completely fall out. The pockets between the gums and teeth become deeper and house more bacteria which may travel via the bloodstream and infect other parts of the body.

Reasons for prophylaxis/teeth cleaning

Prophylaxis is an excellent procedure to help keep the oral cavity in good health and also halt the progression of gum disease. Here are some of the benefits of prophylaxis:

• Tartar removal – Tartar (calculus) and plaque buildup, both above and below the gum line, can cause serious periodontal problems if left untreated. Even using the best brushing and flossing homecare techniques, it can be impossible to remove debris, bacteria and deposits from gum pockets. The experienced eye of a dentist using specialized dental equipment is needed in order to spot and treat problems such as tartar and plaque buildup.
• Aesthetics – It’s hard to feel confident about a smile marred by yellowing, stained teeth. Prophylaxis can rid the teeth of unsightly stains and return the smile to its former glory.
• Fresher breath – Periodontal disease is often signified by persistent bad breath (halitosis). Bad breath is generally caused by a combination of rotting food particles below the gum line, possible gangrene stemming from gum infection, and periodontal problems. The removal of plaque, calculus and bacteria noticeably improves breath and alleviates irritation.
• Identification of health issues – Many health problems first present themselves to the dentist. Since prophylaxis involves a thorough examination of the entire oral cavity, the dentist is able to screen for oral cancer, evaluate the risk of periodontitis and often spot signs of medical problems like diabetes and kidney problems. Recommendations can also be provided for altering the home care regimen.

What does prophylaxis treatment involve?

Prophylaxis can either be performed in the course of a regular dental visit or, if necessary, under general anesthetic. The latter is particularly common where severe periodontal disease is suspected or has been diagnosed by the dentist. An endotracheal tube is sometimes placed in the throat to protect the lungs from harmful bacteria which will be removed from the mouth. Prophylaxis is generally performed in several stages:

• Supragingival cleaning – The dentist will thoroughly clean the area above the gum line with scaling tools to rid them of plaque and calculus.
• Subgingival cleaning – This is the most important step for patients with periodontal disease because the dentist is able to remove calculus from the gum pockets and beneath the gum line.
• Root planing – This is the smoothing of the tooth root by the dentist to eliminate any remaining bacteria. These bacteria are extremely dangerous to periodontitis sufferers, so eliminating them is one of the top priorities of the dentist.
• Medication – Following scaling and root planing, an antibiotic or antimicrobial cream is often placed in the gum pockets. These creams promote fast and healthy healing in the pockets and help ease discomfort.
• X-ray and examination – Routine X-rays can be extremely revealing when it comes to periodontal disease. X-rays show the extent of bone and gum recession, and also aid the dentist in identifying areas which may need future attention.

Prophylaxis is recommended twice annually as a preventative measure, but should be performed every 3-4 months on periodontitis sufferers. Though gum disease cannot be completely reversed, prophylaxis is one of the tools the dentist can use to effectively halt its destructive progress. If you have questions or concerns about prophylaxis or periodontal disease, please ask your dentist.

Pocket reduction surgery (also known as gingivectomy, osseous surgery and flap surgery) is a collective term for a series of several different surgeries aimed at gaining access to the roots of the teeth in order to remove bacteria and tartar (calculus). The human mouth contains dozens of different bacteria at any given time. The bacteria found in plaque (the sticky substance on teeth) produce acids that lead to demineralization of the tooth surface, and ultimately contribute to periodontal disease.

Periodontal infections cause a chronic inflammatory response in the body that literally destroys bone and gum tissues once they invade the subgingival area (below the gum line). Gum pockets form and deepen between the gums and teeth as the tissue continues to be destroyed.

Periodontal disease is a progressive condition which, if left untreated, causes massive bacteria colonization in gum pockets can eventually lead to teeth falling out. Pocket reduction surgery is an attempt to alleviate this destructive cycle, and reduce the depth of the bacteria-harboring pockets.

Reasons for the pocket reduction surgery

Pocket reduction surgery is a common periodontal procedure which has been proven effective at eliminating bacteria, reducing inflammation and saving teeth. The goals of pocket reduction surgery are:

• Reducing bacterial spread – Oral bacteria has been connected to many other serious conditions such as diabetes, heart disease and stroke. Oral bacteria can travel to various parts of the body from inside the bloodstream and begin to colonize. It is important to decrease bacteria in the mouth in order to reduce the risk of secondary infection.
• Halitosis prevention – Halitosis (or bad breath) is generally a result of old food particles between the teeth, and tooth decay. A toothbrush or dental scraper alone may not be able to reach into the depths of the gum pockets, but water jets can flush out food particles and help clean above and below the gumline.
• Facilitate home care – As the gum pockets become progressively deeper, they become incredibly difficult to clean by the patient. The toothbrush and dental floss cannot reach to the bottom of the pockets, increasing the risk of further periodontal infections
• Enhancing the smile – An oral cavity that is affected by periodontal disease is not attractive to the eye. In fact, smiles may be marred by brown gums, rotting teeth and ridge indentations. Pocket reduction surgery halts the progression of gum disease and improves the aesthetics of the smile.

What does pocket reduction surgery involve?

Before recommending treatment or performing any procedure, the dentist will perform thorough visual and x-ray examinations in order to assess the condition of the teeth, gums and underlying bone. Pocket reduction surgery may be performed under local or general anesthetic depending on the preferences of the patient.

The gums will be gently pulled back from the teeth and bacteria and calculus (tartar) will be eliminated. Scaling and root planing will generally be required to fully remove the ossification (tartar) from the surface of the tooth root. If the root is not completely smooth, a planing procedure will be performed to ensure that when the gums do heal, they will not reattach to rough or uneven surfaces.

The final part of the surgery is usually the administration of an antimicrobial liquid to eliminate any remaining bacteria and promote healing. The gum is then sutured with tiny stitches that are left in place for 5-10 days.

Though the gums will be more sensitive immediately following the procedure, there will be a significant reduction in pocket depth and a vast improvement in the condition of the teeth and gums. If you have any questions about pocket reduction surgery or treatment for periodontal disease, please ask your dentist.

Periodontal disease is a progressive condition which leads to gum inflammation, the recession of bone and gum tissue, and tooth loss if left untreated. There are a variety of effective treatments and procedures available, including pocket irrigation, which can assist in treating the progression of the disease.

Pocket irrigation aims to cleanse plaque from the interdental (between teeth) and subgingival (under the gumline) regions of the mouth in order to prevent the colonization of harmful oral bacteria. This procedure is also used to deliver antibacterials to the subgingival areas.

Reasons for pocket irrigation

Pocket irrigation, which is also known as oral irrigation, is a versatile dental treatment used for several different preventative purposes. Pocket irrigation may be performed as part of a professional dental cleaning, or at home with a specially modified oral irrigator. Here are the main ways in which pocket irrigation can be beneficial:

• Interdental cleaning – Pocket irrigators blast plaque, food particles and other debris from between the teeth. The removal of harmful materials and bacteria keep the gum pockets cleaner and shallower; thus helping the gum tissue remain healthy.
• Halitosis prevention – Halitosis (or bad breath) is generally a result of old food particles between the teeth, and tooth decay. A toothbrush or dental scraper alone may not be able to reach into the depths of the gum pockets, but water jets can flush out food particles and help clean above and below the gumline.
• Subgingival cleaning – Pocket irrigators have a rounded tip which eliminates the risk of tissue damage while cleaning under the gumline. The side port opening facilitates extensive cleansing by flushing out bacteria, particles and toxins from below the gumline.
• Antimicrobial application – Antimicrobial substances have proven effective for eliminating and preventing some strains of harmful oral bacteria. Antimicrobial substances can be combined with water, or used as a stand-alone treatment for successful pocket irrigation.

What does pocket irrigation treatment involve?

Pocket irrigation is generally performed in combination with other dental treatments; for example, as part of a professional dental cleaning or in combination with pocket reduction surgery. In the case of a pocket reduction surgery, the tartar and subgingival plaque will be removed with special scaling and root planing instruments. When the pockets are free of debris, an antimicrobial agent may be applied using an oral irrigator. This will help reduce harmful oral bacteria which still remain in the pockets.

During a deep cleaning procedure, a pocket irrigator may be used after scaling and root planing to cleanse the pockets. Again, an antimicrobial agent may be applied to help reduce subgingival oral bacteria. Pocket irrigation can be performed at home as part of the daily oral routine using a water jet or water pick. Flushing the interdental area with water is less harmful to soft tissue than dental floss, but should not be used as a substitute for professional dental cleaning. If you have any questions about pocket irrigation, cleaning your teeth, periodontal disease and treatment, please ask your dentist.

The objective of scaling & root planning is to remove etiologic agents which cause inflammation to the gingival (gum) tissue and surrounding bone. Common etiologic agents removed by this conventional periodontal therapy include dental plaque and tartar (calculus).

These non-surgical procedures which completely cleanse the periodontium, work very effectively for individuals suffering from gingivitis (mild gum inflammation) and moderate/severe periodontal disease.

Reasons for scaling and root planing

Scaling and root planning can be used both as a preventative measure and as a stand-alone treatment. These procedures are performed as a preventative measure for a periodontitis sufferer. Here are some reasons why these dental procedures may be necessary:

• Disease prevention – The oral bacteria which cause periodontal infections can travel via the bloodstream to other parts of the body. Research has shown that lung infections and heart disease have been linked to periodontal bacteria. Scaling and root planing remove bacteria and halts periodontal disease from progressing, thus preventing the bacteria from traveling to other parts of the body.
• Tooth protection – When gum pockets exceed 3mm in depth, there is a greater risk of periodontal disease. As pockets deepen, they tend to house more colonies of dangerous bacteria. Eventually, a chronic inflammatory response by the body begins to destroy gingival and bone tissue which may lead to tooth loss. Periodontal disease is the number one cause of tooth loss in the developed world.
• Aesthetic effects – Scaling and root planing help remove tartar and plaque from the teeth and below the gumline. As an added bonus, if superficial stains are present on the teeth, they will be removed in the process of the scaling and root planning procedure.
• Better breath – One of the most common signs of periodontal disease is halitosis (bad breath). Food particles and bacteria can cause a persistent bad odor in the oral cavity which is alleviated with cleaning procedures such as scaling and root planing.

What do scaling and root planing treatments involve?

Scaling and root planing treatments are only performed after a thorough examination of the mouth. The dentist will take X-rays, conduct visual examinations and make a diagnosis before recommending or beginning these procedures. Depending on the current condition of the gums, the amount of calculus (tartar) present, the depth of the pockets and the progression of the periodontitis, local anesthetic may be used.

Scaling – This procedure is usually performed with special dental instruments and may include an ultrasonic scaling tool. The scaling tool removes calculus and plaque from the surface of the crown and root surfaces. In many cases, the scaling tool includes an irrigation process that can also be used to deliver an antimicrobial agent below the gums that can help reduce oral bacteria.

Root Planing – This procedure is a specific treatment which serves to remove cementum and surface dentin that is embedded with unwanted microorganisms, toxins and tartar. The root of the tooth is literally smoothed in order to promote good healing. Having clean, smooth root surfaces helps bacteria from easily colonizing in future.

Following these deep cleaning procedures, the gum pockets may be treated with antibiotics. This will soothe irritation and help the gum tissues to heal quickly. During the next appointment, the dentist or hygienist will thoroughly examine the gums again to see how well the pockets have healed. If the gum pockets still measure more than 3mm in depth, additional and more intensive treatments may be recommended. If you have any concerns or questions about scaling and root planing, or periodontal disease, please ask your dentist.

According to research conducted by the American Cancer society, more than 30,000 cases of oral cancer are diagnosed each year. More than 7,000 of these cases result in the death of the patient. The good news is that oral cancer can easily be diagnosed with an annual oral cancer exam, and effectively treated when caught in its earliest stages.

Oral cancer is a pathologic process which begins with an asymptomatic stage during which the usual cancer signs may not be readily noticeable. This makes the oral cancer examinations performed by the dentist critically important. Oral cancers can be of varied histologic types such as teratoma, adenocarcinoma and melanoma. The most common type of oral cancer is the malignant squamous cell carcinoma. This oral cancer type usually originates in lip and mouth tissues. There are many different places in the oral cavity and maxillofacial region in which oral cancers commonly occur, including:

• Lips
• Mouth
• Tongue
• Salivary Glands
• Oropharyngeal Region (throat)
• Gums
• Face

Reasons for oral cancer examinations

It is important to note that around 75 percent of oral cancers are linked with modifiable behaviors such as smoking, tobacco use and excessive alcohol consumption. Your dentist can provide literature and education on making life changes and smoking cessation.

When oral cancer is diagnosed in its earliest stages, treatment is generally very effective. Any noticeable abnormalities in the tongue, gums, mouth or surrounding area should be evaluated by a health professional as quickly as possible. During the oral cancer exam, the dentist and dental hygienist will be scrutinizing the maxillofacial and oral regions carefully for signs of pathologic changes. The following signs will be investigated during a routine oral cancer exam:

• Red patches and sores – Red patches on the floor of the mouth, the front and sides of the tongue, white or pink patches which fail to heal and slow healing sores that bleed easily can be indicative of pathologic (cancerous) changes.
• Leukoplakia – This is a hardened white or gray, slightly raised lesion that can appear anywhere inside the mouth. Leukoplakia can be cancerous, or may become cancerous if treatment is not sought.
• Lumps – Soreness, lumps or the general thickening of tissue anywhere in the throat or mouth can signal pathological problems.

Oral cancer exams, diagnosis and treatment

The oral cancer examination is a completely painless process. During the visual part of the examination, the dentist will look for abnormality and feel the face, glands and neck for unusual bumps. Lasers which can highlight pathologic changes are also a wonderful tool for oral cancer checks. The laser can “look” below the surface for abnormal signs and lesions which would be invisible to the naked eye.

If abnormalities, lesions, leukoplakia or lumps are apparent, the dentist will implement a diagnostic impression and treatment plan. In the event that the initial treatment plan is ineffective, a biopsy of the area will be performed. The biopsy includes a clinical evaluation which will identify the precise stage and grade of the oral lesion.

Oral cancer is deemed to be present when the basement membrane of the epithelium has been broken. Malignant types of cancer can readily spread to other places in the oral and maxillofacial regions, posing additional secondary threats. Treatment methods vary according to the precise diagnosis, but may include excision, radiation therapy and chemotherapy.

During bi-annual check-ups, the dentist and hygienist will thoroughly look for changes and lesions in the mouth, but a dedicated comprehensive oral cancer screening should be performed at least once each year. If you have any questions or concerns about oral cancer, please ask your dentist or dental hygienist.

Gingival recession (receding gums) refers to the progressive loss of gum tissue, which can eventually result in tooth root exposure if left untreated. Gum recession is most common in adults over the age of 40, but the process can begin in the teenage years.

Gum recession can be difficult to self-diagnose in its earlier stages because the changes often occur asymptomatically and gradually. Regular dental check ups will help to prevent gum recession and assess risk factors. The following symptoms may be indicative of gum recession:

• Sensitive teeth – When the gums recede enough to expose the cementum protecting the tooth root, the dentin tubules beneath will become more susceptible to external stimuli
• Visible roots – This is one of the main characteristics of a more severe case of gum recession
• Longer-looking teeth – Individuals experiencing gingival recession often have a “toothy” smile. The length of the teeth is perfectly normal, but the gum tissue has been lost, making the teeth appear longer
• Halitosis, inflammation and bleeding – These symptoms are characteristic of gingivitis or periodontal disease. A bacterial infection causes the gums to recede from the teeth and may cause tooth loss if not treated promptly.

Causes of Gum Recession

Gum recession is an incredibly widespread problem that dentists diagnose and treat on a daily basis. It is important to thoroughly examine the affected areas and make an accurate diagnosis of the actual underlying problem. Once the cause of the gum recession has been determined, surgical and non surgical procedures can be performed to halt the progress of the recession, and prevent it from occurring in the future. The most common causes of gingival recession are:

• Overaggressive brushing – Over brushing can almost be as dangerous to the gums as too little. Brushing too hard or brushing with a hard-bristled toothbrush can erode the tooth enamel at the gum line, and irritate or inflame gum tissue.
• Poor oral hygiene – When brushing and flossing are performed improperly or not at all, a plaque build up can begin to affect the teeth. The plaque contains various bacterial toxins which can promote infection and erode the underlying jawbone.
• Chewing tobacco – Any kind of tobacco use has devastating effects on the entire oral cavity. Chewing tobacco in particular, aggravates the gingival lining of the mouth and causes gum recession if used continuously.
• Periodontal disease – Periodontal disease can be a result of improper oral hygiene or caused by systemic diseases such as diabetes. The excess sugars in the mouth and narrowed blood vessels experienced by diabetics create a perfect environment for oral bacteria. The bacterium causes an infection which progresses deeper and deeper into the gum and bone tissue, eventually resulting in tooth loss.

Treatment of Gum Recession

Every case of gum recession is slightly different, and therefore many treatments are available. The nature of the problem which caused the recession to begin with needs to be addressed first.

If overly aggressive brushing techniques are eroding the gums, a softer toothbrush and a gentler brushing technique should be used. If poor oral hygiene is a problem, prophylaxis (professional dental cleaning) may be recommended to rid the gum pockets of debris and bacteria. In the case of a severe calculus (tartar) build up, scaling and root planing will be performed to heal the gingival inflammation and clean the teeth.

Once the cause of the gingival recession has been addressed, surgery of a more cosmetic or restorative nature may be recommended. Gum tissue regeneration and gum grafting are two excellent ways to restore natural symmetry to the gums and make the smile look more aesthetically pleasing. If you have any questions or concerns about periodontal disease, periodontal treatments, or gum recession, please ask your dentist.

