Category Archives: Blog

Tetracycline Stain

Overview

Tetracycline stain is a condition seen as deep stain in the adult teeth (permanent teeth) caused by tetracycline antibiotics taken during tooth development. The stain is seen as varying degrees of horizontal color bands ranging from gray to gray-brown and even some shades of green, with in varying degrees of intensity; depending on when the antibiotics were taken during tooth development.

Avoiding and correcting tetracycline stains

  1. It is widely known that avoiding the use of tetracycline during any phase of tooth development (during pregnancy, infancy, or early childhood) will prevent the teeth from staining.
  2. In some cases, tenacious bleaching can change the intensity of the tetracycline stain. This requires a dedicated, in office and/or daily routine of home bleaching.
  3. I children, composite veneers can act as a temporary solution until they are full grown and all adult teeth are fully erupted. In adulthood, porcelain veneers or crowns will serve as a more permanent solution
  4. It should be noted that covering the teeth with veneers or crowns is an irreversible procedure that carries with it a much greater expense than tooth bleaching.

Thrush

Overview

Thrush, or oral candidiasis, is a fungal infection that may appear as red, white, or creamy colored areas over the soft tissue. These patches of infection are frequently very painful because of the severe inflammation; inflammation involves: pain, heat redness, swelling and loss of function.

What Causes Thrush?

  • Patients taking antibiotics for other medical issues can cause the natural oral flora to become imbalanced, allowing fungal organisms to overgrow
  • Neglecting to remove and thoroughly clean dentures or partials daily
  • A compromised immune system
  • Debilitation by disease among elderly patients

Treatment usually consists of controlling causes by:

  • Reducing or changing the antibiotic causing the outbreak
  • Thoroughly removing and cleaning dentures and partials every day and keeping them out while you sleep, allowing the underlying tissue to recover
  • Using an anti-fungal when the underlying cause cannot be eliminated
  • Simply eating yogurt has shown to eliminate minor cases of Thrush

Cold Sores (Herpes Simplex I)

Overview

This is a Cold Sore or Herpes Simplex I; note the fluid filled vesicles. This is a highly contagious stage of the outbreak.

This is a Cold Sore or Herpes Simplex I; note the fluid filled vesicles. This is a highly contagious stage of the outbreak.

Cold sores are a recurring viral infection (meaning they come back periodically throughout your lifetime) that appear as fluid-filled blisters (called vesicles) on the outside of the mouth.

How Do Patients Get Cold Sores?

The Primary or Initial Infection

The initial or primary infection is caused by the Herpes Type 1 virus. The virus is highly contagious, and occurs when an infected individual transfers the virus to a mucous membrane or break in the skin. The primary infection usually occurs in childhood or infancy, but it can occur at any time throughout your life. As a primary infection, it can occur without symptoms or present as severe flu-like symptoms of primary herpetic gingivostomatitis such as:

  • Swollen lymph nodes, or lymphadenopathy (limf-ad-en-ah-pah-thee)
  • Fever
  • Severely inflamed gum tissue followed by eruption of fluid-filled vesicles throughout the mouth
  • Foul breath odor
  • Extreme pain and discomfort/difficulty eating
This stage of the Cold Sore appears to be crusting and is less contagious.

This stage of the Cold Sore appears to be crusting and is less contagious.

Recurrent Cold Sores

Following the primary infection, the virus remains in the body and can cause symptoms to recur throughout your lifetime. There is usually a period of time when you are aware that a cold sore is about to erupt called the “prodromal period.” The skin itches and burns with no sign of vesicles.

30% – 40% of all dental patients have recurrent cold sores 3-4 times a year depending on what triggers their outbreaks.1  It appears that stress, excitement, wind, cold, sunburn, the flu, or a cold are all triggers for a recurrence of the cold sores.

It should be noted that cold sores can occur anywhere on your body, although they can more easily occur in mucous membranes (mouth, genitalia). They recur wherever they enter your body. For example, if you scratch a cold sore and your finger has an opening in the skin, the virus could potentially enter the body at this point and recur there in the future. This virus is highly contagious, so care should be taken to avoid touching it until well after a scab has formed. Cold sores are not precancerous.

How Long Does a Cold Sore Last?

Cold sores usually heal in 7-10 days and have the potential to leave a scar that may take months disappear. There are a number of systemic antiviral medications on the market that may help control the recurrent outbreaks. Topical medications may be applied  which may or may not stop the progression of an outbreak. The ingestion of the essential amino acid lysine has also shown to be effective in stopping and/or lessening the severity of an outbreak.

