Periodontics

Antibiotic treatments come in several different types, including oral forms and topical gels which are applied directly into the gum pockets.  Research has shown that in the case of acute periodontal infection, refractory periodontal disease, prepubertal periodontal disease, and juvenile periodontal disease, antibiotic treatments have been incredibly effective.

Antibiotics can be prescribed at a low dose for long-term use, or as a short-term medication to deter bacteria from re-colonizing.

Oral Antibiotics

Oral antibiotics tend to affect the whole body and are less commonly prescribed than topical gel.  Here are some specific details about several different types of oral antibiotics:

• Tetracycline Antibiotics – Antibiotics which include tetracycline hydrochloride, doxycycline, and minocycline are the primary drugs used in periodontal treatment.  They have antibacterial properties, reduce inflammation and block collagenase (a protein which destroys the connective tissue).
• Macrolide Antibiotics – This group of antibiotics has proven effective at reducing inflammation, and can also reduce bacterial growth associated with periodontitis.
• Metronidazole – This antibiotic is generally used in combination with amoxicillin or tetracycline to combat inflammation and bacterial growth in severe or chronic periodontitis.

Topical Gels and Strips

The biggest advantage of the direct delivery of antibiotics to the surfaces of the gums is that the whole body is not affected.  Topical gels and direct delivery methods tend to be preferred over their oral counterparts and are extremely effective when used after scaling and root planning procedures. Here are some of the most commonly used direct delivery antibiotics:

• Atridox® – This doxycycline gel conforms to the contours of gum surfaces and solidifies over them. Over several days, this gel gradually releases the antibiotic medication.
• PerioChip® – This chip is placed into the actual gum pocket after root planning procedure. PerioChip® slowly releases Chlorhexidine, a powerful antibacterial antiseptic. PerioChip® reduces pocket depth in most cases in periodontitis sufferers.
• Actisite® – This thin strip is similar to dental floss and contains tetracycline hydrochloride. The thread is placed temporarily directly between the tooth and gum to kill bacteria and reduce the depth of gum pockets. Several threads are sometimes placed for around 10 days to enhance the antibiotic effect.
• Elyzol® – This metronidazole antibiotic comes in gel and strip form. It is unique because it is able to destroy parasites as well as oral bacteria.
• Arestin® – This Minocycline antibiotic comes in mini capsules which are delivered into the gums after scaling and root planning.

Noticeable periodontal improvements are usually seen after systemic or oral antibiotic treatment. Your Periodontist or dentist will incorporate and recommend the necessary antibiotic treatments as necessary for the healing of your periodontal condition.

If you have any questions about periodontal disease or antibiotic treatments, please ask your dentist

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 are 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 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.
• Botox® – Botox® can be injected into the muscles to relax and weaken them.  Botox® is an excellent treatment for bruxism because it weakens the muscles enough to prevent the grinding, but not enough to interfere with everyday functions like chewing and speaking.

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.

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 to 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 home care 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 a 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.

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 buildup 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 planning 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.

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 lifestyle 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.

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 planning 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 planning 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 planning 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, the 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 planning, or 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 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 planning 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.

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:

1. Supragingival Cleaning – The dentist will thoroughly clean the area above the gum line with scaling tools to rid them of plaque and calculus.
2. Subgingival Cleaning – This is the most important step for patients with a periodontal disease because the dentist is able to remove calculus from the gum pockets and beneath the gum line.
3. 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.
4. Medication – Following scaling and root planning, 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.
5. 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.