A gum graft (also known as a gingival graft or periodontal plastic surgery), is a collective name for surgical periodontal procedures that aim to cover an exposed tooth root surface with grafted oral tissue. Exposed tooth roots are usually the result of gingival recession due to periodontal disease. There are other common causes, including overly aggressive brushing and trauma. Here are some of the most common types of gum grafting:

• Free gingival graft – This procedure is often used to thicken gum tissue. A layer of tissue is removed from the palate and relocated to the area affected by gum recession. Both sites will quickly heal without permanent damage.
• Subepithelial connective tissue graft – This procedure is commonly used to cover exposed roots. Tissue is removed fairly painlessly from the outer layer of the palate and relocated to the site of gum recession.
• Acellular dermal matrix allograft – This procedure uses medically processed, donated human tissue as a tissue source for the graft. The advantage of this is procedure is that there is no need for a donor site from the patient’s palate (and thus, less pain).

Reasons for gum grafting

Gum grafting is a common periodontal procedure. Though the name might sound frightening, the procedure is commonly performed with excellent results. Here are some of the major benefits associated with gum grafting:

• Reduced sensitivity – When the tooth root becomes exposed, eating or drinking hot or cold foods can cause extreme sensitivity to the teeth. Gum grafting surgery permanently covers the exposed root, helps reduce discomfort, and restores the good health of the gums.
• Improved appearance – Periodontal disease is characterized by gum recession and inflammation. Gum recession and root exposure can make the teeth look longer than normal and the smile to appear “toothy.” Gum grafting can make the teeth look shorter, more symmetrical and generally more pleasing to look at. In addition, adjacent tissue can be enhanced and augmented during the procedure for aesthetic purposes.
• Improved gum health – Periodontal disease can progress and destroy gum tissue very rapidly. If left untreated, a large amount of gum tissue can be lost in a short period of time. Gum grafting can help halt tissue and bone loss; preventing further problems and protecting exposed roots from further decay.

What does gum grafting treatment involve?

Once the need for gum grafting surgery has been determined, there are several treatments the dentist will want perform before gum grafting takes place. First, the teeth must be thoroughly cleaned supra and subgingivally to remove calculus (tartar) and bacteria. The dentist can also provide literature, advice and educational tools to increase the effectiveness of homecare and help reduce the susceptibility of periodontal disease in the future.

The gum grafting procedure is usually performed under local anesthetic. The exact procedure will depend much on whether tissue is coming from the patient’s palate or a tissue bank. Initially, small incisions will be made at the recipient site to create a small pocket to accommodate the graft. Then a split thickness incision is made and the connective tissue graft is inserted into the space between the two sections of tissue. The graft is usually slightly larger than the recession area, so some excess will be apparent.

Sutures are often placed to further stabilize the graft and to prevent any shifting from the designated site. Surgical material is used to protect the surgical area during the first week of healing. Uniformity and healing of the gums will be achieved in approximately six weeks. If you have any questions about gum grafting, please ask your dentist.

A periodontist is a dentist who specializes in the soft tissues of the mouth and the underlying jawbone which supports the teeth. A dentist must first graduate from an accredited dental school before undertaking an additional three years of study within a periodontology residency training program, in order to qualify as a periodontist.

The primary focus of this residency training is on both surgical and non surgical management of periodontal disease and the placement of dental implants.

Conditions Treated by a Periodontist

The periodontist is mainly concerned with preventing the onset of gum disease (periodontal disease), diagnosing conditions affecting the gums and jawbone, and treating gingivitis, periodontitis and bone loss. Periodontal disease is a progressive condition and the leading cause of tooth loss among adults in the developed world.

The periodontist is able to treat mild, moderate and advanced gum disease by first addressing the bacterial infection at the root of the problem, providing periodontal treatment, then providing information and education on good oral hygiene and the effective cleaning of the teeth. The most common conditions treated by the periodontist are:

• Gingivitis – This is the mild inflammation of the gums which may or may not be signified by pain and bleeding.
• Mild/moderate periodontitis – When the pockets between the teeth and the soft tissues are measured to be between 4-6mm it is classified as moderate periodontitis (gum disease).
• Advanced periodontitis – When the pockets between the teeth and the soft tissues in general exceed 6mm in depth, significant bone loss may occur; causing shifting or loss of teeth.
• Missing teeth – When teeth are missing as a result of bone loss, the periodontist can implant prosthetic teeth. These teeth are anchored to the jawbone and restore functionality to the mouth.

Treatments Performed by a Periodontist

The periodontist is able to perform a wide range of treatments to halt the progression of gum disease, replace missing teeth and make the appearance of the smile more aesthetically pleasing. Here are some of the treatments commonly performed by the periodontist:

• Implant placement – When a tooth or several teeth are missing, the periodontist is able to create a natural-looking replacement by anchoring a prosthetic tooth to the jawbone.
• Osteoplasty (hard tissue recontouring) – Once periodontitis has been treated, the periodontist can recontour the hard tissue to make the smile both natural-looking and aesthetically pleasing.
• Gingivoplasty (soft tissue recontouring) – As gums recede due to periodontitis, the teeth may appear longer; causing a “toothy” smile. The periodontist can remove tissues or straighten the gum line to make the teeth look more even.
• Bone grafting – Dental implants can only be positioned if there is sufficient bone to attach the prosthetic tooth to. If bone loss has occurred, bone grafting is an excellent way to add or “grow” bone so that an implant may be properly secured.
• Deep pocket cleanings – As gingivitis and periodontitis progress, it becomes more difficult to cleanse the pockets between the soft tissues and the teeth. The periodontist can scale and root plane the teeth (sometimes under local anesthetic) to remove debris and infection-causing bacteria.
• Crown lengthening – In order to expose more of the natural tooth, the periodontist can remove some of the surrounding gingival tissue.

The periodontist is a highly skilled dental health professional who is able to diagnose and treat many commonly occurring soft tissue and bone problems in the oral cavity. Be sure to ask your periodontist if you have any questions or concerns.

The term “periodontics” refers to the dental specialty that pertains to the prevention, diagnosis and treatment of periodontal disease that affects the gums and jawbone. The gum tissues serve to surround and support the teeth and the underlying jawbone anchors teeth firmly in place. Periodontists have completed several years of extra dental training and are concerned with maintaining the function, health and aesthetics of the jawbone and tissues.

Reasons for periodontal treatment

Periodontal disease is a progressive condition which begins with mild gum inflammation called gingivitis. It is the leading cause of tooth loss in adults living in the developed world, and should be taken very seriously. Periodontal disease (often called gum disease) is typically signified by red, swollen, painful, or bleeding gums, but in some cases has no noticeable symptoms.

Periodontal disease generally begins when the bacteria living in plaque cause an infection in the surrounding tissues of the teeth, causing them to become irritated and painful. Eventually, this infection will; cause the jawbone to recede and the tooth to become loose. There are several reasons why periodontal treatment may be necessary:

• Moderate/advanced gum disease – This occurs when the gums are bleeding, swollen or red around most teeth and the jawbone has begun to recede.
• Localized gum recession – The infection which propagates moderate or advanced gum disease often begins in one area. Gum recession may also be caused due to over brushing with a hard bristle brush, or due to a tooth that is not positioned properly. Immediate treatment is required to prevent further spreading.
• Before crown lengthening – The periodontist may lengthen the crown of the tooth by removing surrounding soft tissue to provide more tooth exposure.
• Ridge augmentation – This procedure, often called “recontouring” may be required to correct an uneven gum line. Before embarking on treatment, a periodontist needs to treat any bacterial infections and periodontitis.

In the case of mild/moderate periodontal problems, the focus of the periodontist will be on curing the underlying bacterial infection and then providing advice on the most appropriate home cleaning methods.

Sometimes a deep scaling is needed to remove the bacterial plaque and calculus (tartar) from the teeth and tissues. Where periodontal disease is advanced and the jawbone has regressed significantly, more intensive cleaning may be recommended and loose teeth that cannot be saved will be removed.

The periodontist is trained in all aspects of dental implant procedures, which can restore functionality to the mouth when teeth have been affected by periodontitis. Because periodontal disease is progressive, it is essential to remove the bacteria and calculus build up to halt the spread of the infection. Your dentist will be happy to advise you on effective cleaning methods and treatment options.

Third molars, commonly referred to as wisdom teeth, are usually the last four of 32 teeth to erupt (surface) in the mouth, generally making their appearance between the ages of 17 to 25. They are located at the back of the mouth (top and bottom), near the entrance to the throat. The term “wisdom” stems from the idea that the molars surface at a time typically associated with increased maturity or “wisdom”.

In most cases, inadequate space in the mouth does not allow the wisdom teeth to erupt properly and become fully functional. When this happens, the tooth can become impacted (stuck) in an undesirable or potentially harmful position. If left untreated, impacted wisdom teeth can contribute to infection, damage to other teeth, and possibly cysts or tumors. There are several types, or degrees, of impaction based on the actual depth of the teeth within the jaw:

• Soft Tissue Impaction: The upper portion of the tooth (the crown) has penetrated through the bone, but the gingiva (gum) is covering part or all of the tooth’s crown and has not positioned properly around the tooth. Because it is difficult to keep the area clean, food can become trapped below the gum and cause an infection and/or tooth decay, resulting in pain and swelling.
• Partial Bony Impaction: The tooth has partially erupted, but a portion of the crown remains submerged below the gum and surrounding jawbone. Again, because it is difficult to keep the area clean, infection will commonly occur.
• Complete Bony Impaction: The tooth is completely encased by jawbone. This will require more complex removal techniques.

Reasons to remove wisdom teeth

While not all wisdom teeth require removal, wisdom teeth extractions are most often performed because of an active problem such as pain, swelling, decay or infection, or as a preventative measure to avoid serious problems in the future. If impaction of one or more wisdom teeth is present, and left untreated, a number of potentially harmful outcomes can occur, including:

• Damage to nearby teeth: Second molars (the teeth directly in front of the wisdom teeth) can be adversely affected by impacted wisdom teeth, resulting in tooth decay (cavities), periodontal disease (gum disease) and possible bone loss.
• Disease: Although uncommon, cysts and tumors can occur in the areas surrounding impacted wisdom teeth.
• Infection: Bacteria and food can become trapped under the gum tissue, resulting in an infection. The infection can cause considerable pain and danger.
• Tooth Crowding: It has been theorized that impacted wisdom teeth can put pressure on other teeth and cause them to become misaligned (crowded or twisted). This theory isn’t universally accepted by all dental professionals, and it has never been validated by any scientific studies.

Wisdom teeth examination

As with any dental procedure, your dentist will want to initially conduct a thorough examination of the wisdom and surrounding teeth. Panoramic or digital x-rays will be taken in order for your dentist to evaluate the position of the wisdom teeth and determine if a current problem exists, or the likelihood of any potential future problems. The x-rays can also expose additional risk factors, such as deterioration or decay of nearby teeth. Early evaluation and treatment (typically in the mid-teen years) is recommended in order to identify potential problems and to improve the results for patients requiring wisdom teeth extractions. Only after a thorough examination can your dentist provide you with the best options for your particular case.

What does the removal of wisdom teeth involve?

Wisdom teeth removal is a common procedure, generally performed under local anesthesia, intravenous (IV) sedation, or general anesthesia by a specially trained dentist in an office surgery suite. The surgery does not require an overnight stay, and you will be released with post-operative instructions and medication (if necessary), to help manage any swelling or discomfort.

Tempro-Mandibular Joint Dysfunction Syndrome (TMJ) is a common condition affecting a wide variety of people. TMJ is characterized by severe headaches, jaw pain of varying degrees, grinding teeth, and an intermittent ringing in the ears. The vast majority of TMJ sufferers are unaware that the root cause of these problems is something that a dentist can effectively treat.

The symptoms of TMJ are debilitating and can greatly interfere with every day life. The comfort and general well being of the patient is at the heart of the dental practice, so pain relief is the first consideration of the dentist. The dentist is able to test, diagnose, and devise an immediate plan to treat the underlying causes of the TMJ disorder.

Reasons for treating TMJ

TMJ sufferers report that their symptoms generally worsen during periods of prolonged or unexpected stress, and that intense outbreaks of the condition can lead to neck pain and dizziness. The most common cause of TMJ is the misalignment of the teeth, often called “bad bite.” It is possible for the dentist to realign or adjust the teeth without the need for painful or expensive surgeries. The realignment/adjustment will stop the pounding headaches, the jaw pain, and the dizziness.

The grinding teeth symptom is particularly common and usually occurs at night. The grinding will eventually erode the structure of the teeth and lead to much more severe dental problems in the future. Untreated TMJ is one of the prime underlying factors in eroded jawbones and loose teeth. It is important for anyone experiencing the symptoms of TMJ to visit the dentist for an exact diagnosis.

What does treating TMJ involve?

TMJ could be a result of several different problems. Bad bite is the most common, but an injury resulting from a blow to the meniscus cartilage is also a possibility. Initially, the dentist will thoroughly examine the jaw area, the patients bite, take x-rays, and review the patient’s history in order to make an accurate diagnosis and recommend necessary treatment.

Once a firm diagnosis is attained, there are several ways in which relief can be provided. A specially molded bite guard can be created to stop teeth grinding during the night. A bite relationship analysis may be recommended by the dentist. The dentist can also provide advice on relaxation techniques which will lessen the effects of stress. As a last alternative, the dentist is also able to prescribe muscle relaxants.

A better option is to change the shape of the teeth and get rid of the bad bite completely, often called “realignment.” This is especially useful because it alleviates TMJ symptoms and may improve the aesthetic appearance of the teeth as well. Realignment involves adjusting the relationship between how the upper teeth come together with the lower teeth. This may require new restorations and/or adjusting the natural teeth as well. It is not a painful procedure, and it is one the dentist has performed with great success numerous times. As with any procedure, the dentist will be happy to answer questions and discuss symptoms, options, and treatments.

If you are experiencing any symptoms of TMJ, we encourage you to contact our office today to schedule an appointment.

Sleep apnea is a potentially life-threatening sleep disorder characterized by repeated pauses in breathing during sleep. The term sleep apnea is derived from the Greek etymology meaning “without breath”. Breathing pauses can last anywhere from several seconds to minutes, and happen as often as 30 times or more per hour. Ongoing disrupted breathing causes an imbalance between the carbon dioxide and oxygen levels in the bloodstream, as not enough carbon dioxide is exiting and not enough oxygen is entering the body.

Sensing this imbalance, the brain sends a message to the body, telling it to wake up to restart breathing the process. People with sleep apnea will partially awake as they struggle to breathe, and this is often accompanied by loud snoring or choking sensations. Because people with sleep apnea don’t always completely awake during the episodes, they are often unaware they have a sleeping disorder and it can remain undiagnosed.

There are two main types of this disorder; central sleep apnea which occurs when the brain fails to send important signals to the breathing muscles, and obstructive sleep apnea which occurs when air cannot flow through the nose or mouth even though the body is still trying to breathe. Obstructive sleep apnea is far more prevalent and easily treatable by the dentist.

Common signs of obstructive sleep apnea can include severe early morning headaches, sleepiness in the daytime, and insomnia. Fortunately, the dentist is equipped with the necessary technology and expertise to treat sleep apnea in several different ways.

Reason for treating sleep apnea

It is very important to seek medical attention if sleep apnea is suspected. A sufferer can completely stop numerous times per hour, and this can quickly turn into a deadly situation. Obstructive sleep apnea occurs when the soft tissue lying at the back of the patient’s throat collapses into the airway. The tongue then falls towards the back of the throat which tightens the blockage and prevents oxygen from entering the lungs.

The problem worsens when the chest region, diaphragm, and abdomen fight for air. The efforts they make to obtain vital oxygen only cause a further tightening of the blockage. The patient must arouse from deep sleep to tense the tongue and remove the soft tissue from the airway.

Because sleep apnea causes carbon dioxide levels to skyrocket in the blood and oxygen levels to decrease, the heart has to pump harder and faster to compensate for the lack of oxygen. Sleep apnea patients can technically “die” many times each night. Sleep apnea has been linked to a series of serious heart-related conditions, and should be investigated by the dentist at the earliest opportunity.

What does sleep apnea treatment involve?

Initially, the dentist will want to conduct tests in order to investigate, diagnose, and pinpoint a suitable treatment. The dentist can offer many different treatment options which depend largely on the exact diagnosis and the health of the patient. The dentist may advise the patient to halt some habits that aggravate sleep apnea such as smoking, alcohol consumption, and tranquilizer use.

Sleeping masks were traditionally used to keep the patient’s airways open while they slept, but nowadays there are some less intrusive options. Dental devices that gently tease the lower jaw forward are very effective in preventing the tongue from blocking the main air passage. These dental devices are gentle, easy to wear, and often help patients avoid unwanted surgeries.

A more permanent solution is to have surgery that sections the lower jaw and helps pull the bone holding the tongue forward slightly. This surgery has an impressive success rate and is simple for the dentist or oral surgeon to perform. The dentist needs to formally make a diagnosis of each individual case before recommending the best course of action.

Platelet Rich Plasma or PRP is a by-product of blood that is exceptionally rich in platelets. PRP has long been used in hospitals to accelerate the body’s own healing process, but it is only fairly recently that advances in technology have allowed this same technique to be used in the dental office.

The blood platelets perform several essential functions in the body, including blood clot formation and the release of growth factors that help to heal wounds. These growth factors stimulate the stem cells to produce new host tissue as quickly as possible, which is why platelet rich plasma is so effective in the post-treatment healing process. There are several ways in which PRP can be used in clinical dentistry:

• Bone Grafting For Implants – This includes closure of a cleft lip and cleft palate deformities, sinus lifts, ridge augmentation, and both inlay and onlay grafts.
• Bone Repair – PRP can be used in facial trauma reconstruction, repairing of defects due to tooth removal, or the removal of growths and cysts.
• Fistula Repair – This includes the repair of fistulas between the mouth and the sinus cavity.

Reasons for platelet rich plasma treatment

Platelet rich plasma application is now widely used to expedite the post-procedure healing process and is completely safe. Since the blood used will come from the patient’s own body, disease transmission is not a factor. Almost all patients report a much greater degree of comfort immediately after their procedure. There are also several more distinct advantages of PRP. In the majority of cases, the pathological changes experienced in the oral region are uncomfortable and disfiguring, but not life threatening. However, oral cancer is on the rise (especially among men) and the chances of survival are around 80% if an immediate diagnosis is made.

