We take out teeth that we shouldn't have to.

It seems like it occurs at least weekly. A patient comes in to have a tooth removed that I diagnosed as needing treatment years before. Unfortunately, the needed treatment wasn't done, because it wasn't convenient, the patient wanted to wait for new insurance, the holidays were coming up, etc. Now the tooth isn't savable and must be removed and replaced at a far higher cost, if it can be replaced at all. We all live busy lives, and it seems as though there's never enough time or a convenient time for anything. The one thing that you can't get back, besides time, is often your health. Take care of small problems when they occur so that they don't become bigger problems later on, or, worse yet, become life long issues. Our primary goal in our practice is to save teeth, hopefully for the life of the patient. Replacing them is a necessary service, but teeth are better then any replacement, so do whatever necessary from a hygiene and treatment standpoint to keep them healthy. Your body and your wallet will both thank you. 

I've been undergoing treatment for gum disease for years, why doesn't it just go away?

Well, it really depends on the treatment that you are receiving. Most general dentists do not do "definitive treatment". What is definitive treatment? Definitive treatment is any procedure that is meant to reverse periodontal disease and yield results that are likely to significantly improve gum and bone health and make the gums more resistant to further disease. Scaling and root planing is not definitive treatment. I see patients every day that have undergone multiple session of deep scaling, yet their disease is either not getting better or getting worse. The reason for this is that even the best dentist or hygienist can't adequately clean root surfaces in deep periodontal pockets well enough to reverse the disease process. Osseous surgery, bone grafts, and laser surgery are definitive treatments, and few general dentists do these procedures. These are the types of procedures that can grow back bone that's been lost and yield new gum attachment that is more resistant to bacteria that cause gum disease. While there is no cure for gum disease, there are very few cases where it cannot be controlled to the point where teeth are not in danger of being lost. To be sure, scaling and root planing is better than doing nothing, and it is indicated in more minor periodontal disease, but it often leads to nothing more than a slowing down of the disease in moderate and severe periodontitis. At our office, we primarily perform FDA recognized laser periodontal therapy that yields regeneration of the periodontal tissues. We are able to do this with no more discomfort than standard scaling and root planing. The process is also less expensive than standard osseous surgery with bone grafts. If you have been on the periodontal merry-go-round for years with less than optimal gum health, come in and let us develop a plan to get you off of that ride and on the road to truly healthy gums. 

How long can I wait to replace my tooth?

I get this question at least weekly, and the answer is that I can't give you an exact number of months or weeks, but short of some expensive bone grafting, you will never have more bone than you do right now. Add to that the fact that the adjacent teeth aren't just locked into their current position. They will drift over time, closing the existing space and creating issues beyond just available bone. Implants do several things. They help you chew, provide support for your cheeks and lips, help your smile, preserve bone, and keep the adjacent teeth in position. A missing tooth is a missing link in your overall oral and physical health. Even if you don't decide to have an implant placed, a bridge or a partial denture is better than doing nothing. It's all about you and your well-being. It's that important. 

Does Periodontal Disease cause Alzheimer's Disease?

"I don't care, it's just my mouth." I hear this often from people who place little value on their oral health. They really believe that their mouth isn't connected to the rest of their body. Scientists are finding that, not only is it connected, many of our most common chronic diseases, such as cardiovascular disease, diabetes, and now Alzheimer's may be associated with periodontal (gum) disease. In a recent study published in Science Advances, researchers found that one of the main bacteria responsible for periodontal disease was found in the central nervous systems of Alzheimer's patients. This indicates a possible link between gum disease and Alzheimer's. Previous studies have found decreased cognitive function in people with advanced gum disease. The health of your mouth certainly is associated with your overall health, so make your oral health a priority, and you'll likely lead a longer and better life. 