Dental lasers can be used to shorten the duration by stopping the fluid filled blisters from erupting and spreading, creating faster healing.

Cold Sores Misunderstood

The common perception of the cold sore is that they are trivial in nature. These recurrent lesions are highly contagious due to the fluid filled vesicles saturated with the virus.1  Touching the cold sore and transmitting the virus to hands can spread the virus to oneself or others. The cold sore virus is the leading cause of non-impact blindness in the U.S. called Herpes Whitlow; 1.5 million cases are reported each year resulting in 40,000 cases of blindness.2

1. Embil J, Stephens R, Manual R, Prevalence od Recurrent Herpes Labialis and apthous lesions among young adults on six continents, Journal of the Canadian Medical Association, October 4, 1975, Vol 113, p627-630

2. Browning W, McCarthy J, A Case Series, Herpes Simplex Vitus as an Occupational Hazard, J Est. Rest. Dent, 2012 24(1) p. 61-66

Whitening/bleaching

Overview

After bleaching the teeth on the right, they are several shades lighter than the teeth on the left. Tooth bleaching can demonstrate dramatic results, whitening and brightening any smile.

After bleaching the teeth on the right, they are several shades lighter than the teeth on the left. Tooth bleaching can demonstrate dramatic results, whitening and brightening any smile.

Whitening works by applying carbamide or hydrogen peroxide solution to the tooth surface. Peroxide whitener reacts with water to form hydrogen, which produces the whitening. The degree of tooth whitening obtained is directly proportional to the strength of the whitening solution and the amount of time the solution is in contact with the tooth. Concentrations used for tooth whitening can be as low as 2-5% or as high as 22-35%. Some patients experience no side effects in whitening, while others experience tooth sensitivity and/or burns to the soft tissue.

Results depend on a number of factors:

  • The strength or percentage of the bleaching solution
  • The amount of time the bleaching agent remains active
  • The amount of time the active solution is in contact with your teeth
  • The number of repeated applications

Disadvantages of whitening include, but may not be limited to:

  • The possibility of extreme tooth sensitivity to cold and air
  • The burning of gum tissue (excess solution can spread to gum tissue and cause burns)
  • There is a limit to how white your teeth may become; many patients have unrealistic expectations and continue to seek whiter and whiter teeth, even after their teeth have been whitened as far as they will go.
  • Fillings and crowns will not whiten with your teeth; if you have a crown or fillings in the area you plan to bleach, you may need to have them replaced after you have reached your bleaching goals.

Whitening procedures

  1. For at-home whitening/bleaching, a custom tray (made for each individual patient) is the best method to deliver the bleach. The custom tray holds the whitening agent close to the tooth surface..

    For at-home whitening/bleaching, a custom tray (made for each individual patient) is the best method to deliver the bleach. The custom tray holds the whitening agent close to the tooth surface..

    Whitening strips are impregnated with various percentages of bleaching agent and can be purchased over the counter. They are placed on your teeth like a band-aid, wrapping around the edges of your teeth. Depending on the strength of the strips, these strips whiten your teeth over time. With repeated use, your teeth will whiten, and at some point, you will reach an end point where no further whitening will occur.

  2. Whitening trays are a take-home system that involves filling custom trays with various percentages of whitener and placing them over your teeth for a period of time. There are custom trays manufactured by your dentist that fit only you. There are over-the-counter trays, which do not hold bleaching solution as close to your teeth as the custom trays will. It is the close proximity of the bleaching agent to the tooth surface that whitens your teeth.
  3. In-office whitening systems are used under the supervision of your dentist. This system uses a powerfully high percentage of bleaching agent, and heat from a UV light activate and heighten the bleaching reaction. Gum tissue around your teeth is blocked with a protective “dam” because the solution can burn the soft tissue.

     

  4. Internal bleaching is whitening your tooth from the inside. If you have a tooth that has changed color following a root canal treatment that does not need a crown, this procedure may help. Once a tooth has had a root canal treatment and the color of the tooth has changed, your dentist can bleach the tooth from the inside. Once the root canal treatment has been completed and the opening to the canal has been sealed, a mixture of superoxyl and peroxide is placed on a cotton pellet and sealed inside the crown of your tooth. This method of whitening is called a “walking bleach,” and it will lose its power to whiten and have to be replaced with a fresh solution in a few days. This type of whitening can take between one and as many as six or more visits to reach the desired results. The length of time required to reach the desired results is usually dependent on how long your tooth has been dead.