Oral cancer is a general term used when referring to any type of cancer affecting the tongue, jaw, and lower cheek area. Since it is impossible for the dentist to decisively diagnose a pathological disease without taking a biopsy sample of the affected area, seeking immediate treatment when changes are first noticed might be a life and death decision. For less serious problems, there are several options available, such as:

Lower Infection Risk – PRP is smeared thickly on the wound after the procedure by the dentist and actually seals the wound away from infectious agents, lowering the risk of problems.

• Accelerated Healing – The saturation of the wound with PRP helps increase tissue synthesis due to its growth factors, and this in turn results in faster tissue regeneration. Speedier healing decreases the risk of later infections, complications, and discomfort.
• Safety and Convenience – Disease transmission is non-issue since the blood is harvested from the patient’s own blood supply. The amount of blood needed is small and can be collected during a routine outpatient procedure.

What does platelet rich plasma treatment involve?

The dentist will initially assess if your candidate for PRP treatment. Patients with blood clotting disorders will be unable to take advantage of this treatment. A small (about 2 oz) sample of your blood will be collected during a scheduled outpatient treatment. The blood will be placed into a centrifuge to separate the plasma from the red blood cells. A second centrifuge will be used to concentrate the platelets which contain the growth factor.

Immediately after suturing the wound, the dentist will apply the PRP to the surgical area in a high concentration. This will expedite your healing and decrease the amount of discomfort following the surgery. The dentist will provide aftercare instructions pertaining to the surgery and a prescription for pain medication as required.

If you have any questions about treatment with platelet rich plasma or would like to find out if you are a candidate and can benefit from this treatment, please contact our office today to schedule an appointment.

An oral exam is routinely performed by the dentist during the course of an initial comprehensive exam and regular check-ups. An oral cancer exam refers to the identification and management of diseases pertaining to the maxillofacial and oral regions.

The soft tissue of the mouth is normally lined with mucosa, which is special type of skin that should appear smooth in texture and pink in color. Any alteration of the color or texture of the mucosa may signal the beginning of a pathologic process. These changes may occur on the face, neck, and areas of the mouth (e.g., gums, tongue, lips, etc.). The most serious of these pathologic changes (which may or may not be painful) is oral cancer, but there are also many other common pathologic problems.

Geographic Tongue – Also known as Benign Migratory Glossitis or Erythema Migrans, is a condition where the tongue is missing papillae (small bumps) in different areas, and a map-like appearance can develop. This condition is usually seen as red well defined areas on or around the sides of the tongue. The red patches (which can look like an unsightly rash) may come and go from hours to months at a time and cause increased sensitivity to certain substances.

• Median Palatal Cyst – This cyst is of developmental origin and is essentially a fluid filled skin sac. It usually appears in the middle of the palate and may cause substantial discomfort.
• Hairy Tongue – An overgrowth of bacteria or a yeast infection in the mouth which can cause the tongue to appear hairy and black. This condition is usually a result of poor oral hygiene, chronic or extensive use of antibiotics, or radiation treatments to the head or neck. It is often also seen in HIV positive patients and those who are intravenous drug users. Hairy Tongue may or may not require treatment.

Treatment of Pathological Diseases

In the majority of cases, the pathological changes experienced in the oral region are uncomfortable and disfiguring, but not life threatening. However, oral cancer is on the rise (especially among men) and the chances of survival are around 80% if an immediate diagnosis is made.

Oral cancer is a general term used when referring to any type of cancer affecting the tongue, jaw, and lower cheek area. Since it is impossible for the dentist to decisively diagnose a pathological disease without taking a biopsy sample of the affected area, seeking immediate treatment when changes are first noticed might be a life and death decision. For less serious problems, there are several options available, such as:

• Antibiotics – In the case of a bacterial infection or persistent soreness, the dentist may prescribe a dose of antibiotics to return the mucosa to its natural state. This will alleviate soreness and discomfort.
• Diluted Hydrogen Peroxide – When poor oral hygiene is causing changes to the soft tissue, the dentist may prescribe a diluted hydrogen peroxide mouthwash. This will kill more bacteria than regular mouthwash and improve halitosis (bad breath).
• Oral Surgery – If the patient has cysts or abnormal non-cancerous growths, the dentist may decide to completely remove them. This can improve comfort levels, alleviate breathing problems, and make speech substantially easier depending on the location of the cyst.

Oral Examinations

During the course of a regular check up, the dentist will thoroughly inspect the soft tissue of the mouth and take serious note of any changes. If there are cell changes present, the dentist will take a biopsy of the affected area and send it away to be analyzed by laboratory specialists. When definitive results are obtained, the dentist can decide on the best course of treatment.

Oral Cancer Screenings

An oral cancer screening is usually performed during a comprehensive or recall (check-up) exam. Screening is painless and only takes a few minutes. The dentist or hygienist will use a laser light to assess the soft tissue for cell changes that might be indicative of oral cancer. If such cell changes are present, a small biopsy will be taken and sent to a laboratory for review. If the biopsy indicates that oral cancer is present, an excision (removal) will generally be performed.

If you are experiencing any pain or symptoms that cause you concern, we encourage you to contact us today to schedule an appointment.

Bone grafting is often closely associated with dental restorations such as bridge work and dental implants. In the majority of cases, the success of a restoration procedure can hinge on the height, depth, and width of the jawbone at the implant site. When the jawbone has receded or sustained significant damage, the implant(s) cannot be supported on this unstable foundation and bone grafting is usually recommended for the ensuing restoration.

There are several major factors that affect jaw bone volume. An Oral Maxillofacial Surgeon can diagnose and treat a wide variety conditions. The following are just some of the many conditions, treatments and procedures oral and maxillofacial surgeon deal with on a daily basis:

• Periodontal Disease – Periodontal disease can affect and permanently damage the jaw bone that supports the teeth. Affected areas progressively worsen until the teeth become unstable.
• Tooth Extraction – Studies have shown that patients who have experienced a tooth extraction subsequently lose 40-60% of the bone surrounding the extraction site during the following three years. Loss of bone results in what is called a “bone defect”.
• Injuries and Infections – Dental injuries and other physical injuries resulting from a blow to the jaw can cause the bone to recede. Infections can also cause the jaw bone to recede in a similar way.

Reasons for bone grafts

Bone grafting is a highly successful procedure in most cases. It is also a preferable alternative to having missing teeth, diseased teeth, or tooth deformities. Bone grafting can increase the height or width of the jawbone and fill in voids and defects in the bone. There are essentially two basic ways in which bone grafting can positively impact the health and stability of the teeth:

• Jaw Stabilization – Bone grafting stabilizes and helps restore the jaw foundation for restorative or implant surgery. Deformities can also be corrected and the restructuring of the bone can provide added support.
• Preservation – Bone grafting can be used to limit or prevent bone recession following a tooth extraction, periodontal disease, or other invasive processes.

Oral Examination

Initially, the dentist will thoroughly examine the affected area in order to assess the general condition of the teeth and gums. If periodontal disease is present or the adjacent teeth are in poor condition, these factors will be fully addressed before the bone grafting procedure can begin. The dentist will also recommend panoramic x-rays in order to assess the precise depth and width of the existing bone. On occasion, a CAT scan may be recommended to determine the bone condition. Depending on these results, the dentist may also anesthetize the area and explore into the gum in order to determine what kind and how much bone is required.

What Does Bone Grafting Involve?

There are several types of bone grafts. Your dentist will determine the best type for your particular condition.

• Autogenous Bone Graft – Harvested from the patient’s own body (usually from the posterior part of the lower jaw or the chin). This method is usually preferred because it produces the most predictable results.
• Allograft Bone Graft – Cadaver or synthetic bone is used in this type of graft.
• Xenograft – Cow bone is used in this type of graft.

The bone grafting procedure can often take several months to complete. Bone is typically harvested from your own body (or on rare occasions obtained from a “bone bank”) and added to the affected site. This bone will fuse with the existing bone and the migration of cells will cause firm adhesion and cell growth. Supplementing the jaw with bone will result in greater bone mass to help support and anchor the implant(s).

During the surgery, the dentist will numb the grafting and extraction sites using local anesthetic. A small incision will be made to prepare the site for the new bone and it will be anchored into place. On occasion, a synthetic membrane may be used to cover the new bone. This membrane prevents soft tissue and bacterial invasions, and encourages new bone growth. The surgery does not require an overnight stay, and you will be provided with comprehensive instructions for your post-operative care. The dentist will prescribe medications to help manage infection, discomfort and swelling.

Oral & Maxillofacial Surgeons are specialists with advanced training and expertise in the diagnosis and treatment of various head and neck conditions and injuries. After four years of dental school, an Oral & Maxillofacial Surgeon completes four to six years of additional formal training in treating the craniomaxillofacial complex. This specialty is one of 9 dental specialties recognized internationally and by the American Dental Association (ADA).

An Oral Maxillofacial Surgeon can diagnose and treat a wide variety conditions. The following are just some of the many conditions, treatments and procedures oral and maxillofacial surgeon deal with on a daily basis:

• TMJ, Facial Pain, & Facial Reconstruction
• Dental Implants
• Tooth Extractions & Impacted Teeth
• Wisdom Teeth
• Misaligned Jaws
• Cleft Lip & Palate
• Apicoectomy
• Oral Cancers , Tumors, Cysts, & Biopsies
• Sleep Apnea
• Facial Cosmetic Surgery

Whether your dentist refers you to our office, you have pain or symptoms causing you concern, or you simply have questions you would like answered, please contact our office today to schedule an appointment. We are here to answer your questions and provide the treatment you deserve!

Invisalign invisibly straightens your teeth with a series of custom-molded aligners. Forget everything you’ve heard about teeth straightening. Because now there’s breakthrough technology that lets you get the smile you always wanted without bands, brackets or wires.

A clear alternative

By using a series of clear removable aligners, Invisalign straightens your teeth right before your eyes. Change them about every 2 weeks, your teeth will move—little by little, week by week—until they have moved to the final position your orthodontist or dentist has prescribed. Comfortable to wear, our aligners are also removable so you can eat, drink, brush, and floss as usual.

Less treatment time

A typical Invisalign case takes about a year from start to finish. You’ll see your doctor every month or two to see how you’re progressing. Every few visits you’ll be given additional aligners to continue your treatment. Commonly, the number of aligners worn during treatment is between 18 and 30, but treatment time and number of aligners will vary from case to case.

Invisible And Comfortable

Invisalign is an invisible solution. So you won’t draw undue attention to your mouth while in treatment. In fact, virtually no one will know you’re wearing them unless you tell. Comfortable to wear, our aligners are also removable so you can eat, drink, brush, and floss as usual.

Is Invisalign for Me?

Invisalign can be used to treat the vast majority of common problems for adults and teens. Whether your smile needs minor improvements or more extensive adjustments, Invisalign can certainly help. It’s successful in treating overly crowded or widely spaced teeth. It can also relieve more complex issues, including overbites, underbites and even crossbites. In fact, an Invisalign Certified Orthodontist or Dentist can use Invisalign clear aligners in all or part of just about any treatment plan.

Look your best during treatment.

Invisalign is clear and practically invisible, so nothing gets in the way of your new smile. No wonder Invisalign is the choice of over half a million people.

The following are the most commonly used terms in orthodontics. If you have any questions about orthodontics or would like to schedule an appointment, please contact our office.

• Anterior Teeth: The upper and lower six front teeth on each arch.
• Appliance: Any orthodontic device which moves or retains teeth. Appliances may also alter the positioning of the jaw.
• Arch: The entire upper or lower jaw.
• Archwire: The metal wire that connects orthodontic brackets. This wire guides the teeth into their new alignment.
• Band with bracket: Metal bands (rings) that are generally cemented around the back teeth.
• Braces: Fixed orthodontic appliances designed to align teeth.
• Brackets: The tiny metal, ceramic or clear brackets that are affixed to each individual tooth on the arch.
• Brushing: This is a crucial part of home dental care. Orthodontists recommend those wearing braces to brush after every meal and snack to eliminate bacteria and plaque.
• Buccal: The outer (cheek) side of posterior teeth in the lower and upper arches.
• Cephalometric Radiograph: A side x-ray of the face and head used to show growth and development.
• Chain: Elastics connected together and placed around the brackets to stabilize the archwire and gently close spaces.
• Class I Malocclusion: Molars are correctly aligned, but there is an anterior/posterior crossbite, an openbite or overcrowding on the arches.
• Class II Malocclusion: Also known as an overbite. The upper front teeth are positioned further forward than the lower teeth.
• Class III Malocclusion: Also known as an underbite. The lower front teeth are positioned further forward than the upper front teeth.
• Closed Bite: The upper front teeth completely overlap the bottom teeth causing a deep overbite.
• Congenitally Missing Teeth: Some permanent teeth fail to develop and erupt due to genetic factors.
• Crossbite: A malocclusion in which the upper back teeth bite inside or outside the lower back teeth, or the lower front teeth bite in front of the upper front teeth.
• De-banding: The removal of orthodontic bands from the teeth.
• De-bonding: The removal of affixed orthodontic brackets from the teeth.
• Diagnostic Records: Records used to assess, plan and implement treatments. These records usually include medical and dental history, radiographs, panoramic radiographs, bite molds and intraoral/extraoral photographs.
• Digital Radiograph: Digital x-rays of the teeth which can be viewed, stored and transmitted via computer.
• Elastics: Some braces may require that elastic rubber bands be attached to exert additional pressure to an individual tooth or a group of teeth.
• Eruption: The way in which teeth surface through the gums inside the mouth.
• Fixed Orthodontic Appliances: Orthodontic appliances which are affixed to the teeth by the orthodontist and cannot be removed by the patient.
• Flossing: An essential part of home care that removes debris and plaque from above and below the gumline.
• Functional Appliances: Orthodontic appliances that use the muscle movement created by swallowing, eating and speaking to gently move and align the teeth and jaws.
• Gingiva: The gums and soft tissue around the teeth.
• Headgear: A removable appliance comprised of a brace and external archwire. This device modifies growth and promotes tooth movement.
• Impressions: Teeth impressions are taken to allow the orthodontist to see exactly how a patient’s teeth fit together.
• Interceptive Treatment: Treatment performed on children who have a mixture of adult and baby teeth. Early treatment can help reduce the need for major orthodontic treatment in the future.
• Invisalign®: A newer, removable type of dental aligner that is completely transparent and doesn’t interfere with eating because it’s removable. Not all patients are candidates for Invisalign®.
• Ligating Modules: An elastic donut-shaped ring which helps secure the archwire to the bracket.
• Ligation: Securing the archwire to the brackets.
• Lingual Side: The side of the teeth (in both arches) that is closest to the tongue.
• Malocclusion: Literally means “bad bite” in Latin, and refers to teeth that do not fit together correctly.
• Mandible: The lower jaw.
• Maxilla: The upper jaw.
• Mouthguard: A removable plastic or rubber device that protects teeth and braces from sporting injuries.
• Open Bite: Upper and lower teeth fail to make contact with each other. This malocclusion is generally classified as anterior or posterior.
• Orthodontics: The unique branch of dentistry concerned with diagnosing, preventing and correcting malocclusions and jaw irregularities.
• Orthodontist: A dental specialist who prevents, diagnoses and treats jaw irregularities and malocclusions. Orthodontists must complete two or three additional years of college after dental school and complete a residency program.
• Palatal Expander: A removable or fixed device designed to expand the palate in order create room on either the upper or lower arch.
• Panoramic Radiograph: An extraoral (external) x-ray that shows the teeth and jaws.
• Plaque: The sticky film of saliva, food particles and bacteria that contributes to gum disease and tooth decay.
• Posterior Teeth: Back teeth.
• Removable Appliance: An orthodontic brace or device that can be removed at will by the patient. It must be worn for the designated amount of time each day to be effective.
• Separators: A wire loop or elastic ring placed between the teeth to create room for the subsequent placement of bands or orthodontic appliance.
• Space Maintainer: A fixed appliance used to hold space for permanent (adult) tooth. This is usually used when a baby tooth has been lost earlier than anticipated.
• Wax: Orthodontic relief wax is a home care remedy used to alleviate irritations caused by braces.
• Wires: Attached to the brackets to gently move the teeth into proper alignment.

When braces are finally removed, the “retention” phase begins for most individuals. The objective of this phase is to ensure the teeth do not regress back to their previous position. A retainer will be used to maintain the improved position of the teeth. A retainer is a fixed or removable dental appliance which has been custom-made by the orthodontist to fit the teeth. Retainers are generally made from transparent plastic and thin wires to optimize the comfort of the patient.

Retainers are worn for varying amounts of time, depending on the type of orthodontic treatment and the age of the patient. Perseverance and commitment are required to make this final stage of treatment successful. If the retainer is not worn as directed by the orthodontist, treatment can fail or take much longer than anticipated.

What types of retainer are available?

There are a variety of retainers available; each one geared towards treating a different kind of dental problem. The orthodontist will make a retainer recommendation depending on the nature of the original diagnosis and the orthodontic treatment plan. The following are some of the most common types of retainers:

• Hawley retainer – The Hawley retainer consists of a metal wire on an acrylic arch. The metal wire may be periodically adjusted by the orthodontist to ensure the teeth stay in the desired position. The acrylic arch is designed to fit comfortably on the lingual walls or palate of the mouth.
• Essix – The Essix retainer is the most commonly used vacuum formed retainer (VFR). A mold is initially made of the teeth in their new alignment, and then clear PVC trays are created to fit over the arch in its entirety. VFR’s are much cheaper than many other types of retainers and also do not affect the aesthetic appearance of the smile in the same way as the Hawley retainer. The disadvantage of VFR’s is that they break and scratch more easily than other types of retainers.
• Fixed retainers – A fixed retainer is somewhat similar to a lingual brace in that it is affixed to the tongue side of a few teeth. Usually, a fixed retainer is used in cases where there has been either rapid or substantial movement of the teeth. It usually consists of a single wire. The inclination of the teeth to move rapidly means they are also more likely to regress back to their previous position if a fixed retainer is not placed.

What do I need to consider when using a retainer?

There are a few basic things to consider for proper use and maintenance of your retainer.

