Posts for: April, 2014
Because its symptoms can be easy to overlook, gum disease is sometimes called a “silent” malady. But don't underestimate this problem! Untreated periodontal disease can progress into a serious condition, possibly leading to tooth loss and even systemic (whole-body) health issues. With proper preventive measures and appropriate treatment, however, the disease can be controlled.
The root cause of periodontal disease — actually, a group of related diseases, all of which affect the tissues surrounding the teeth — is the buildup of bacterial plaque (also referred to as biofilm) around the gums. While hundreds of types of bacteria live in the mouth, only a comparatively few are thought to be harmful. But when oral hygiene (namely, brushing and flossing) is inadequate, the environment in the mouth becomes favorable to those harmful types.
The disease often begins with inflammation of the gums called gingivitis. It symptoms include bad breath, bleeding gums, and soreness, redness, or tenderness of the gum tissue. However, in some people these early warning signs are ignored, or masked by the effects of harmful habits like smoking.
Gum disease is chronic; that means, if left alone, it will worsen over time. Periodontitis, as it progresses, causes damage to the ligament that helps hold the tooth in place, as well as bone loss. This may become increasingly severe, and ultimately result in the loss of the tooth. Severe periodontitis is also associated with whole-body (systemic) inflammation, which has been linked to an increased incidence of cardiovascular diseases, like stroke and heart attack.
But there's no reason to allow gum disease to progress to this stage! Prevention — that is, regular daily brushing and flossing as well as regular dental cleanings — is a primary means of keeping this problem at bay. Plus, every time you have a regular dental checkup, your gums are examined for early signs of trouble. Of course, if you notice the symptoms of gum disease, you should come in for a check-up as soon as you can.
There are a number of effective treatments for gum disease. One of the most conservative, routine ways are those regular dental cleanings we referred to earlier, usually called scaling and root planning. Using hand-held and ultrasonic instruments, the buildup of plaque (tartar) is carefully removed, sometimes under local anesthesia. A follow-up evaluation may show that this treatment, carried out on a regular schedule, is all that's needed. Or, it may be time for a more comprehensive therapy.
If you have concerns about gum disease, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Understanding Gum (Periodontal) Disease” and “Warning Signs of Periodontal (Gum) Disease.”
The proliferation of drugs to treat all manner of diseases and conditions has heightened concerns not only about general side effects, but also how a particular drug may affect treatments for other conditions. There are indications, for example, that drugs classified as blood thinners could cause complications for patients undergoing oral surgery.
Blood thinners like Warfarin are typically prescribed to patients with artificial heart valves or who are at significant risk for stroke, heart attack, or the formation of clots that could potentially damage the heart and lungs. The drug reduces the coagulation (clotting) mechanism in blood; aspirin taken regularly should also be considered a blood thinner.
As with any invasive procedure, blood thinners can complicate oral surgery. Blood doesn’t clot normally and so bleeding during a procedure is more difficult to stop. This doesn’t necessarily mean the surgery can’t be performed. For one thing, many oral procedures like tooth removal involve little trauma to tissues and bleeding in the hands of a careful and experienced surgeon. The surgeon can also use hemostatic agents during surgery that will stabilize blood clotting, as well as suturing the incision in such a way as to reduce bleeding from surface capillaries. In the case of a tooth extraction, a bone graft placed within the empty socket not only reduces bone loss from a missing tooth, but can also enhance bleeding control.
In consultation with your medical doctor, it’s also possible to temporarily stop or reduce your medication dosage in anticipation of a pending oral surgery. While it may not be safe to stop the drug altogether, a reduced dosage can ease the anti-coagulant effect and reduce any complications from bleeding that might occur during the surgery. You can then resume normal dosage soon after the procedure.
During your pre-op examination, it’s important to let your surgeon know about any drugs you are currently taking, including over-the-counter drugs like aspirin. The oral surgeon will then be able to take the necessary steps, including working with your medical doctor, to ensure your surgical procedure is safe and uneventful.
If you would like more information on oral surgery precautions while taking blood thinners and other medication, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Oral Surgery & Blood Thinners.”
There’s no question that x-ray imaging has transformed how we diagnose and treat dental problems. But traditional x-rays have at least one limitation — they are two-dimensional portraits that can only provide a portion of the information available. If you could view the interior of teeth or other mouth structures in three dimensions, you would have access to more detail about their conditions.
Computerized axial tomography (CAT) scanning has brought that third dimensional view to physicians generally and, in more recent years, to dentists. The latest development in this technology is known as Cone Beam Computed Tomography (CBCT). A CBCT emits a spiral of x-rays that form a cone-shaped beam that is caught on detectors. Using digital geometry, the CBCT then generates a three-dimensional image by precisely “layering” this large series of two-dimensional images caught by the detectors on top of each other.
CBCT is already making a significant impact in dentistry and its related specialties. Dentists now can visualize with amazingly precise detail the three-dimensional anatomy of the teeth, jaws, facial bone and other structures in the head and neck area. Orthodontists can examine the growth stages of a patient’s teeth eruption to better prepare treatment strategies. Oral surgeons can determine the precise location of impacted teeth and their exact proximity to nerves and sinuses. And, periodontists who specialize in gum disease and treatment can better determine the level of bone loss and gum attachment for more accurate diagnoses and effective treatment.