Implant rescue

So, you went for your regular dental cleaning appointment, and the implant that you paid so much for is exhibiting bone loss. You dentist is kind of in a quandary of what to do, so he sends you to a surgeon who offers you an expensive bone graft or just removing or replacing the implant. You really don't want to have to pay for this all over again with the uncertainty of how long a bone graft or another implant will last. Well, there is another alternative, LAPIP. The Laser-assisted Peri-implant Procedure offers a way to get your existing implant healthy again. This is a short, comfortable way to restore a healthy environment around your existing implant.  It even helps grow back bone that has been lost around your implant, all without incisions, sutures, or bone grafts. Our patients seldom have to take any pain medicine beyond just some ibuprofen, and you can go about your regular activities the rest of that day. If you have ailing implants, give our office a call, and we can tailor a treatment plan for you that may save your implant and your wallet. 

Desquamative gingivitis

This is a group of autoimmune diseases characterized by blisters, sloughing, and ulceration of the gums. Only a special biopsy can determine which of these diseases you have. The treatment is topical steroids with or without oral medication. These diseases can be very painful and can also involve the skin or even the eyes, in which case blindness is possible if severe enough and left untreated. If you think that you may have something like that described above, see a periodontist for a proper diagnosis and treatment. 

More periodontal diseases

The one periodontal disease that seems to be increasing in my practice is Lichen planus. This is an autoimmune disease that can be a minor nuisance, a source of significant discomfort, or even a precursor to oral cancer. Generally, there are red and white areas that can be on the gums, tongue or inside the cheeks that may or may not be painful and sometimes have spontaneous bleeding. One hallmark of the disease are white lines called Wickham's striae, but they are not always present. The disease process is not well understood, but it falls somewhere between an allergy and an overactive immune system, Regardless, anti-inflammatories (generally steroids) are the most effect treatment. Topical steroids are effective for minor forms of the disease, but, in more aggressive cases, system steroids are necessary to get the disease under control. A biopsy is necessary for a definitive diagnosis. There are some studies that show a weak correlation between Lichen planus and oral cancer, and it can be severe enough to cause loss of bone around the teeth and even tooth loss. If you think that you may have Lichen planus, seeing a periodontist for a biopsy is the first step to getting it under control. 

Gum recession

Although not really classified as a disease process, the second most common gum issue is recession of the gums, leading to exposure of tooth roots, sensitivity, decay, and esthetic issues. This isn't generally due to infection, although it can be. Causes of recession are traumatic tooth brushing, tooth clenching and grinding, orthodontic treatment, thin gum tissue, tooth wear, and there may also be a genetic or diet component as well. Of course prevention is best, and all people should use a soft tooth brush and use a circular rather than sawing motion with the brush. Pressing hard with an electric tooth brush is also an issue. Bite guards are the best way to deal with clenching and grinding, and teeth with thin gums should be grafted before orthodontic treatment. After the recession has occurred, there are a variety of procedures for recovering the roots and preventing future problems. These include repositioned flaps, grafts (from the patient, synthetic, or from human tissue banks), and orthodontic treatment to reposition teeth back within the bony housing. If grafts are necessary, we have a variety of techniques for best addressing the particular issue that your condition presents. While you may see one or another grafting technique promoted on dental websites, the truth of the matter is that no one procedure is best to treat all recession issues. Periodontists are trained in many techniques and have the best judgement and experience to recommend the optimum procedure for your particular condition. 

Periodontal Diseases

Today, I'm going to start a series about periodontal diseases, and we'll start with adult periodontitis, the most common form of gum disease. 

Adult periodontal disease is defined as a loss of attachment and support for the teeth as a result of inflammation caused by certain oral bacteria. These bacteria are normally found in the mouth, but, in some people, and under some conditions, they cause inflammation in the area surrounding the teeth that leads to bone loss and, eventually, tooth loss. This is a complex process that involves many different bacteria, but the caveat is that the bacteria themselves do not directly cause the bone loss. It is an over-response by the body's own immune system that causes the damage. This is why there is tremendous variability in the amount of dental plaque (100% bacteria by weight) that is necessary to cause problems. You may know people who seldom brush, floss, or have regular dental cleanings that don't have gum issues. They have more resistance to the inflammation caused by plaque. Other people do a good job of keeping their teeth clean, but still have bone loss. Of course, the best way to prevent gum disease is to keep your teeth as clean as possible and have regular dental cleaning, regardless of your susceptibility to gum disease. If you have gum problems, see a dentist or periodontist, so you can minimize the damage and get back to a healthy mouth that will benefit you throughout life.