• Don’t lose the appliance – Removable retainers are very easy to lose. It is advisable to place your retainer in the case it came in while eating, drinking and brushing. Leaving a retainer folded in a napkin at a restaurant or in a public restroom can be very costly if lost because a replacement must be created. A brightly colored case serves as a great reminder.
• Don’t drink while wearing a retainer – It is tempting to drink while wearing a retainer because of the unobtrusive nature of the device. However, excess liquid trapped under the trays can vastly intensify acid exposure to teeth, increasing the probability of tooth decay.
• Don’t eat while wearing a retainer – It can be difficult and awkward to eat while wearing a removable retainer and it can also damage the device. Food can get trapped around a Hawley retainer wire or underneath the palate, causing bad breath. When worn on the upper and lower arches simultaneously, VFR retainers do not allow the teeth to meet. This means that chewing is almost impossible.
• Clean the retainer properly – Removable retainers can become breeding grounds for calculus and bacteria. It is essential to clean the inside and outside thoroughly as often as possible. Hawley retainers can be cleaned with a toothbrush. Because harsh bristles can damage the PVC surface of a VFR, denture cleaner or a specialized retainer cleaner is recommended for this type of device.
• Wear the retainer as directed – This phase of treatment is critical. The hard work has been done, the braces are off and now it is tempting not to wear the retainer as often as the orthodontist recommends. Retainers are needed to give the muscles, tissues and bones time to stabilize the teeth in their new alignment. Failure to wear the retainer as directed can have regrettable consequences, such as teeth returning to their original position, added expense and lost time.

If you have any questions or concerns about retainers, please contact our office.

One of the most commonly asked questions about dental braces is whether placing them causes any pain or discomfort. The honest answer is that braces do not hurt at all when they are applied to the teeth, so there is no reason to be anxious. In most cases, there may be mild soreness or discomfort after the orthodontic wire is engaged into the brackets, which may last for a few days.

There are two common types of fixed dental braces used to realign the teeth: Ceramic fixed braces and metal fixed braces. Both types of fixed appliances include brackets which are affixed to each individual tooth, and an archwire the orthodontist fits into the bracket slot to gently move the teeth into proper alignment. Elastic or wire ties will be applied to hold the wire in place. Some orthodontists may use self-ligating brackets which do not require a rubber or wire tie to secure the wire.

Fixed dental braces are used to treat a wide variety of malocclusions, including overbite, underbite, crossbite and overcrowding. If the orthodontist has determined that the malocclusion has been caused by overcrowding, it is possible that teeth may need to be extracted to increase the amount of available space to properly align the teeth.

What to expect when getting braces

Here is an overview of what you can expect when getting braces:

• Placement day – The placement of braces will not be painful in the slightest. It may take longer to eat meals, but this is largely because it takes some time to adjust to wearing the braces. In some cases, the teeth may feel more sensitive than usual. Hard, difficult to chew foods should be avoided in favor of a softer, more liquid-based diet for the first few days after placement of braces.
• Two days after placement – The first several days after placement of braces can be slightly uncomfortable. This is because the teeth are beginning the realignment process and are not used to the pressure of the archwire and orthodontic elastic bands. The orthodontist will provide relief wax to apply over the braces as necessary. Wax helps provide a smooth surface and alleviates irritation on the inner cheeks and lips. Additionally, over-the-counter pain medication (e.g., Motrin® and Advil®) may be taken as directed to relieve mild soreness.
• Five days after placement – After five days, any initial discomfort associated with the braces should be completely gone. The teeth will have gradually acclimated to the braces, and eating should be much easier. Certain hard foods may still pose a challenge to the wearer, but normal eating may be resumed at this point.
• Orthodontic appointments – Regular orthodontic appointments are necessary to allow the orthodontist to change the archwire, change the rubber or metal ties, and make adjustments to the braces. Fixed braces work by gradually moving the teeth into a new and proper alignment, so gentle pressure needs to be applied constantly. The first several days after an orthodontic adjustment may be slightly uncomfortable, but remember that this discomfort will quickly fade.
• Dealing with discomfort – Over-the-counter pain medication and orthodontic relief wax will help alleviate any mild soreness and discomfort following placement o braces and orthodontic adjustments. Another effective remedy is to chew sugar-free gum, as this increases blood flow which helps reduces discomfort and can also encourage the teeth to align quicker.

If you have any questions or concerns about orthodontic treatment, please contact our office.

Orthodontic braces were historically associated with teenagers. Today, an increasing number of adults are choosing to wear braces to straighten their teeth and correct malocclusions (bad bites). In fact, it is now estimated that almost one third of all current orthodontic patients are adults.

Orthodontic braces are predictable, versatile and incredibly successful at realigning the teeth. Braces work in the same way regardless of the age of the patient, but the treatment time is greatly reduced in patients who are still experiencing jaw growth and have not been affected by gum disease. In short, an adult can experience the same beautiful end results as a teenager, but treatment often takes longer.

Can adults benefit from orthodontic braces?

Absolutely! Crooked or misaligned teeth look unsightly, which in many cases leads to poor self esteem and a lack of self confidence. Aside from poor aesthetics, improperly aligned teeth can also cause difficulties biting, chewing and articulating clearly. Generally speaking, orthodontists agree that straight teeth tend to be healthier teeth. Straight teeth offer a multitude of health and dental benefits including:

• Reduction in general tooth decay
• Decreased likelihood of developing periodontal disease
• Decreased likelihood of tooth injury
• Reduction in digestive disorders

Fortunately, orthodontic braces have been adapted and modified to make them more convenient for adults. There are now a wide range of fixed and removable orthodontic devices available, depending on the precise classification of the malocclusion.

The most common types of malocclusion are underbite (lower teeth protrude further than upper teeth), overbite (upper teeth protrude further than lower teeth) and overcrowding, where there is insufficient space on the arches to accommodate the full complement of adult teeth. Prior to recommending specific orthodontic treatment, the orthodontist will recommend treatment of any pre-existing dental conditions such as gum disease, excess plaque and tooth decay. Orthodontic braces can greatly exacerbate any or all of these conditions.

What are the main types of orthodontic braces?

The following are some of the most popular orthodontic braces:

• Traditional braces – These braces are strong and tend not to stain the teeth. They are comprised of individual brackets which are cemented to each tooth and accompanied by an archwire which constantly asserts gentle pressure on the teeth. Traditional braces are generally metal but are also available in a clear synthetic material and “tooth colored” ceramic. The ceramic brackets are generally more comfortable than the metal alternative, but can become discolored by coffee, wine, smoking and certain foods.
• Invisalign® – Invisalign aligners are favored by many adults because they are both removable and invisible to onlookers. Invisalign® aligners are clear trays, and should be worn for the recommended amount of time each day for the quickest results. Invisalign® aligners are more comfortable and less obtrusive than traditional braces, but also tend to be more costly. Not all patients are candidates for Invisalign®.
• Lingual braces – These appliances are usually metal and fixed on the tongue side of the teeth, therefore not seen when a patient smiles. Lingual braces tend to be moderately expensive and in some cases, can interfere with normal speech.

If you have any questions about orthodontic braces, please contact our office.

Many children are ambivalent about getting braces. On the one hand, they like the idea of perfect teeth, but on the other hand they are nervous about whether the braces will cause pain and discomfort. The good news is that the placement of orthodontic braces is not at all painful, and the end result will be a beautiful straight smile.

Although patients of any age can benefit from orthodontic braces, they tend to work much quicker on pre-teens and teenagers since they are still experiencing jaw growth. The American Association of Orthodontists (AAO) recommends that children should first see an orthodontist around the age of seven years-old. An orthodontic examination may be beneficial before age seven if facial or oral irregularities are noted.

What Causes misalignment of teeth?

Poorly aligned teeth often cause problems speaking, biting and chewing. Most irregularities are genetic or occur as a result of developmental issues. Conversely, some irregularities are acquired or greatly exacerbated by certain habits and behaviors such as:

• Mouth breathing
• Thumb or finger sucking
• Prolonged pacifier use
• Poor oral hygiene
• Poor nutrition

What’s involved when a child gets braces?

The orthodontist initially conducts a visual examination of the child’s teeth. This will be accompanied by panoramic x-rays, study models (bite impressions) and computer generated images of the head and neck. These preliminary assessments are sometimes known as the “planning phase” because they aid the orthodontist in making a diagnosis and planning the most effective treatment.

In many cases, the orthodontist will recommend “fixed” orthodontic braces for a child. Fixed braces cannot be lost, forgotten or removed at will, which means that treatment is completed more quickly. Removable appliances may also be utilized, which are less intrusive, and are generally used to treat various types of defects. Here is a brief overview of some of the main types of orthodontic appliances used for children:

• Fixed braces – Braces comprised of brackets which are affixed to each individual tooth, and an archwire which connect the brackets. The brackets are usually made of metal, ceramic, or a clear synthetic material which is less noticeable to the naked eye. After braces have been applied, the child will have regular appointments to have the braces adjusted by the orthodontist. Orthodontic elastic bands are often added to the braces to aid in the movement of specific teeth.
• Headgear – This type of appliance is most useful to treat developmental irregularities. A headgear is a custom-made appliance attached to wire that is worn to aid in tooth movement. A headgear is intended to be worn for 12-20 hours r each day and must be worn as recommended to achieve good results.
• Retainers – Retainers are typically utilized in the third phase (retention phase). When the original malocclusion has been treated with braces, it is essential that the teeth do not regress back to the original misalignment. Wearing a retainer ensures the teeth maintain their proper alignment, and gives the jawbone around the teeth a chance to stabilize.

If you have questions about braces for children, please contact our office.

The benefits of orthodontic treatment often go beyond the obvious physical changes of an improved bite and straighter teeth; it’s also a great way to improve a person’s overall self-image. While having beautiful straight teeth is important, even more important is the need to alleviate any potential health problems associated with the teeth or jaw. Crooked teeth or jaw problems may contribute to improper cleaning of teeth, leading to tooth decay and, possibly, gum disease or total tooth loss. Orthodontic problems that go untreated can lead to chewing and digestion difficulties, speech impairments, and abnormal wear of tooth surfaces. Over time, excessive strain on gum tissue and the bone that supports the teeth can affect the jaw joints leading to problems such as headaches or face and neck pain.

The American Association of Orthodontics recommends that children get an orthodontic evaluation no later than age 7. Though orthodontic treatment can be done at any age, timely treatment ensures maximum dental health.

With all of the recent advancements in orthodontics, wearing braces has never been easier. State-of-the-art appliances and treatments are now available, from traditional metal braces, to clear and tooth colored brackets, to NASA type wires that are heat activated and require fewer adjustments! Some patients may even be candidates for treatment with Invisalign, a revolutionary way to straighten teeth using clear, retainer type aligners that require no braces or wires! If treatment is necessary, we will thoroughly discuss which treatment option is best suited for you!

Reasons for orthodontic treatment (braces) adults & children:

• Breathing or swallowing problems – Mouth breathing can lead to snoring and sleep apnea.
• Crossbite – One or more upper teeth bite inside the lower teeth (towards the tongue)
• Crowding – Involving extra teeth or malpositioned teeth.
• Deep Overbite – The lower front teeth bite into the upper tissue of the upper teeth
• Disfiguring of the face & mouth – Affects the development of the jaw and position of the teeth.
  Jaw & jaw joint pain
• Missing or extra teeth – Due to tooth decay, injuries, or inherited problems.
• Overjet (protruding upper teeth) – Upper teeth that protrude beyond normal and are usually associated with a short lower jaw.
• Self-image – An attractive smile can boost a person’s self-image and confidence.
• Spacing between teeth – Teeth are missing or may be too small or too large.
• Speech, chewing or biting problems
• Underbite (lower jaw protrusion) – Lower jaw is longer than the upper jaw.

Specific to children:

• Finger or thumb sucking – These habits can cause protrusion of the upper incisor teeth, and mouth breathing.
• Teeth erupting out of position – Can be guided to proper alignment.

What does orthodontic treatment involve?

Orthodontic treatment involves three phases:

1. Planning Phase – Your first couple of visits may include the following:

• A medical and dental history evaluation.
• Castings or “molds” of your teeth.
• Computer generated photograph of the head and neck that will aid in planning.
• Photographs of your face and mouth.
• X-rays of the teeth and jaws.
• After careful planning, your orthodontist will design and apply braces or fabricate custom-made appliances for you.

2. Active Phase – Active treatment involves visiting your orthodontist on a regular basis for adjustments and following specific treatment requirements to ensure successful treatment.

3. Retention Phase – When treatment is completed, the braces and/or appliances are removed and a new appliance is made. Usually these retainers are removable and will maintain the changes made to your teeth if worn continuously until the teeth and bone are stabilized in their new positions.

Treatment and retention times vary depending on each individual case. Your orthodontist will ensure you have a successful treatment for a beautiful smile that can last a lifetime. Orthodontics can not only help straighten your teeth, giving you an appealing smile, but can greatly contribute to the health of your jaw, teeth and sometimes your overall health.

Orthodontics is a specialized branch of dentistry that is concerned with diagnosing, treating and preventing malocclusions (bad bites) and other irregularities in the jaw region and face. Orthodontists are specially trained to correct these problems and to restore health, functionality and a beautiful aesthetic appearance to the smile. Though orthodontics was originally aimed at treating children and teenagers, almost one third of orthodontic patients are now adults. A person of any age can be successfully treated by an orthodontist.

A malocclusion (improper bite) can affect anyone at any age, and can significantly impact the individual’s clarity of speech, chewing ability and facial symmetry. In addition, a severe malocclusion can also contribute to several serious dental and physical conditions such as digestive difficulties, TMJ, periodontal disease and severe tooth decay. It is important to seek orthodontic treatment early to avoid expensive restorative procedures in the future.

What problems can orthodontics treat?

Orthodontics can treat a wide range of dental problems and in most cases, completely realign the teeth. Orthodontists may work alone, or in combination with a maxillofacial surgeon. The typical irregularities requiring orthodontic treatment are as follows:

• Overcrowding – An overcrowded mouth means there is insufficient space within the jaw for all of the adult teeth to fit naturally. Overcrowding may lead to displaced, rotated or completely misaligned teeth.
• Overbite – An overbite refers to the protrusion of the maxilla (upper jaw) relative to the mandible (lower jaw). An overbite gives the smile a “toothy” appearance and the chin looks like it has receded.
• Underbite – An underbite, also known as a negative underjet, refers to the protrusion of the mandible (lower jaw) in relation to the maxilla (upper jaw). An underbite makes the chin look overly prominent. Developmental delays and genetic factors generally cause underbites and overbites.

How can orthodontics help?

Orthodontic dentistry offers techniques which will realign the teeth and revitalize the smile. There are several treatments the orthodontist may use, depending on the results of panoramic x-rays, study models (bite impressions) and a thorough visual examination. Fixed dental braces can be used to expediently correct even the most severe case of misalignment. These braces consist of metal or ceramic brackets which are affixed to each tooth and an archwire which is used to gradually move the teeth through the duration of the treatment.

Removable appliances include headgear (which consists of a metal wire device attached to customized braces), retainers, Invisalign® aligners (which are almost invisible to the naked eye), palate expanders and tooth movers. Faceguards are generally used to correct developmental delays in both the upper and lower jaw, and palate expanders are used to combat overcrowding. Whatever the dental irregularity or the age of the individual, orthodontic appliances can properly realign the teeth and create a beautiful smile. If you have any questions or concerns about orthodontic treatments or how they can benefit you, please contact our office.

A malocclusion is an incorrect relationship between the maxilla (upper arch) and the mandible (lower arch), or a general misalignment of the teeth. Malocclusions are so common that most individuals experience one, to some degree. The poor alignment of the teeth is thought to be a result of genetic factors combined with poor oral habits, or other factors in the early years.

Moderate malocclusion commonly requires treatment by an orthodontist. Orthodontists are dentists who specialize in the treatment of malocclusions and other facial irregularities. The following are three main classifications of malocclusion:

• Class I – The occlusion is typical, but there are spacing or overcrowding problems with the other teeth.
• Class II – The malocclusion is an overbite (the upper teeth are positioned further forward than the lower teeth). This can be caused by the protrusion of anterior teeth or the overlapping of the central teeth by the lateral teeth.
• Class III – Prognathism (also known as “underbite”) is a malocclusion caused by the lower teeth being positioned further forward than the upper teeth. An underbite usually occurs when the jawbone is large or the maxillary bone is short.

Reasons for treating a malocclusion

A severe malocclusion may lead to skeletal disharmony of the lower face. In a more extreme case, the orthodontist may work in combination with a maxillofacial dentist to reconstruct the jaw. It is never too late to seek treatment for a malocclusion. Children and adults alike have completed orthodontic realignment procedures and have been delighted with the resulting even, straight smile. Here are some of the main reasons to seek orthodontic treatment for a malocclusion:

• Reduced risk of tooth decay – A malocclusion often causes an uneven wear pattern on the teeth. The constant wearing of the same teeth can lead to tooth erosion and decay.
• Better oral hygiene – A malocclusion can be caused by overcrowding. When too many teeth are competing for too little space, it can be difficult to clean the teeth and gums effectively. It is much easier to clean straight teeth that are properly aligned.
• Reduced risk of TMJ – Temporomandibular jaw syndrome (TMJ) is thought to be caused by a malocclusion. Headaches, facial pains and grinding teeth during sleep all result from the excessive pressure to the temporomandibular joint. Realigning the teeth reduces pressure, and eliminates these symptoms.

How is a malocclusion treated?

A malocclusion is usually treated with dental braces. The orthodontist takes panoramic x-rays, conducts visual examinations and bite impressions of the whole mouth before deciding on the best course of treatment. If a malocclusion is obviously caused by overcrowding, the orthodontist may decide an extraction is the only way to create enough space for the realignment. However, in the case of an underbite, crossbite or overbite, there are several different orthodontic appliances available, such as:

• Fixed multibracket braces – This type of dental braces consists of brackets cemented to each tooth, and an archwire that connects each one. The orthodontist adjusts or changes the wire on a regular basis to train the teeth into proper alignment.
• Removable devices – There are many non-fixed dental braces available to treat a malocclusion. Retainers, headgear and palate expanders are amongst the most common. Retainers are generally used to hold the teeth in the correct position whilst the jawbone grows properly around them.
• Invisalign® – These dental aligners are removable and invisible to the naked eye. Invisalign works in much the same way as fixed dental braces, but do not impact the aesthetics of the smile. Not all patients are candidates for Invisalign®.