While a CBCT delivers a higher dose of x-rays than a traditional panoramic radiograph, it actually delivers a lower dosage than a digital standard 18 film full mouth series or than conventional medical CT scanners. The field of view also determines the level of x-ray exposure — the smaller the field of view (and more concentrated the x-rays) the higher the dosage and the better detail of anatomy.
The good news, though, is that a low dosage CBCT scan can still provide a level of detail that can provide dentists with a very accurate view of anatomical features, including bone density and mass, in three dimensions. That capability can vastly elevate the accuracy of diagnoses and lay the groundwork for effective dental treatment.
If you would like more information on the uses of CBCT scanning to help you maintain dental health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “CAT Scans in Dentistry.”
If you’ve come in to our office lately, chances are you’ve been asked to fill out a form or answer a question about what medications — both prescription and non-prescription — you are currently using. Of course, if you’re taking a blood-pressure drug or a pill to help control your cholesterol, you wouldn’t hesitate to put it on the list. But how about those vitamins and herbal supplements you take — do you really have to list those too?
The answer is a definite yes — and some of the reasons why may surprise you. Did you know that many “natural” dietary supplements can have potentially serious interactions with other drugs you may be prescribed? For example, herbal preparations made from the plant called St. John’s Wort are often used by people seeking relief from depression or anxiety. However, the active chemical compounds in this herb can interfere with some anesthetic drugs, and may make it harder for you to recover from the effects of anesthesia. Ginkgo biloba and some other commonly used herbs have a similar effect.
Even some vitamins have the potential to cause negative interactions. Large doses of Vitamin E, for example, can increase the risk of internal bleeding in people who are taking blood thinners or non-steroidal anti-inflammatory medications (NSAIDS), such as aspirin and ibuprofen. These medications are commonly prescribed for pain relief after minor dental procedures.
Does that mean you have to stop taking vitamins and herbal supplements if you may need a dental or medical procedure? Not necessarily. Vitamins are indeed vital to your health, and a deficiency in one or more of these important substances can result in serious diseases — like scurvy, which formerly plagued sailors lacking access to fresh fruits and vegetables. If you’ve been told you have a vitamin deficiency, taking vitamin pills is a must.
But the best way to get the proper amount of vitamins is through a healthy, well-balanced diet rich in fruits, vegetables, and whole grains. Not only does consuming these foods give you the most “natural” source of vitamins — it also provides you with other essential micronutrients and fiber, and it is low in fat and cholesterol.
No nutritional supplement is a substitute for a healthy diet — and that’s something we’d like everyone to remember. We’d also like to remind you to tell us about ALL the medications and supplements you’re taking, especially if you’re going to have a procedure. Giving us complete information will help ensure that you’ll remain as healthy and safe as possible.
If you have questions about dietary supplements, nutrition and your teeth, please call our office to arrange a consultation. You can learn more in the Dear Doctor magazine article “Vitamins & Dietary Supplements: What Every Consumer Should Know.”
Permanent tooth loss at any age greatly affects long-term oral health. But because their jaw and facial structures are still developing, it’s particularly consequential for adolescents. Add to that any planned orthodontic treatment, and a little extra care is warranted when a teenager loses a tooth.
The biggest concern is potential bone loss caused by the missing tooth. Because the mouth structures are still developing, bone loss can be especially problematic for any future restorations of missing teeth. One of the best ways to slow or stop bone loss is to surgically insert bone-grafting material at the time of an extraction. Bone grafts act as scaffolds that the body builds natural bone upon; eventually the natural bone completely replaces the graft material.
When it comes to the matter of orthodontics, the treatment plan will be to either close the space so that future tooth replacement isn’t necessary or maintain the space for future tooth replacement. If the choice is the latter, the orthodontist will maintain enough space during installation of the braces for future replacement. In the meantime, the orthodontist can install temporary, color-matched tooth replacements within the braces to cover the gap. After the braces have been removed, artificial crowns may also be incorporated into the retainers for a more natural appearance until receiving a permanent replacement.
The best choice for that permanent replacement is a dental implant, a “stand-alone” system that encourages bone maintenance and doesn’t interfere or impact adjacent teeth. The only real question for adolescents is when to install the implants.
The mouth’s structural development doesn’t conclude until early adulthood: in males around ages 20, and in females typically a year or so earlier. Your dentist will evaluate your adolescent’s growth and development to determine if he or she is ahead or behind the growth curve. Natural teeth grow and develop along with the corresponding bone growth, but implants are artificial devices that don’t “grow” with the natural bone. It’s important, therefore, to postpone an implant installation until the jaw structure has fully developed — if done too early, the implant crown’s length won’t appear to be proportionally right (especially in relation to natural teeth) as the jaw continues to grow.
If you would like more information on dental implants for teenagers, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dental Implants for Teenagers.”