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. 

Don't waste it!

Time is short to use your 2018 benefits. If you have been putting off treatment and have benefits remaining, you don't have much time to maximize those benefits. Most offices will be closed for Christmas and New Years, so get scheduled ASAP before you are forced to push your treatment to next year. 

Make the commitment to yourself now!

Just like everything else in life, people procrastinate when it comes to their oral health, and the consequences can be worse than you might have imagined. There are situations in which we are forced to make hard decisions of whether or not to retain teeth that might be otherwise savable. In most cases, these terrible decisions involve oropharyngeal cancer. Approximately 52,000 people in the United States will be diagnosed with this horrible and sometimes disfiguring cancer this year. Of those, approximately 20% will die of that cancer. Radiation treatment is one of the primary means of treating cancers of the head and neck, and the side effects can be very debilitating. As  dentists, there are several consequences of radiation treatment that we deal with. In most cases, the salivary glands are a casualty of radiation, which leads to greatly reduced saliva flow, dry mouth (xerostomia) and subsequent root decay and periodontal (gum) disease. The other major side effect is perhaps the worst of all. Radiation causes the bone of the jaws to be far less resilient when it comes to repairing itself following any type of trauma. Trauma includes oral surgery such as root canal treatments, implant placement, periodontal surgery, and tooth extraction. Even the rubbing of a denture on the gum tissue can cause major problems that can lead too a disease process known as osteoradionecrosis. This causes bone loss that can spread to encompass most or all of the bone in the upper or lower jaw. In order to prevent this, we generally extract unhealthy teeth prior to the radiation treatment that would otherwise be savable, because after the radiation treatment, a tooth requiring removal could cause osteonecrosis and the horrible consequences associated with it. For people who have kept up with their oral care prior to their cancer diagnosis, this is pretty much a non-issue. For those who have decay and/or gum disease, it means the loss of the teeth involved and difficulty ever replacing those teeth. Any oncologist will tell you that the overall health of a patient entering cancer treatment has a major impact on the success of that treatment and the quality of life afterwards. Do yourself a favor and do what it takes to keep your body and your mouth in a healthy state. We can't predict what the future holds for us, but going into that future as healthy as possible can only make it better. 

I'm just going to put this off for a while?

We all procrastinate in many facets of our lives, but doing it with your healthcare can have consequences. I can't tell you how many times patients have returned for treatment after months or even years, and it was either not possible to save a tooth or they had lost too much bone to replace a tooth without extensive bone grafting prior to implant placement. Bone is preserved as long at healthy teeth and implants are present. It tends to be lost when nothing is present. Your ability to smile confidently and chew efficiently all of the foods that you prefer are such an important part of your life, why would you want to compromise that because you think that there will be a more convenient time to address it? I can't tell you the number of times patients have told me that they wish they'd addressed something sooner. You only have one body, and your mouth is an integral part of that body. Make a commitment today to be the healthiest and happiest person that you can be. You'll thank yourself for it the rest of your life.

It's all about the people.

You can't run a busy practice without great staff, and I'm fortunate to have the very best. Every time I see my physician, I'm reminded of how fortunate I am to have a staff that works hard, genuinely cares about the patients, and makes my life so much better. Eriko, Chenell, and Cornelia are wonderful people who make our practice special. Come in and see for yourself how wonderful it is to have people who care. 

Badly needed time off!

My family and I just got back from a sorely needed vacation. Everyone needs a break from time to time, and, as busy as we've been, I definitely fall into that category. That being said, it's great to get back to may patients who really help to give my life purpose beyond my family. 

Everybody needs a break

I'm just back from Breckenridge, my first vacation in two years. It's time off with my family that was sorely needed and certainly enjoyed. Everyone needs a chance to smell fresh air and get a break from the daily routine. That being said, I'm looking forward to seeing my patients again. I truly enjoy what I do, and wouldn't trade the relationships that I have with my patients for anything. 

What are you waiting for?

Every day you don't deal with an issue, dental or otherwise, is a day that you go without the benefits of the solution. Procrastination is the root cause of most of the treatment that I perform. Don't do that to yourself. Deal with your problems when they occur, save yourself time and money, and improve your quality of life. Treat mouth like it's the only one you have, because it is.

My roots are showing. Is this a problem?

Well, like all issues, it just depends on the circumstances. If you are a young adult with significant root exposure (more than 2mm), yes. If you are a middle aged or older person, and you've noticed more root showing recently, yes, this probably needs to be addressed. Keep in mind that gum recession is usually a slow process, but it can lead to tooth loss. The main treatment is a gum graft to cover exposed roots and provide thick, attached gum tissue that is resistant to further recession. If you even think that you may have a problem, it's best to get it checked by your dentist or periodontist. 

Why are my gums receding?

There area a number of causes for gum recession and root exposure. Traumatic tooth brushing or using a hard tooth brush is one that's preventable. You should use a soft brush and make small circles with it as you go from tooth to tooth. Don't scrub with a sawing motion, and use light pressure. If you use an electric brush, don't push too hard. Most of the current models will either stop or a flashing red light will come on when you press too hard. Another cause of tooth recession is grinding and clenching your teeth. This is a hard habit to break, but a bite guard can help control the damage that this causes. Lastly, some people are just born with thin gums that are prone to recession. These are the people who most benefit from gum grafts. Generally, once a graft is done, the gums stabilize and further recession is minimized. 

"I'll just replace the tooth when I get insurance."

I hear this quite often, and it sometimes leads to a more expensive tooth replacement. Even if you have a bone graft at the time of a tooth removal, bone will tend to be lost over time. Often this necessitates another bone graft prior to implant placement. The best time to get an implant is at the time of the tooth removal if possible. The second best time is a few months after the tooth was removed and a bone graft placed. Too often when people put off tooth replacement, months turn into years, and the replacement becomes more complex than it had to be. An implant is an investment in yourself, why not enjoy the benefits of it for the maximum amount of time and possibly save money in the long run?

"My gums have receded, and my dentist wants to cover my exposed roots with white fillings."

If there is decay on a root surface, it will need a filling to stop and prevent further decay. Placing white fillings over root surfaces for aesthetic reasons though is sometimes a bad idea. If the objection is gum recession, why not cover the exposed root with gum tissue? This is generally the best option, as it prevents further recession, reduces sensitivity, and looks more natural. Once a filling has been placed on a root surface, it is more difficult to get a gum graft to adhere. Before you get a root filling, see a periodontist for a consultation. He can tell you if there is a better alternative.