If you have any questions about malocclusions, please contact our office.

Orthodontics is one of many dental specialties. The word “orthodontics” is derived from the Greek words orthos, meaning proper or straight and odons meaning teeth. Orthodontics is specifically concerned with diagnosing and treating tooth misalignment and irregularity in the jaw area. Initially, orthodontic treatments were geared toward the treatment of teens and pre-teens, but these days around 30 percent of orthodontic patients are adults.

There are many advantages to well-aligned teeth, including easier cleaning, better oral hygiene, clearer speech and a more pleasant smile. Though orthodontic treatment can be effective at any age, the American Dental Association suggests that an orthodontic assessment should be performed around the age of seven. The earlier orthodontic treatment begins, the more quickly the problem can be successfully resolved.

What problems can be treated with orthodontics?

Orthodontics is a versatile branch of dentistry that can be used alone, or in combination with maxillofacial or cosmetic dentistry.

Here are some of the common conditions treated with orthodontics:

• Anteroposterior deviations – The discrepancy between a pair of closed jaws is known as an anteroposterior discrepancy or deviation. An example of such a discrepancy would be an overbite (where the upper teeth are further forward than the lower teeth), or an under-bite (where the lower teeth are further forward then the upper teeth).
• Overcrowding – Overcrowding is a common orthodontic problem. It occurs when there is an insufficient space for the normal growth and development of adult teeth.
• Aesthetic problems – A beautiful straight smile may be marred by a single misaligned tooth. This tooth can be realigned with ease and accuracy by the orthodontist. Alternatively, orthodontists can also work to reshape and restructure the lips, jaw or the face.

Orthodontic Solutions

Orthodontics is a technologically advanced field which offers many sophisticated solutions to malocclusions and other cosmetic problems. The orthodontist will generally perform a visual examination, panoramic x-rays and study models (bite impressions) in order to assess the exact nature of the discrepancy. When a diagnosis has been made, there are a variety of orthodontic treatment options available. Here is an overview of some of the most common treatments:

• Fixed orthodontic braces – A metal or ceramic dental base is affixed to each tooth, and a dental wire is inserted through each base. The orthodontist is able to gradually train the teeth into proper alignment by regularly adjusting the wire. When the desired results are achieved, the fixed dental braces are completely removed.
• Removable appliances – There are a wide range of removable appliances commonly used in orthodontics, including headgear that correct overbites, Hawley retainers that improve the position of the teeth even as the jawbone reforms, and facemasks which are used to correct an underbite.
• Invisalign® – This is a newer, removable type of dental aligner that is completely transparent. Invisalign® does not interfere with eating because of its removable nature, and mechanically works in the same way as the traditional metal dental braces. Not all patients are candidates for Invisalign®.

If you have any questions or concerns about orthodontics, please contact your Walnut Creek dentist, Dr. Darvishzadeh’s office.

Orthodontics is a branch of dentistry specializing in the diagnosis, prevention, and treatment of jaw, face and bite irregularities (malocclusions*). Orthodontic treatment is provided by an oral health care provider known as an Orthodontist, who has typically completed two to three years of additional training beyond dental school.

Recent years have brought about many changes within the dental industry, specifically with regards to orthodontic treatment and care. Now more than ever patients are experiencing fewer incidences of cavities and missing teeth due to the heightened awareness of fluoride use and preventative dentistry. This increasing awareness on the health and look of a patient’s smile has fueled the desire for many to seek out orthodontia not only as a medical necessity, but for cosmetic reasons as well.

Whether it’s traditional braces or custom made removable appliances, orthodontics can help you have the healthy, straight, beautiful smile you’ve been waiting for!

Benefits of a fixed bridge on implants

When all teeth are missing or in such condition that they need to be replaced, a fixed bridge anchored to dental implants is the best permanent solution. Before dental implants, there were no fixed solution available for people who lost all their teeth. Today, it is possible to replace a full jaw with dental implants and a fixed bridge that results in a permanent, stable and high aesthetic solution.

• Lets you eat and function like having natural teeth
• A solid, stable solution that will serve you for life
• Preserves your facial appearance and prevents bone loss

Treatment

The treatment procedure and number of visits is largely dependent on the specific conditions. But all in all, 8-10 visits should be enough to have a fixed bridge installed. Most patients report that they were much more comfortable following the procedure than they had anticipated.

INSTALLING THE FIXED BRIDGE STEP-BY-STEP

The course of treatment described here is one of several options available. Consult your dentist to find out what the best solution is for you, given your specific condition.

1. Before the procedure: The dentist determines what needs to be done and prepares both himself and the patient for the coming treatment procedure.
2. Installing the implants: The first step is installing dental implants to replace the lost tooth roots. In this case, five implants are used. Temporary teeth are attached that enable you to eat and function like normal while waiting for the permanent bridge to be installed.
3. Attaching the bridge : The final bridge is securely installed on top of the implants. With a full jaw replacement like this, it normally takes 2-3 visits to have the bridge completely attached.
4. End result: Your new teeth should be hard to tell from natural both for you and others. People who have had traditional dentures before getting a fixed bridge often describe this as an overwhelming and very positive experience.

ALTERNATIVES TO A FIXED BRIDGE

An alternative to a fixed bridge is a removable over-denture, which is anchored on implants. The old fashioned denture has many disadvantages and should be avoided if possible.

Removable, implant anchored over-denture: A removable full denture that is connected to either a ball or bar attachment, which in turn is anchored on two or more implants in the front part of the jaw. The implants help keep the denture in place and provide better function and comfort. Cost is usually the reason why this solution is chosen over a fixed bridge although the end result can’t be compared.

Removable full denture: A denture that is loosely placed on top of the gum to cover the lost teeth. This alternative has no real advantages except for its low price and easy installation. The disadvantages are many: discomfort in eating, poor aesthetics, affected speech, and sore gums from denture movement. Moreover, a full denture placed in the upper jaw severely reduces the sense of taste.

Benefits of an all-ceramic crown on implant

When both the tooth and root are damaged, the best permanent replacement is a dental implant in conjunction with a ceramic crown. This solution both looks and functions just like a natural tooth. In this case, a so-called one-piece implant is used. This means that all components are installed as a single unit, resulting in immediately full functioning teeth, shorter treatment time and minimized pain.

• Immediately functioning teeth
• Excellent aesthetic result
• Life long, stable solution

Treatment

This procedure normally includes four visits to the dentist. You should expect to be able to work the day after having the implant installed.

INSTALLING THE NEW TOOTH STEP-BY-STEP

The course of treatment described here is one of several options available. Consult your dentist to find out what the best solution is for you, given your specific condition.

1. Before the procedure: The dentist makes a first examination and takes one or more x-rays of the area to prepare for the procedure.
2. Installing the implant: The implant is installed. At this time, a temporary tooth is provided that allows you eat and function like normal almost immediately. The implant will need a few months to integrate with the jawbone before the next step is taken.
3. Attaching the new crown: The final step is the placement of the permanent ceramic tooth. The new tooth is installed for life. No additional treatment is needed.
4. End result: You should expect the new tooth to fit and function just like a natural tooth. Do your usual dental hygiene to keep the tooth and gum around it clean.

ALTERNATIVES TO AN ALL-CERAMIC CROWN ON IMPLANT

Tooth-supported fixed bridge: A traditional bridge involves grinding down adjacent teeth to support the bridge. It is a stable solution with good aesthetics and function that is fairly easy to install. However, this alternative has two main disadvantages: continuous bone resorption in the edentulous area, and sacrificing healthy teeth on behalf of the bridge.

Removable partial denture: This is not a permanent alternative to a lost tooth. It is unstable and loosely attached, which affects both function and comfort. A removable partial denture is made of plastic a material that can’t create the same aesthetic result as a ceramic crown. The benefits are few but do exist, adjacent teeth aren’t affected. It is easily and quickly installed and relatively cheap.

Resin-bonded bridge: This alternative has some clear advantages: it is quickly installed, functions well and, since it is made of ceramic, it gives a high aesthetic result. Moreover, natural healthy teeth aren’t affected. But it is not very permanent. The resin-bonded bridge will eventually come off probably after just a couple of years and will then have to be reinstalled.

Benefits with fixed bridge on implants

In this case, when replacing three teeth in the far back of the mouth, a fixed bridge anchored to dental implants is the only fixed alternative. Traditional dentures can’t offer the same stability or function. Having dental implants replacing your lost back teeth will give you new, unparalleled strength and stability that allows you to eat what you want. It will also preserve your jawbone and facial appearance.

• The only fixed alternative in this situation.
• A stable, secure solution that lets you eat what you want
• Preserves your facial appearance and prevents bone loss

Treatment

After the initial examination, you can expect 4-5 additional visits until the final fixed bridge is permanently attached. It is normal to experience some minor bruising and swelling in the gum and soft tissue afterwards. Any discomfort is usually treated with an ordinary painkiller. You should expect to be able to work the next day

INSTALLING THE FIXED BRIDGE STEP-BY-STEP

The course of treatment described here is one of several options available. Consult your dentist to find out what the best solution is for you, given your specific condition.

1. Before the procedure: Three teeth at back end of the mouth are missing. The only real replacement alternative is installing a fixed bridge. The bridge contains all teeth in one piece and is anchored on dental implants.
2. Installing the implant: First, the implants are installed. This is normally done in a single session. A temporary bridge may be placed at the same time, making it possible for you to function like normal almost immediately after leaving the dentist.
3. Attaching the bridge: The implants need to integrate with the jawbone before the permanent bridge is attached. This is normally done 1-2 months after the implant installation. The time will vary, depending on the teeth affected and the aesthetical demands.
4. End result: The new bridge will handle all the pressure that your strong, natural back teeth did. You will have a stable and secure solution that allows you to eat what you want.

ALTERNATIVES TO FIXED BRIDGE

Removable partial denture : This alternative is often perceived as uncomfortable and a bit complicated to use. Function can’t be compared to that of a bridge. This denture is made of plastic and metal, which affects its look. It is quite expensive to fabricate due to its many parts. However, the installation process is simple, and natural teeth are spared.

A denture is a removable dental appliance replacement for missing teeth and surrounding tissue. They are made to closely resemble your natural teeth and may even enhance your smile. There are two types of dentures – complete and partial dentures. Complete dentures are used when all of the teeth are missing, while partial dentures are used when some natural teeth remain. A Partial denture not only fills in the spaces created by missing teeth, it prevents other teeth from shifting.

A Complete denture may be either “conventional” or “immediate.” A conventional type is made after the teeth have been removed and the gum tissue has healed, usually taking 4 to 6 weeks. During this time the patient will go without teeth. Immediate dentures are made in advance and immediately placed after the teeth are removed, thus preventing the patient from having to be without teeth during the healing process. Once the tissues shrink and heal, adjustments will have to be made. Dentures are very durable appliances and will last many years, but may have to be remade, repaired, or readjusted due to normal wear.

Reasons for dentures:

• Complete Denture – Loss of all teeth in an arch
• Partial Denture – Loss of several teeth in an arch
• Enhancing smile and facial tissues
• Improving chewing, speech, and digestion

What does getting dentures involve?

The process of getting dentures requires several appointments, usually over several weeks. Highly accurate impressions (molds) and measurements are taken and used to create your custom denture. Several “try-in” appointments may be necessary to ensure proper shape, color, and fit. At the final appointment, your dentist will precisely adjust and place the completed denture, ensuring a natural and comfortable fit.

It is normal to experience increased saliva flow, some soreness, and possible speech and chewing difficulty, however this will subside as your muscles and tissues get used to the new dentures. You will be given care instructions for your new dentures. Proper cleaning of your new dental appliance, good oral hygiene, and regular dental visits will aid in the life of your new dentures.

Root canal therapy is needed when the nerve of a tooth is affected by decay or infection. In order to save the tooth, the pulp (the living tissue inside the tooth), nerves, bacteria, and any decay are removed and the resulting space is filled with special, medicated, dental materials, which restore the tooth to its full function.

Having a root canal done on a tooth is the treatment of choice to save a tooth that otherwise would die and have to be removed. Many patients believe that removing a tooth that has problems is the solution, but what is not realized is that extracting (pulling) a tooth will ultimately be more costly and cause significant problems for adjacent teeth. Root canal treatment is highly successful and usually lasts a lifetime, although on occasion, a tooth will have to be retreated due to new infections. Signs and symptoms for possible root canal therapy:

• An abscess (or pimple) on the gums
• Sensitivity to hot and cold
• Severe toothache pain
• Sometimes no symptoms are present
• Swelling and/or tenderness

Reasons for root canal therapy:

• Decay has reached the tooth pulp (the living tissue inside the tooth)
• Infection or abscess have developed inside the tooth or at the root tip
• Injury or trauma to the tooth

What does root canal therapy involve?

A root canal procedure requires one or more appointments and can be performed by a dentist or endodontist (a root canal specialist). While the tooth is numb, a rubber dam (a sheet of rubber) will be placed around the tooth to keep it dry and free of saliva. An access opening is made on top of the tooth and a series of root canal files are placed into the opening, one at a time, removing the pulp, nerve tissue, and bacteria. If tooth decay is present, it will also be removed with special dental instruments.

Once the tooth is thoroughly cleaned, it will be sealed with either a permanent filling or, if additional appointments are needed, a temporary filling will be placed. At the next appointment, usually a week later, the roots and the inside cavity of the tooth will be filled and sealed with special dental materials. A filling will be placed to cover the opening on top of the tooth. In addition, all teeth that have root canal treatment should have a crown (cap) placed. This will protect the tooth and prevent it from breaking, and restore it to its full function.

After treatment, your tooth may still be sensitive, but this will subside as the inflammation diminishes and the tooth has healed. You will be given care instructions after each appointment. Good oral hygiene practices and regular dental visits will aid in the life of your root canal treatment.

A crown (or cap) is a covering that encases the entire tooth surface restoring it to its original shape and size. A crown protects and strengthens tooth structure that cannot be restored with fillings or other types of restorations.

Although there are several types of crowns, porcelain (tooth colored crown) are the most popular. They are highly durable and will last many years, but like most dental restorations, they may eventually need to be replaced. Porcelain crowns are made to match the shape, size, and color or your teeth giving you a natural, long-lasting beautiful smile. Reasons for crowns:

• Broken or fractured teeth
• Cosmetic enhancement
• Decayed teeth
• Fractured fillings
• Large fillings
• Tooth has a root canal

What does getting a crown involve?

A crown procedure usually requires two appointments. Your first appointment will include taking several highly accurate molds (or impressions) that will be used to create your custom crown. A mold will also be used to create a temporary crown which will stay on your tooth for approximately two weeks until your new crown is fabricated by a dental laboratory.

While the tooth is numb, the dentist will prepare the tooth by removing any decay and shaping the surface to properly fit the crown. Once these details are accomplished, your temporary crown will be placed with temporary cement and your bite will be checked to ensure you are biting properly.

At your second appointment your temporary crown will be removed, the tooth will be cleaned, and your new crown will be carefully placed to ensure the spacing and bite are accurate. You will be given care instructions and encouraged to have regular dental visits to check your new crown.

It’s great news that the incidence of tooth decay has significantly diminished over the years due to the use of fluorides and an increase in patient awareness. However, teeth are still susceptible to decay, infection, and breakage and sometimes need to be restored back to health. Through improved techniques and modern technology, we are now able to offer more options for restoring a tooth back to its normal shape, appearance and function.

Should your teeth ever require a restorative treatment, you can rest assured knowing we will always discuss with you the available options, and recommend what we believe to be the most comfortable and least invasive treatment. Providing you with excellent care is our number one priority when creating your beautiful smile. Reasons for restorative dentistry:

• Enhance your smile
• Fill in unattractive spaces between teeth
• Improve or correct an improper bite
• Prevent the loss of a tooth
• Relieve dental pain
• Repair damaged and decayed teeth
• Replace missing teeth
• Replace old, unattractive dental treatments
• Restore normal eating and chewing

The term “periodontal”means “around the tooth.” Periodontal disease (also known as periodontitis and gum disease) is a common inflammatory condition which affects the supporting and surrounding soft tissues of the tooth; also the jawbone itself when in its most advanced stages.

Periodontal disease is most often preceded by gingivitis which is a bacterial infection of the gum tissue. A bacterial infection affects the gums when the toxins contained in plaque begin to irritate and inflame the gum tissues. Once this bacterial infection colonizes in the gum pockets between the teeth, it becomes much more difficult to remove and treat. Periodontal disease is a progressive condition that eventually leads to the destruction of the connective tissue and jawbone. If left untreated, it can lead to shifting teeth, loose teeth and eventually tooth loss. Periodontal disease is the leading cause of tooth loss among adults in the developed world and should always be promptly treated.

Types of Periodontal Disease

When left untreated, gingivitis (mild gum inflammation) can spread to below the gum line. When the gums become irritated by the toxins contained in plaque, a chronic inflammatory response causes the body to break down and destroy its own bone and soft tissue. There may be little or no symptoms as periodontal disease causes the teeth to separate from the infected gum tissue. Deepening pockets between the gums and teeth are generally indicative that soft tissue and bone is being destroyed by periodontal disease. Here are some of the most common types of periodontal disease:

• Chronic periodontitis: Inflammation within supporting tissues cause deep pockets and gum recession. It may appear the teeth are lengthening, but in actuality, the gums (gingiva) are receding. This is the most common form of periodontal disease and is characterized by progressive loss of attachment, interspersed with periods of rapid progression.
• Aggressive periodontitis: This form of gum disease occurs in an otherwise clinically healthy individual. It is characterized by rapid loss of gum attachment, chronic bone destruction and familial aggregation.
• Necrotizing periodontitis: This form of periodontal disease most often occurs in individuals suffering from systemic conditions such as HIV, immunosuppression and malnutrition. Necrosis (tissue death) occurs in the periodontal ligament, alveolar bone and gingival tissues.
• Periodontitis caused by systemic disease: This form of gum disease often begins at an early age. Medical condition such as respiratory disease, diabetes and heart disease are common cofactors.

Treatment for Periodontal Disease

There are many surgical and nonsurgical treatments the periodontist may choose to perform, depending upon the exact condition of the teeth, gums and jawbone. A complete periodontal exam of the mouth will be done before any treatment is performed or recommended. Here are some of the more common treatments for periodontal disease:

• Scaling and root planing: In order to preserve the health of the gum tissue, the bacteria and calculus (tartar) which initially caused the infection, must be removed. The gum pockets will be cleaned and treated with antibiotics as necessary to help alleviate the infection. A prescription mouthwash may be incorporated into daily cleaning routines.
• Tissue regeneration: When the bone and gum tissues have been destroyed, regrowth can be actively encouraged using grafting procedures. A membrane may be inserted into the affected areas to assist in the regeneration process.
• Pocket elimination surgery: Pocket elimination surgery (also known as flap surgery) is a surgical treatment which can be performed to reduce the pocket size between the teeth and gums. Surgery on the jawbone is another option which serves to eliminate indentations in the bone which foster the colonization of bacteria.
• Dental implants: When teeth have been lost due to periodontal disease, the aesthetics and functionality of the mouth can be restored by implanting prosthetic teeth into the jawbone. Tissue regeneration procedures may be required prior to the placement of a dental implant in order to strengthen the bone.

It only takes twenty four hours for plaque that is not removed from your teeth to turn into calculus (tartar)! Daily home cleaning helps control plaque and tartar formation, but those hard to reach areas will always need special attention.

Once your periodontal treatment has been completed, your dentist and dental hygienist will recommend that you have regular maintenance cleanings (periodontal cleanings), usually four times a year. At these cleaning appointments, the pocket depths will be carefully checked to ensure that they are healthy. Plaque and calculus that is difficult for you to remove on a daily basis will be removed from above and below the gum line. In addition to your periodontal cleaning and evaluation, your appointment will usually include:

• 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.
• Examination of existing restorations: Check current fillings, crowns, etc.
• Examination of tooth decay: Check all tooth surfaces for decay.
• Oral cancer screening: Check the face, neck, lips, tongue, throat, cheek tissues, and gums for any signs of oral cancer.
• Oral hygiene recommendations: Review and recommend oral hygiene aids as needed. (Electric toothbrushes, special periodontal brushes, fluorides, rinses, etc.)
• Teeth polishing: Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.

Good oral hygiene practices and periodontal cleanings are essential in maintaining dental health and keeping periodontal disease under control!

Periodontal treatment methods depend upon the type and severity of the disease. Your dentist and dental hygienist will evaluate for periodontal disease and recommend the appropriate treatment. Periodontal disease progresses as the sulcus (pocket or space) between the tooth and gums gets filled with bacteria, plaque, and tartar, causing irritation to the surrounding tissues. When these irritants remain in the pocket space, they can cause damage to the gums and eventually, the bone that supports the teeth!

If the disease is caught in the early stages of gingivitis, and no damage has been done, one to two regular cleanings will be recommended. You will also be given instructions on improving your daily oral hygiene habits and having regular dental cleanings.

If the disease has progressed to more advanced stages, a special periodontal cleaning called scaling and root planning (deep cleaning) will be recommended. It is usually done one quadrant of the mouth at a time while the area is numb. In this procedure, tartar, plaque, and toxins are removed from above and below the gum line (scaling) and rough spots on root surfaces are made smooth (planning). This procedure helps gum tissue to heal and pockets to shrink. Medications, special medicated mouth rinses, and an electric tooth brush may be recommended to help control infection and healing.

If the pockets do not heal after scaling and root planning, periodontal surgery may be needed to reduce pocket depths, making teeth easier to clean. Your dentist may also recommend that you see a Periodontist (specialist of the gums and supporting bone).

Periodontal disease is diagnosed by your dentist or dental hygienist during a periodontal examination. This type of exam should always be part of your regular dental check-up. A periodontal probe (small dental instrument) is gently used to measure the sulcus (pocket or space) between the tooth and the gums. The depth of a healthy sulcus measures three millimeters or less and does not bleed. The periodontal probe helps indicate if pockets are deeper than three millimeters. As periodontal disease progresses, the pockets usually get deeper. Your dentist or hygienist will use pocket depths, amount of bleeding, inflammation, tooth mobility, etc., to make a diagnosis that will fall into a category below:

• Gingivitis: Gingivitis is the first stage of periodontal disease. Plaque and its toxin by-products irritate the gums, making them tender, inflamed, and likely to bleed.
• Periodontitis: Plaque hardens into calculus (tartar). As calculus and plaque continue to build up, the gums begin to recede from the teeth. Deeper pockets form between the gums and teeth and become filled with bacteria and pus. The gums become very irritated, inflamed, and bleed easily.Slight to moderate bone loss may be present.
• Advanced Periodontitis: The teeth lose more support as the gums, bone, and periodontal ligament continue to be destroyed. Unless treated, the affected teeth will become very loose and may be lost. Generalized moderate to severe bone loss may be present.

Periodontal disease (also called periodontitis and gum disease) has been linked to respiratory disease through recent research studies. Researchers have concluded that periodontal disease can worsen conditions such as chronic obstructive pulmonary disease (COPD) and may actually play a causal role in the contraction of pneumonia, bronchitis and emphysema.

Periodontal disease is a progressive condition which generally begins with a bacterial infection. The bacteria found in plaque begin to colonize in gingival tissue, causing an inflammatory response in which the body destroys both gum and bone tissue. The sufferer may notice the teeth “lengthening” as the gums recede while the disease progresses. If left untreated, erosion of the bone tissue brings about a less stable base for the teeth, meaning loose, shifting or complete tooth loss.

There are a number of different respiratory diseases linked to periodontal disease. Pneumonia, COPD, and bronchitis are among the most common. Generally, bacterial respiratory infections occur due to the inhalation of fine droplets from the mouth into the lungs. COPD is a leading cause of death and should be taken very seriously.

Reasons for the Connection

The fact that respiratory disease and periodontal disease are linked may seem far-fetched, but there is plenty of evidence to support it. Here are some of the reasons for the link between periodontal disease and respiratory disease:

• Bacterial spread: The specific type of oral bacterium that causes periodontal disease can easily be drawn into the lower respiratory tract. Once the bacteria colonize in the lungs, it can cause pneumonia and exacerbate serious conditions such as COPD.
• Low immunity: It has been well-documented that most people who experience chronic or persistent respiratory problems suffer from low immunity. This low immunity allows oral bacteria to embed itself above and below the gum line without being challenged by the body’s immune system. Not only does this accelerate the progression of periodontal disease, it also puts the sufferer at increased risk of developing emphysema, pneumonia and COPD.
• Modifiable factors: Smoking is thought to be the leading cause of COPD and other chronic respiratory conditions. Tobacco use also damages the gingiva and compromises the good health of the oral cavity in its entirety. Tobacco use slows the healing process, causes gum pockets to grow deeper and also accelerates attachment loss. Smoking is not the sole cause of periodontal disease, but it is certainly a cofactor to avoid.
• Inflammation: Periodontal disease causes the inflammation and irritation of oral tissue. It is possible that the oral bacteria causing the irritation could contribute to inflammation of the lung lining, thus limiting the amount of air that can freely pass to and from the lungs.

Diagnosis and Treatment

When respiratory disease and periodontal disease are both diagnosed in one individual, it is important for the dentist and doctor to function as a team to control both conditions. There are many non-surgical and surgical options available, depending on the specific condition of the teeth, gums and jaw.

The dentist is able to assess the extent of the inflammation and tissue loss and can treat the bacterial infection easily. Scaling procedures cleanse the pockets of debris and root planing smoothes the tooth root to eliminate any remaining bacteria. The dentist generally places antibiotics into the pockets after cleaning to promote good healing and reduce the risk of the infection returning.

Whichever treatment is deemed the most suitable, the benefits of controlling periodontal disease are two-fold. Firstly, any discomfort in the oral region will be reduced and the gums will be much healthier. Secondly, the frequent, unpleasant respiratory infections associated with COPD and other common respiratory problems will reduce in number. If you have questions or concerns about respiratory disease or periodontal disease, please ask your dentist.

Researchers have shown that periodontal disease in expectant mothers actually exposes their unborn child to many different risks; particularly if they also happen to be diabetes sufferers. Periodontal disease generally begins with a bacterial infection in the gum (gingival) tissue, which progressively destroys the tissue and the underlying bone. If left untreated, the bacterial infection causes an inflammatory reaction in the body, which can significantly deepen the gum pockets (space between the teeth and gums) and forces the gum and jawbone to recede. Eventually, the progressive nature of periodontal disease causes the teeth to become loose and unstable, and eventually fall out.

Pregnancy causes many hormonal changes which increase the risk of the expectant mother to develop gingivitis (inflammation of the gum tissue) and periodontal disease. These oral problems have been linked in many research studies to preeclampsia, low birth weight of the baby and premature birth. Expectant women should seek immediate treatment for periodontal disease in order to reduce the risk of pre-natal and post-natal complications.

Reasons for the Connection

There are many different reasons why periodontal disease may affect the health of the mother and her unborn child:

• Prostaglandin: Periodontal disease appears to elevate levels of prostaglandin in mothers who are suffering from the more advanced forms of the condition. Prostaglandin is a labor-inducing compound found in one of the oral bacteria strains associated with periodontitis. Elevated levels of prostaglandin can cause the mother to give birth prematurely and deliver a baby with a low birth weight.
• C – reactive protein (CRP): This protein, which has been previously linked to heart disease, has now been associated with adverse pregnancy outcomes including preeclampsia and premature birth. Periodontal infections elevate C-reactive protein levels and amplify the body’s natural inflammatory response. Periodontal bacteria may enter the bloodstream causing the liver to produce CRP which leads to inflamed arteries as well as possible blood clots. These inflammatory effects can then lead to blocked arteries causing strokes or heart attacks.
• Bacteria spread: The bacteria which colonize in the gum pockets can readily travel through the bloodstream and affect other parts of the body. In pregnant women, research has found that oral bacteria and associated pathogens have colonized in the internal mammary glands and coronary arteries.

Diagnosis and Treatment

There are many safe, non surgical treatment options available for pregnant women. It is of paramount importance to halt the progress of periodontal disease in order to increase the chances of a safe and healthy delivery. Initially, the dentist will assess the exact condition of the gums and jawbone in order to make a precise diagnosis. Scaling and root planing are two common non-surgical procedures used to rid the tooth-root surfaces of calculus (tartar) and remove the bacterial toxins from the gum pockets.

The advantages to the pregnant woman are plentiful. The risks of pregnancy complications caused by periodontal disease are reduced by as much as 50%, and these treatments will alleviate many unpleasant and harmful effects associated with gingivitis and periodontal infection.

Dentists can provide dental education and recommendations to the pregnant women on effective home care which can reduce risks that may affect her and/or her child’s health. Risks of periodontal disease can be vastly reduced by proper home care, smoking cessation, dietary changes and the ingestion of supplementary vitamins. If you have any questions or concerns about periodontal disease and its affect on pregnancy, please ask your dentist.

Periodontal disease is characterized by a progressive loss of supportive gingival tissue in the gums and jawbone. It is the number one cause of tooth loss among adults in the developed world. Periodontal disease occurs when toxins found in oral plaque inflame and irritate the soft tissues surrounding the teeth. If left untreated, bacteria colonies initially cause the systematic destruction of gum tissue, and then proceed to destroy the underlying bone tissue.

Osteoporosis is a common metabolic bone disease which frequently occurs in postmenopausal women, and occurs less frequently in men. Osteoporosis is characterized by bone fragility, low bone mass and a decrease in bone mineral density. Many studies have explored and identified a connection between periodontal disease and osteoporosis. A study conducted at the University of New York at Buffalo in 1995 concluded that post-menopausal women who suffered from osteoporosis were 86% more likely to also develop periodontal disease.

Reasons for the Connection

Though studies are still being conducted in order to further assess the extent of the relationship between osteoporosis and periodontal disease, the researchers have thus far made the following connections:

• Estrogen deficiency: Estrogen deficiency accompanies menopause and also speeds up the progression of oral bone loss. The lack of estrogen accelerates the rate of attachment loss (fibers and tissues which keep the teeth stable are destroyed).
• Low mineral bone density: This is thought to be one of several causes of osteoporosis, and the inflammation from periodontal disease makes weakened bones more prone to break down. This is why periodontitis can be more progressive in patients with osteoporosis.
  Diagnosis and Treatment

Osteoporosis and periodontal disease are much less dangerous if they are diagnosed in the early stages. Once a diagnosis has been made, the dentist will generally work with the patient’s doctor to ensure that both diseases are effectively controlled. Here are some methods commonly used to diagnose and treat the diseases:

• Routine dental x-rays: X-rays can be effectively used to screen for bone loss in the upper and lower jaw, and the dentist can provide interventions for preventing and treating periodontal disease. It is believed that minimizing periodontal disease will help treat osteoporosis.
• Estrogen supplements: Providing post-menopausal women with estrogen supplements lowers the rate of attachment loss and also lowers gingival inflammation, which in turn protects the teeth from periodontal disease.
• Assessment of risk factors: Dentists and doctors are able to closely monitor the patients that are at an increased risk of developing both diseases by assessing family history, medical history, X-ray results, current medications and modifiable risk factors. Tobacco use, obesity, poor diet and estrogen deficiency can all be managed using a combination of education, support and prescription medications.

If you have any questions about periodontal disease and its connection with osteoporosis, please ask your dentist.

Periodontal disease, heart disease and stroke may seem to be unlikely bedfellows, but researchers have found that gum disease sufferers are nearly twice as likely to also suffer from coronary heart disease. In addition, research studies have discovered that oral infection is indeed a risk factor for stroke. People diagnosed with acute cerebrovascular ischemia were more likely to also be experiencing some degree of periodontal disease.

Periodontal disease is a progressive condition in which the gingival tissue surrounding the teeth is infected by the colonization of bacteria. Bacteria found in plaque colonize first above, then below the g gumline causing the tissue to pull away from the teeth. If periodontal disease is left untreated, deep pockets form between the gums and the teeth and the tissue of the underlying jawbone is also destroyed. The destruction of bone tissue causes the teeth to shift, wobble or completely detach from the bone.

Coronary heart disease occurs when the walls of the coronary arteries become progressively thicker due to the buildup of fatty proteins. The heart then suffers from a lack of oxygen and must labor significantly harder to pump blood to the rest of the body. Coronary heart disease sufferers sometimes experience blood clots which obstruct normal blood flow and reduce the amount of vital nutrients and oxygen the heart needs to function properly. This phenomenon often leads to heart attacks.

Reasons for the Connection

There is little doubt that the presence of periodontal disease can exacerbate existing heart conditions. The periodontist and cardiologist generally work as a team in order to treat individuals experiencing both conditions. There are several theories which may explain the link between heart disease, stroke and periodontal disease, which include the following:

• Oral bacteria affect the heart: There are many different strains of periodontal bacteria. Researchers assert that some of these strains of bacteria enter the bloodstream and attach to the fatty plaques in the heart blood vessels (coronary arteries). This attachment then contributes to clot formation causing grave danger to the individual.
• Inflammation: Periodontal disease causes severe inflammation in the gum tissue which elevates the white blood cell count and also the high sensitivity C-reactive protein levels. Research studies have shown that elevated levels of C-reactive proteins have been linked to heart disease.
• Infectious susceptibility: Individuals who experience particularly high levels of oral bacteria may have weaker immune systems and an inadequate host inflammatory response. These factors may induce specific vascular effects which have previously been shown to contribute in the onset of certain forms of heart disease.

Diagnosis and Treatment

Since periodontal disease appears to be a risk factor for both heart attack and stroke, it is extremely important to seek immediate treatment. Initially, the periodontist will conduct thorough examinations to assess the exact condition of the teeth, gums and jawbone. X-rays can be helpful in determining whether bone loss is prevalent in the upper and lower jaw.

The dentist is able to conduct deep cleaning treatments such as scaling and root planing to remove hardened calculus (tartar) deposits from the gum pockets. An antibiotic may be prescribed to ensure that the bacterium is completely destroyed and the periodontal infection does not spread. In most cases, periodontal disease can be prevented with regular cleanings and proper home care. If you have questions or concerns about periodontal disease and its relation to heart disease and stroke, please ask your dentist.

Periodontal disease (also known as periodontitis and gum disease) is a progressive condition and the leading cause of tooth loss amongst adults in the developed world. Periodontal disease occurs when the toxins found in plaque begin to irritate or inflame the gingiva (gum tissue). The resulting bacterial infection often known as gingivitis, can eventually lead to the destruction of the gum tissue and underlying bone. If periodontal disease is not treated, it can also lead to loose teeth or tooth loss.

There are many common types of periodontal disease including aggressive, chronic, necrotizing periodontitis, and periodontitis associated with systemic diseases. Each of these types of periodontal disease has its own distinct characteristics and symptoms, and all require prompt treatment by a dentist to halt subsequent bone and tissue loss.

Common Signs & Symptoms

It is extremely important to note that periodontal disease can progress without any signs or symptoms such as pain. This is why regular dental checkups are exceptionally important. Described below are some of the most common signs and symptoms of periodontitis. If you have any of these signs or symptoms, the advice of a general dentist or periodontist should be sought as soon as possible:

• Unexplained bleeding: Bleeding when brushing, flossing or eating food is one of the most common symptoms of a periodontal infection. The toxins in plaque cause a bacterial infection which makes the tissues prone to bleeding.
• Pain, redness or swelling: A periodontal infection may be present if the gums are swollen, red or painful for no apparent reason. It is essential to halt the progression of the infection before the gum tissue and jaw bone have been affected. It is also critical to treat the infection before it is carried into the bloodstream to other areas of the body.
• Longer-looking teeth: Periodontal disease can lead to gum recession. The toxins produced by bacteria can destroy the supporting tissue and bones, thus making the teeth look longer and the smile appear more “toothy.”
• Bad breath/halitosis: Although breath odor can originate from back of the tongue, the lungs and stomach, from the food we consume, or from tobacco use, bad breath may be caused by old food particles which sit between the teeth and underneath the gumline. The deeper gum pockets are able to house more debris and bacteria, causing a foul odor.
• Loose teeth/change in bite pattern: A sign of rapidly progressing periodontitis is the loosening or shifting of the teeth in the affected area. As the bone tissue gets destroyed, teeth that were once firmly attached to the jawbone become loose or may shift in position.
• Pus: Pus oozing from between the teeth is a definitive sign that a periodontal infection is in progress. The pus is a result of the body trying to fight the bacterial infection.

Treatment of Periodontal Disease

It is of paramount importance to halt the progression of periodontal disease before it causes further damage to the gum tissues and jawbone. The dentist will initially assess the whole mouth in order to ascertain the progress of the disease. When a diagnosis has been made, the dentist may treat the bacterial infection with antibiotics in conjunction with nonsurgical or surgical treatment or both. In the case of moderate periodontal disease, the pockets (under the gum line) of the teeth will be completely cleared of debris using a procedure called scaling and root planing. The pockets may be filled with antibiotics to promote good healing and kill any bacteria that remain. Severe periodontitis can be treated in several different ways, such as:

• Laser treatment: This can be used to reduce the size of the pockets between the teeth and the gums.
• Tissue & bone grafting: Where a considerable amount of bone or gum tissue has been destroyed, the dentist may elect to graft new tissue by inserting a membrane to stimulate tissue growth.
• Pocket elimination surgery: The dentist may choose to perform “flap surgery” to directly reduce the size of the gum pockets.
  If you have any further questions about the signs and symptoms of periodontal disease, please ask your dentist.

Periodontal disease (also known as periodontitis and gum disease) is a progressive disease which affects the supporting and surrounding tissue of the gums, and also the underlying jawbone. If left untreated, periodontal disease can result in loose, unstable teeth, and even tooth loss. Periodontal disease is in fact the leading cause of tooth loss in adults in the developed world and should not be taken lightly.

Periodontal disease begins when the toxins found in plaque start to attack the soft or gingival tissue surrounding the teeth. This bacterium embeds itself in the gum and rapidly breeds, causing a bacterial infection. As the infection progresses, it starts to burrow deeper into the tissue causing inflammation or irritation between the teeth and gums. The response of the body is to destroy the infected tissue, which is why the gums appear to recede. The resulting pockets between the teeth deepen and, if no treatment is sought, the tissue which makes up the jawbone also recedes causing unstable teeth and tooth loss.

Types of Periodontal Disease

There are many different varieties of periodontal disease, and many ways in which these variations manifest themselves. All require immediate treatment by a periodontist to halt the progression and save the gum tissue and bone. Here are some of the most common types of periodontal disease along with the treatments typically performed to correct them:

Gingivitis

Gingivitis is the mildest and most common form of periodontitis. It is caused by the toxins in plaque and leads to periodontal disease. People at increased risk of developing gingivitis include pregnant women, women taking birth control pills, people with uncontrolled diabetes, steroid users and people who control seizures and blood pressure using medication.

Treatment: Gingivitis is easily reversible using a solid combination of home care and professional cleaning. The dentist may perform root planing and deep scaling procedures to cleanse the pockets of debris. A combination of antibiotics and medicated mouthwashes may be used to kill any remaining bacteria and promote the good healing of the pockets.

Chronic Periodontal Disease

Chronic periodontal disease is the most common form of the disease, and occurs much more frequently in people over 45. Chronic periodontal disease is characterized by inflammation below the gum line and the progressive destruction of the gingival and bone tissue. It may appear that the teeth are gradually growing in length, but in actuality the gums are gradually recessing.

Treatment: Unfortunately unlike gingivitis, chronic periodontal disease cannot be completely cured because the supportive tissue cannot be rebuilt. However, the dentist can halt the progression of the disease using scaling and root planing procedures in combination with antimicrobial treatments. If necessary, the periodontist can perform surgical treatments such as pocket reduction surgery and also tissue grafts to strengthen the bone and improve the aesthetic appearance of the oral cavity.

Aggressive Periodontal Disease

Aggressive periodontal disease is characterized by the rapid loss of gum attachment, the rapid loss of bone tissue and familial aggregation. The disease itself is essentially the same as chronic periodontitis but the progression is much faster. Smokers and those with a family history of this disease are at an increased risk of developing aggressive periodontitis.

Treatment: The treatments for aggressive periodontal disease are the same as those for chronic periodontal disease, but aggressive periodontal disease sufferers are far more likely to require a surgical intervention. This form of the disease is harder to halt and treat, but the dentist will perform scaling, root planing, antimicrobial, and in some cases laser procedures in an attempt to save valuable tissue and bone.

Periodontal Disease Relating to Systemic Conditions

Periodontal disease can be a symptom of a disease or condition affecting the rest of the body. Depending on the underlying condition, the disease can behave like aggressive periodontal disease, working quickly to destroy tissue. Heart disease, diabetes and respiratory disease are the most common co-factors, though there are many others. Even in cases where little plaque coats the teeth, many medical conditions intensify and accelerate the progression of periodontal disease.

Treatment: Initially, the medical condition which caused the onset of periodontal disease must be controlled. The dentist will halt the progression of the disease using the same treatments used for controlling aggressive and chronic periodontal disease.

Necrotizing Periodontal Disease

This form of the disease rapidly worsens and is more prevalent among people who suffer from HIV, immunosuppression, malnutrition, chronic stress or choose to smoke. Tissue death (necrosis) frequently affects the periodontal ligament, gingival tissues and alveolar bone.

Treatment: Necrotizing periodontal disease is extremely rare. Because it may be associated with HIV or another serious medical condition, it is likely the dentist will consult with a physician before commencing treatment. Scaling, root planing, antibiotic pills, medicated mouth wash and fungicidal medicines are generally used to treat this form of the disease. If you have any question or concerns about the different types of periodontal disease and treatments, please ask your dentist.

The word periodontal means “around the tooth”. Periodontal disease attacks the gums and the bone that support the teeth. Plaque is a sticky film of food debris, bacteria, and saliva. If plaque is not removed, it turns into calculus (tartar). When plaque and calculus are not removed, they begin to destroy the gums and bone. Periodontal disease is characterized by red, swollen, and bleeding gums. 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.

Not only is it the number one reason for tooth loss, research suggests that there may be a link between periodontal disease and other diseases such as, stroke, bacterial pneumonia, diabetes, cardiovascular disease, and increased risk during pregnancy. Researchers are determining if inflammation and bacteria associated with periodontal disease affects these systemic diseases and conditions. Smoking also increases the risk of periodontal disease. Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease.

Signs and symptoms of periodontal disease

• Bleeding gums – Gums should never bleed, even when you brush vigorously or use dental floss
• Loose teeth – Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone)
• New spacing between teeth – Caused by bone loss
• Persistent bad breath – Caused by bacteria in the mouth
• Pus around the teeth and gums – Sign that there is an infection present
• Receding gums – Loss of gum around a tooth
• Red and puffy gums – Gums should never be red or swollen
• Tenderness or Discomfort – Plaque, calculus, and bacteria irritate the gums and teeth

What does tooth whitening involve?

This type of tooth whitening usually requires two visits. At the first appointment, impressions (molds) will be made of your teeth to fabricate custom, clear plastic, trays. At your second appointment, you will try on the trays for proper fit, and adjustments will be made if necessary. The trays are worn with special whitening solution either twice a day for 30 minutes or overnight for a couple of weeks depending on the degree of staining and desired level of whitening. It is normal to experience tooth sensitivity during the time you are whitening your teeth, but it will subside shortly after you have stopped bleaching.

You will receive care instructions for your teeth and trays, and be encouraged to visit your dentist regularly to help maintain a beautiful, healthy, white smile.

IMPROVING EXISTING TEETH

If a tooth is damaged or of poor quality, a new ceramic crown is probably the best solution. Installation is fast. The end result is fantastic. The all-ceramic Procera crown has many advantages over traditional crowns. Besides its high esthetic qualities, the function and longevity of the crown is excellent as well. Benefits of a new Procera crown:

• Superior aesthetic result, compared to traditional crowns
• Easy installation, quick results
• Short and convenient treatment

Treatment:

In the best case, the new crown is installed in two dentist visits in one week’s time. The inconvenience and after-effects will be minimal. View treatment procedure:

• COURSE OF TREATMENT
• PLACING A NEW CROWN STEP-BY-STEP

The course of treatment described here is one of several options available. Consult your dentist to find out what the best solution is for you, given your specific condition.

1. Before the procedure: The dentist makes a first evaluation and makes an impression of the existing crown. The impression is used as the prototype for the new crown.
2. Preparing the old tooth: The natural tooth is given minor preparation or adjustments. A temporary crown is attached.
3. Placing the new crown: A week or so after the first visit, the permanent crown is securely fitted. Normally, it will serve its owner for life.
4. End result: The end result is a new tooth that should blend in perfectly with the others. Brush and floss as recommended by your dentist or dental hygienist.

ALTERNATIVES TO AN ALL-CERAMIC CROWN

Porcelain fused to metal

Simply put, a new all-ceramic Procera crown is aesthetically superior to any other type of crown. You just can’t get the same finish and natural, living look with a traditional metal core crown. However, the latter is an established and well-known solution. This is probably why it is still commonly used, even though function, installation and price are normally equal to that of a ceramic crown.

Veneers are very thin pieces of durable, tooth shaped porcelain that are custom made (for shape and color) by a professional dental laboratory. They are bonded onto the front of teeth to create a beautiful and attractive smile.

Veneers can completely reshape your teeth and smile. They can often be alternatives to crowns and the ideal solution in treating many dental conditions. As with most dental restorations, veneers are not permanent and may someday need replacement. They are very durable and will last many years, giving you a beautiful long lasting smile. Reasons for porcelain veneers:

• Cosmetically, to create a uniform, white, beautiful smile
• Crooked teeth
• Misshapen teeth
• Severely discolored or stained teeth
• Teeth that are too small or large
• Unwanted or uneven spaces
• Worn or chipped teeth

What does getting porcelain veneers involve?

Getting veneers usually requires two visits to complete the process, with little or no anesthesia required during the procedure. The teeth are prepared by lightly buffing and shaping the surface to allow for the thickness of the veneer. A mold or impression of the teeth is taken and a shade (color) will then be chosen by you and the dentist.

On the second visit the teeth will be cleansed with special liquids to achieve a durable bond. Bonding cement is then placed between the tooth and veneer and a special light beam is used to harden and set the bond. You will receive care instructions for veneers. Proper brushing, flossing and regular dental visits will aid in the life of your new veneers.

A dental bridge is a fixed (non-removable) appliance and is an excellent way to replace missing teeth. There are several types of bridges. You and your dentist will discuss the best options for your particular case. The “traditional bridge” is the most popular type and is usually made of porcelain fused to metal. Porcelain fixed bridges are most popular because they resemble your natural teeth. This type of bridge consists to two crowns that go over two anchoring teeth (abutment teeth) and are attached to pontics (artificial teeth), filling the gap created by one or more missing teeth.

Dental bridges are highly durable and will last many years, however they may need replacement or need to be re-cemented due to normal wear. Reasons for a fixed bridge:

• Fill space of missing teeth
• Maintain facial shape
• Prevent remaining teeth from drifting out of position
• Restore chewing and speaking ability
• Restore your smile
• Upgrade from a removable partial denture to a permanent dental appliance

What does getting a fixed bridge involve?

Getting a bridge usually requires two or more visits. While the teeth are numb, the two anchoring teeth are prepared by removing a portion of enamel to allow for a crown. Next, a highly accurate impression (mold) is made which will be sent to a dental laboratory where the bridge will be fabricated. In addition, a temporary bridge will be made and worn for several weeks until your next appointment.

At the second visit, you permanent bridge will be carefully checked, adjusted, and cemented to achieve a proper fit. Occasionally your dentist may only temporarily cement the bridge, allowing your teeth and tissue time to get used to the new bridge. The new bridge will be permanently cemented at a later time. You will receive care instructions at the conclusion of your treatment. Proper brushing, flossing and regular dental visits will aid in the life of your new permanent bridge.

A composite (tooth colored) filling is used to repair a tooth that is affected by decay, cracks, fractures, etc. The decayed or affected portion of the tooth will be removed and then filled with a composite filling. There are many types of filling materials available, each with their own advantages and disadvantages. You and your dentist can discuss the best options for restoring your teeth. Composite fillings, along with silver amalgam fillings, are the most widely used today. Because composite fillings are tooth colored, they can be closely matched to the color of existing teeth, and are more aesthetically suited for use in front teeth or the more visible areas of the teeth.

As with most dental restorations, composite fillings are not permanent and may someday have to be replaced. They are very durable, and will last many years, giving you a long lasting, beautiful smile. Reasons for composite fillings:

• Chipped teeth
• Closing space between two teeth
• Cracked or broken teeth
• Decayed teeth
• Worn teeth.

How are composite fillings placed?

Composite fillings are usually placed in one appointment. While the tooth is numb, your dentist will remove decay as necessary. The space will then be thoroughly cleaned and carefully prepared before the new filling is placed. If the decay was near the nerve of the tooth, a special medication will be applied for added protection. The composite filling will then be precisely placed, shaped, and polished, restoring your tooth to its original shape and function.

It is normal to experience sensitivity to hot and cold when composite fillings are first placed, however this will subside shortly after your tooth acclimates to the new filling. You will be given care instructions at the conclusion of your treatment. Good oral hygiene practices, eating habits, and regular dental visits will aid in the life of your new fillings.

Dental implants are a great way to replace missing teeth and also provide a fixed solution to having removable partial or complete dentures. Implants provide excellent support and stability for these dental appliances. Dental implants are artificial roots and teeth (usually titanium) that are surgically placed into the upper or lower jaw bone by a dentist or Periodontist – a specialist of the gums and supporting bone. The teeth attached to implants are very natural looking and often enhance or restore a patient’s smile!

Dental implants are very strong, stable, and durable and will last many years, but on occasion, they will have to be re-tightened or replaced due to normal wear. Reasons for dental implants:

• Replace one or more missing teeth without affecting adjacent teeth
• Resolve joint pain or bite problems caused by teeth shifting into missing tooth space
• Restore a patient’s confident smile
• Restore chewing, speech, and digestion
• Restore or enhance facial tissues
• Support a bridge or denture, making them more secure and comfortable

What does getting dental implants involve?

The process of getting implants requires a number of visits over several months. X-rays and impressions (molds) are taken of the jaw and teeth to determine bone, gum tissue, and spacing available for an implant. While the area is numb, the implant will be surgically placed into the bone and allowed to heal and integrate itself onto the bone for up to six months. Depending on the type of implant, a second surgery may be required in order to place the “post” that will hold the artificial tooth in place. With other implants the post and anchor are already attached and placed at the same time.

To schedule your free consultation session today, call us at (925) 478-5747 now!

An onlay restoration is a custom made filling made of composite material, gold, or tooth-colored porcelain. Porcelain onlays are popular because they resemble your natural tooth. An onlay is sometimes also referred to as a partial crown. Porcelain onlays are made by a professional dental laboratory and is permanently cemented onto the tooth by your dentist.

Onlays can be utilized to conservatively repair teeth that have large defective fillings or have been damaged by decay or trauma. Onlays are an ideal alternative to crowns (caps) because less tooth structure is removed in the preparation of onlays. Onlays are essentially identical to inlays with the exception that one or more of the chewing cusps have also been affected and need to be included in the restoration. As with most dental restorations, onlays are not always permanent and may someday require replacement. They are highly durable and will last many years, giving you a beautiful long lasting smile. Reasons for onlay restorations:

• Broken or fractured teeth
• Cosmetic enhancement
• Decayed teeth
• Fractured fillings
• Large fillings

What does getting an onlay involve?

An onlay procedure usually requires two appointments. Your first appointment will include taking several highly accurate impressions (molds) that will be used to create your custom onlay and a temporary restoration. While the tooth is numb, the dentist will remove any decay and/or old filling materials. The space will then be thoroughly cleaned and carefully prepared, shaping the surface to properly fit an onlay restoration. A temporary filling will be applied to protect the tooth while your onlay is made by a dental laboratory.

At your second appointment, your new onlay will be carefully and precisely cemented into place. A few adjustments may be necessary to ensure a proper fit and that your bite is comfortable. You will receive care instruction at the conclusion of your treatment. Good oral hygiene practices, a proper diet, and regular dental visits will aid in the life of your new onlay.

An inlay restoration is a custom made filling made of composite material, gold, or tooth-colored porcelain. Porcelain inlays are popular because they resemble your natural tooth. A porcelain inlay is made by a professional dental laboratory and is permanently cemented into the tooth by your dentist.

Inlays can be utilized to conservatively repair teeth that have large defective fillings or have been damaged by decay or trauma. Inlays are an ideal alternative to conventional silver and composite fillings. Also, they are more conservative than crowns because less tooth structure is removed in the preparation of inlays. As with most dental restorations, inlays are not always permanent and may someday require replacement. They are highly durable and will last many years, giving you a beautiful long lasting smile. Reasons for inlay restorations:

• Broken or fractured teeth.
• Cosmetic enhancement.
• Decayed teeth.
• Fractured fillings.
• Large fillings.

What does getting an inlay involve?

An inlay procedure usually requires two appointments. Your first appointment will include taking several highly accurate impressions (molds) that will be used to create your custom inlay and a temporary restoration. While the tooth is numb, the dentist will remove any decay and/or old filling materials. The space will then be thoroughly cleaned and carefully prepared, shaping the surface to properly fit an inlay restoration. A temporary filling will be applied to protect the tooth while your inlay is made by a dental laboratory.

At your second appointment your new inlay will be carefully and precisely cemented into place. A few adjustments may be necessary to ensure a proper fit and that your bite is comfortable. You will receive care instruction at the conclusion of your treatment. Good oral hygiene practices, a proper diet, and regular dental visits will aid in the life of your new inlay.

In the past decade there has been a dramatic interest in cosmetic dentistry. We all realize that having a healthy, bright, beautiful smile enhances our appearance and allows us to smile with confidence. Thanks to the advances in modern cosmetic dentistry, we are able to improve our teeth and smiles with quick, painless and surprisingly affordable treatments. Cosmetic dental treatments can:

• Change the size, shape, and alignment of certain teeth.
• Fill in unattractive spaces between teeth.
• Improve or correct bites.
• Lighten or brighten the color of teeth.
• Repair decayed, broken, cracked, or chipped teeth.
• Replace missing teeth.
• Replace old, unattractive dental treatments.

When treating patients, the goal of the dentist is to get a beautiful healthy smile that lasts a lifetime. In achieving this goal, your own personal care plays a big role. Homecare starts with eating a healthy and balanced diet, reducing sugary snacks and using dental aids correctly to help control plaque and bacteria that lead to dental disease.

Tooth Brushing

With an ADA approved soft bristle toothbrush and paste, your teeth should be brushed twice daily, especially when before going to bed at night.

• The brush should be places at 45 degrees angle to the gums, gently brushing using a small circular motion and ensuring you feel the bristles on the gums
• Properly brush the outer, inner and the biting surface of your teeth
• Clean the inside of the front teeth by using the tip of the brush
• Freshen your breath and remove bacteria from the tongue by brushing your tongue

It is recommended that you use an electric toothbrush because of the ease of use and effectiveness of removing plaque. Simple place the bristles on the teeth and allow the brush to do its work.

Flossing

The best way to keep the area between your teeth and below the gum line clean is by flossing daily. Not only does flossing help clean these areas, but also disrupts plaque colonies building up, which prevents damage to the teeth, bone and gums.

• Wrap approximately 18 inches of floss on the middle finger of each hand, leaving around 2 inches of floss between the hands
• Gently insert the floss between the teeth and use your thumps and forefingers to guide the floss
• The floss should be curved into a “U” shape around each tooth and under the gum line. Clean the side of each tooth by moving the floss up and down

If you have difficulty holding floss, floss holders are recommended.

Rinsing

After brushing, it’s important to rinse your mouth, and after meals if you are unable to brush. It is important to get advice on mouth rinses from dentists and hygienists on their appropriateness for you if they are over-the-counter varieties. And finally, use dental aids along with these guidelines that are recommended by your dental hygienist and dentist. These include:

• Irrigation devices
• Tongue cleaners
• Rubber tip stimulators
• Fluoride
• Medicated rinses
• Inter-dental brushes

These all play an important role in good dental home care.

The latest technology used to take dental x-rays is digital radiography (digital x-rays). An electric sensor (instead of an x-ray film) is used in this technique that captures and stores the digital image on a computer. This helps the dentist or hygienist detect problems easier because the image can be instantly viewed and enlarged. Radiation is reduced 80-90% by digital x-rays compared to the low exposure of the standard dental x-rays.
These powerful diagnostic tools that will provide valuable and essential information are highly important during a dental examination. Dental abnormalities are detected accurately and safely by dentists and hygienists which creates an accurate treatment plan. Problem areas may go undetected without x-rays. The following may be revealed by dental x-rays:

• Decay between the teeth
• Bone loss
• Abscesses or cysts
• Cancerous and non-cancerous tumours
• Poor tooth or root positions
• Problems inside a tooth or below the gum line
• Developmental abnormalities

You will save valuable time and money as well as unnecessary discomfort by detecting and treating dental problems in the early stages.

Dental x-rays – Are they safe?

We all get natural exposure to radiation from our environment. A significantly lower level of radiation is emitted by digital x-rays compared to the standard traditional dental x-rays. The benefit digital x-rays pose is that they are not only better for health and safety of the patient, but they are also more comfortable, reducing the amount of time it takes to be in the dental office. There is also no need to develop x-rays since the digital image is taken electronically, eliminating the disposal of harmful chemicals and waste into the environment.
Dentists will still take necessary precautions to ensure the patient’s exposure to radiation is limited, even though digital x-rays are considered very safe. Therefore, the precaution includes only taking the x-ray when necessary and using lead apron shields to protect the body from harm.

How often should a dental x-ray be performed?

Each individual is different, and depending on their needs, x-rays will be performed accordingly.
The dentist and hygienist will decide n the frequency of an x-ray based on the review of:

• Dental and medical history
• Signs and symptoms
• Dental examinations
• Consideration of age
• Risk of disease

For new patients, a full mouth series of x-rays is recommended, which will be sufficient and good for 3-5 years. During check-up or recall visits, Bite-Wing x-rays (x-rays of top and bottom teeth biting together) are recommended once or twice a year to detect dental issues.

At your initial dental appointment, a comprehensive dental exam will be performed by your dentist. Your dentist or hygienist will include the following at regular check-up exams:

X-ray examinations (radiographs): These are important to detect tumours, decay, bone loss and cysts. X-rays also aid in determining root positions and tooth positions
Gum Disease Evaluations: Check signs of periodontal disease by checking gums and bone around the teeth
Oral Cancer Screening: Check for any signs of oral cancer by examining the face, neck, lips, tongue, throat, tissues and gum
Tooth Decay Examination: Special instruments will be used to check all tooth surfaces for decay
Existing restoration examinations: Current crowns, fillings, etc…

Professional Dental Cleaning

Dental Prophylaxis (Professional dental cleanings) is performed by dental hygienists. This cleaning appointment will include a dental examination and the following:

Calculus (tartar) removal: Calculus is plaque that has been hardened and left of the tooth for quite some time, and eventually attached itself to the tooth surface. Calculus can be removed by special dental instruments and forms above and below the gum line.
Plaque Removal: Plaque is an almost invisible sticky film that forms on the teeth. It is a growing group of food debris, saliva and live bacteria. This bacteria produces toxins and tend to inflame the gums. This is normally the beginning phase of periodontal disease.
Teeth Polishing: This removed stains and plaque that is not otherwise removed by tooth brushing and scaling.

Sealants are very thin plastic coatings that are applied to the surfaces of the molars, premolars and any pits and fissures (deep grooves) of the teeth. More than 75% of dental decay starts with deep grooves within the teeth. Teeth such as these are very difficult to clean and are likely to decay. Sealants will seal deep grooves with the aim of protecting them, which will create a smooth and easy to clean surface. Sealants can protect teeth from decay for many years, but need regular dental checkups to check on wear and chipping.

Reasons for Sealants:

Baby Teeth – If child is cavity prone, or if the teeth have deep grooves
Children and Teenagers – Anytime during the cavity prone years of 6-16 or as soon as the six year molars (first permanent back teeth) appear
Adults – Surfaces of the tooth without decay but have depressions and deep grooves.

What do sealants involve?

The process of applying the sealant only takes a couple of minutes per tooth, and is done so by your dental hygienist or dentist.
Teeth that are due to be sealed are cleaned thoroughly and surrounded by cotton to keep the area dry. To help the sealant bond to the teeth, a special solution is applied to the surface of the enamel. The teeth are then rinsed and dried. To cover the deep grooves and depressions, the sealant material is painted carefully onto the enamel surface. The material will either harden automatically or require a special curing light depending on the sealant used. Good care at home, a balanced diet and regular dental visits will help in the life of your new sealants.

Although having regular check-ups at your local Walnut Creek Dentist and Walnut Creek Hygienist is important to maintain excellent oral hygiene and diagnosing any issues, they are not a 100% fool proof solution. To avoid future dental problems, thorough oral homecare procedures should be performed on a daily basis.
The leading cause of tooth loss in the developed World is Periodontal disease (Also known as gum disease and periodontitis), and more often than not, it could have been avoided. Self-cleaning on a daily basis along with professional cleaning bi-annually can eradicate a high percentage of bacteria and plaque that can cause disease. An additional benefit is that you will pose a lovely sparkling white smile.
The supermarkets now boast a wide variety of oral hygiene aids, and sometimes it becomes difficult to decide what ones provide the most benefit for your dental hygiene. Here are some common oral hygiene aids for home:

Dental Floss: This comes in many varieties and flavors, as is the most common sub-gingival (below the gum) and inter-dental cleaner. It consists of nylon filaments or polyethylene ribbons, and used to remove food particles and plaque from between the teeth. Care must be taken when flossing, because rash flossing can cause bleeding and tissue damage. Floss should be used twice daily after brushing.
Inter-Dental Cleaners: Inter-dental brushes in addition to dental floss is recommended by many periodontists and hygienists. They come is various types and sizes, and are gentle on the gums and effective in cleaning the contours of the teeth in between the gums.
Mouth Rinses: Two types of mouth rinses are available: Cosmetic rinses that are sold over the counter and halt bad breath temporarily, and therapeutic rinses which may require prescription, depending on your circumstance. Due to studies showing the ineffectiveness of and minimal results against plaque, most dentists are skeptical at their benefits. However, Therapeutic rinses which are regulated by the FDA contain active ingredients that fight cavities, plaque and bad breath. Rinses should be used after brushing.
Oral Irrigators: These have been made to clear debris from below the gum line, just like Water jets and Waterpiks. Water will be sprayed continually into the pockets of the gum to remove food particles and harmful bacteria. These should not be used in replacement of brushing and flossing, although effective in lowering the risk of gum disease. To remove deeper debris, professional cleaning should be made bi-annually.
Rubber Tip Stimulators: These tools are excellent at removing plaque around the gum line and stimulating the flow of blood to the gums. The stimulator should be traced gently along the inner and outer gum line at least once daily. Plaque on the tip can be rinsed off by water. Store in a cool dry place, and remove the tip once it starts to show signs of wear and tear.
Tongue Cleaners: These have been made to keep the tongue clean by removing build up of fungi, food debris and bacteria on the surface of the tongue. The bacteria and fungi that build up on the tongue have been related to halitosis and other diseases such as stroke, respiratory disease, heart disease and diabetes. Tongue cleaners are shaped in accordance of the contours of the tongue, and can be made out of wood, plastic or metal. Tongue cleaning should be done prior to brushing to avoid ingestion of bacteria and fungi.
Toothbrushes: There are a wide range of great toothbrushes available. Due to the effectiveness of electric toothbrushes over manual toothbrushes, dentists generally recommend the electric option. Food particles and plaque will be easily dislodged around the gums and teeth by the vibratory and rotational motion of the electric toothbrush. Although the same results are obtained by a manual toothbrush, more effort is needed. Every three months, manual toothbrushes should be replaced because the bristles wear out and become ineffective over time. Soft bristle versions are far less damaging to the gum tissue than the medium and hard bristle versions. To allow proper cleaning to all teeth, an appropriate sized ADA approved toothbrush should be chosen. Ideally, teeth should be brushed after each meal, or minimally twice daily.
Please ask your Walnut Creek dentist, Dr. Darvish or dental hygienist if you have questions regarding oral hygiene aids.

The most effective agent available to prevent tooth decay is fluoride. Fluoride is a natural mineral available in water supplies and food with varying amounts. Many health and professional organizations support the benefit of fluoride, which have been well known for over 50 years.
There are two ways in which fluoride works, which are Topical Fluoride and Systemic Fluoride.

Topical Fluoride

Once teeth have erupted, topical fluoride will strengthen teeth by seeping into the outer surface of the enamel of the teeth, which will make the teeth more resistant to decay. Topical fluoride is gained by fluoride containing products such as:

• Toothpaste
• Mouthwashes
• Gels

It is recommended by dentists and hygienists that children have professional application of fluoride twice a year during check-ups.

Systemic Fluoride

This not only strengthens teeth that have erupted, but also under the gums. A source of systemic fluoride is within most foods and our supplies of water. A dentist can also prescribe as a supplement in gel or drop form. This form has been recommended for infants and tablet for best suited for children who are into their teen years. At the same time, it’s vital to check up on the amount of fluoride children ingest. Fluorosis (white spots on the teeth) is a condition that can occur if too much fluoride has been comsumed.
Even though we obtain fluoride through food and water, in most cases, this is not enough to prevent tooth decay. Home professional fluoride treatments may be recommended by your dentist of dental hygienist for the list of reasons below:

• Inadequate exposure to fluoride
• Poor oral hygiene habits
• Exposed or sensitive root surfaces
• Excessive carbohydrate or sugar intake
• Recent dental decay history
• Inadequate saliva flow caused by a particular medical condition, medication or treatments
• Fissures and deep pits of the chewing surface of the teeth

Tooth decay will not be prevented by fluoride alone! It is a combination of brushing twice daily, flossing daily, reducing sugary snacks, eating a healthy balanced diet and making regular visits to your Walnut Creek dentist, Dr. Darvishzadeh.

A key importance to oral health and hygiene is brushing and flossing. Although professional cleaning provided semi-annually by your Walnut Creek dentist, Dr. Darvishzadeh will remove debris, tartar, and plaque, it is equally valuable maintaining your teeth cleaning regularly at home. To prevent serious disease, improve the health of your mouth and have a sparkling smile, proper brushing and flossing is imperative.
Here are some of the reasons why it is essential to brush and floss properly:

Prevention of tooth decay: One of the leading causes of tooth loss is tooth decay, and often the treatment requires complex dental procedures. When acid within the plaque erodes the natural enamel of the teeth, tooth decay occurs. By following proper hygiene methods at home, this can be prevented.
Prevention of periodontal disease: Periodontal disease is a very serious progressive condition that can lead to jawbone recession, gum recession and tooth loss. Toxins found within the plaque can lead to periodontal disease. This can also lead to serious health problems to other parts of the body. A good way to steer clear of periodontal disease, is to remove tartar and plaque from the surface of the tooth by using a toothbrush and dental floss between the teeth.
Prevention of Halitosis: Old particles of food on or between the teeth can cause halitosis or bad breath. Regular brushing or flossing of the teeth can remove these particles, leaving you with a mouth that is healthy and fresh.
Prevention of staining: Various factors can cause the yellowing or staining of the teeth, such as tea, coffee or smoking. The more regularly brushing and flossing techniques remove the staining from the teeth, the less likely it will be that the stains will become permanent.
How to Brush Properly
Ideally, brushing of the teeth should be done twice a day; in the morning and at night before bed. The best toothbrush will be no more than 3 months old, soft round-end bristles and small in size. To access all parts of the mouth, the head of the brush should be small, and to avoid damage to the gum tissue, the bristles should be soft. Electric toothbrushes have been given a seal of approval by the American Dental Association (ADA), claiming that the oscillating and rotating head of electric toothbrushes are more effective than standard toothbrushes. Follow the steps below for a proper guide to brushing:

• Just where the teeth and gums meet, place the toothbrush at a 45 degree angle
• Brush the teeth and gum line gently by using small circular motions
• Avoid scrubbing or applying too much pressure on the teeth, which can cause damage to enamel and gums
• Brush every surface of each and every tooth, including the chewing side, tongue side and cheek side. Put more emphasis on the teeth at the back of the mouth
• Stroke back and forth with the brush on the chewing surfaces
• To remove fungi, food and debris, brush the tongue

How to Floss Properly

A great method to remove plaque from the inter-dental regions (between the teeth) is by flossing. Preventing periodontal disease and limiting the gum pockets depth is achieved by flossing. Flossing should be performed on a daily basis, because brushing alone cannot reach the inter-dental regions. Choose floss that is pleasant to use, the flavor and type is relatively unimportant. Follow the steps below for a proper guide to flossing:

• Cut approximately 18 inches of floss
• Wrap a part of the floss on the middle finger of each hand, until the hands are 2-3 inches apart
• Gently work the floss between the teeth and towards the gum line
• The floss should be curved into a “U” shape around each tooth and should be carefully slid beneath the gum line
• To remove inter-dental plague and debris, gently move the floss up and down
• Avoid popping the floss in and out between the teeth due to the risk of inflaming and cutting the gums

An essential tool is the dental radiograph (X-Ray). They are preventative and diagnostic tools that provide important information that is not visible during a normal dental examination by your dentist.
To complete a thorough and accurate dental treatment plan, dentists and hygienists use this information to detect hidden dental abnormalities. Areas with problems could go unnoticed without the aid of an x-ray.
Dental x-rays can reveal the following:

• Bone loss
• Decay within the inter-dental areas
• Poor tooth and root positions
• Issues within the tooth and below the gum line
• Cysts or abscesses
• Abnormalities
• Cancerous and non-cancerous tumors

You can save your teeth, avoid unnecessary pain, time and money by having dental issues detected at an early stage.

Is it Safe to Have a Dental x-ray?

Every one of us is exposed to natural radiation in the environment. A dental x-ray will expose you to the same amount of radiation that you come into contact with in a single day.
Only a low level of radiation is exposed by dental x-rays, and they have been considered as safe. Necessary precautions are taken by the dentist to limit the radiation exposure to the patient. The precautions include:

Modern fast film that reduces the exposure time of each x-ray
Lead apron shields that protect your body

How Often Should Dental X-Rays be Performed?

Depending on how many times an x-ray should be performed, each individual is different depending on their personal dental health requirements. The dentist and hygienist will decide n the frequency of an x-ray based on the review of:

• Dental and medical history
• Signs and symptoms
• Dental examinations
• Consideration of age
• Risk of disease

For new patients, a full mouth series of x-rays is recommended, which will be sufficient and good for 3-5 years. During check-up or recall visits, Bite-Wing x-rays (x-rays of top and bottom teeth biting together) are recommended once or twice a year to detect dental issues.

When embarking on a prevention program, it is a cooperative effort from everyone, including the patient, the Walnut Creek Dentist, Dr. Darvishzadeh and his staff. The aim is to prevent the onset, progress and recurrence of dental conditions and diseases by preserving the natural dentition and supporting structures. With a good balanced diet and oral hygiene, preventing dental disease begins at home. This then continues at the dental surgery by your dentist and hygienist to promote, restore and maintain oral health. Prevention will include:

• X-Rays
• Cleanings
• Dental Examinations
• Sealants & Fluoride (Aid in protecting your teeth)

The secret to a confident, beautiful and healthy smile is prevention of oral disease. Prevention will also avoid expensive and serious dental problems. Your hygienists in Walnut Creek are well trained to serve our patients. Contact us today at Walnut Creek Dental to schedule your free consultation!