Cosmetic Dentistry

Overview

A beautiful, white, healthy smile.

A beautiful, white, healthy smile.

The American Heritage Dictionary defines cosmetic as “the correction of physical defects.” Cosmetic dentistry is the correction of dental defects including a wide variety of problems, including dark fillings; broken teeth; yellow teeth, the closing of spaces; and the changing of the shape, contour, position and even the sizeof your teeth.

Procedures designed to help you achieve a whiter, brighter, more beautiful smile can be as simple as placing whitening strips or as complicated as full-mouth reconstruction utilizing crowns, bridges, veneers, implants; even orthodontic treatment (the realigning of your teeth with “braces”), depending on the treatment plan.

The Cosmetic Solutions

  1. Whitening/bleaching

    After bleaching the right side only: the teeth on the right are several shades lighter than the unbleached teeth on the left.

    After bleaching the right side only: the teeth on the right are several shades lighter than the unbleached teeth on the left.

    Whitening works by applying carbamide or hydrogen peroxide solution to the tooth surface. Peroxide whitener reacts with water to form hydrogen, which produces the whitening. The degree of tooth whitening obtained is directly proportional to the strength of the whitening solution and the amount of time the solution is in contact with the tooth. Concentrations used for tooth whitening can be as low as 2-5% or as high as 22-35%. Some patients experience no side effects in whitening, while others experience tooth sensitivity and/or burns to the soft tissue. See Whitening/Bleaching.

  2. White, bonded fillings

    White fillings, whether in your smile or in your back teeth, may need replacement for cosmetic or health reasons.

    1. Over time, the composite fillings in your front teeth will stain from various foods, coffee, tea, dark soda, or tobacco.
    2. The margins of your fillings may become defective over time, and the accumulation of bacterial plaque on these fillings can create recurrent decay, necessitating replacement.
  3. Direct bonding with composite (composite veneers)

    Direct bonding involves the complete coverage of the front of your teeth with tooth-colored filling material. Prior to placement of the composite material, tooth structure may or may not need to be removed, depending on each individual case. The tooth is etched and an adhesive is placed on the surface, followed by the layering of various colors of composite designed to mimic natural tooth structure. The direct bond is then contoured and polished to a high shine. Direct bonding may be able to close spaces, straighten teeth with minor misalignments, and improve color, shape, and contour. Although this procedure is usually less expensive than placing porcelain crowns or veneers, this material will stain over time and does not last as long as porcelain. This is because composite is a porous material, while porcelain is a very dense, smooth material.

  4. Porcelain veneers

    A dental laboratory model showing the right tooth is a full porcelain crown and the left tooth is a porcelain veneer.

    A dental laboratory model showing the right tooth is a full porcelain crown and the left tooth is a porcelain veneer.

    If you look at many kitchen countertops, you will notice that they are covered by a very thin layer of Formica that is glued to a wooden frame. Think of the wooden frame as your tooth and the Formica as the porcelain veneer.

    The purpose of placing veneers is to avoid excessive tooth removal. A very thin portion of your tooth is removed from the front, sides and biting edge of the tooth. Laboratory-constructed veneers are then bonded to the remaining tooth structure to replace the removed tooth structure, thus obtaining the desire cosmetic result (closing spaces, as in the example).

    Typically, veneers are used on the front upper and lower teeth, but they can be used on all teeth that show in your smile. One of the most difficult procedures is placing a single veneer or crown on a front tooth because the challenge of capturing the exact color of surrounding teeth, translucency and surface finish is difficult. If your dentist has done this to your satisfaction, he or she has an exceptional eye for detail and extremely good communication with his or her dental laboratory.

    Reasons to place porcelain veneers:

    • When there are several spaces to close or fewer large spaces, the treatment plan may indicate that more teeth need to be prepared to achieve the desired results; if too few teeth are used, the final result may leave you with oversized teeth. The general rule is that the more space there is to close, the more teeth need to be prepared. The filling of space is distributed over a greater number of teeth, creating a much nicer result.
    • The preparation is designed according to the final goal of the treatment plan, such as giving the appearance of moving the teeth forward, backward, right, or left.
    • To change the length or shape of the teeth
    • To change the color of the teeth
    • To make minor changes in the position of a tooth

    A porcelain veneer does not cover the entire tooth. Therefore, if large changes in position are needed, a full crown may be necessary to bring the tooth into the desired alignment.

  5. Porcelain crowns

    A dental laboratory model of a patient who has had their four front teeth restored with all porcelain crowns. The crowns will be returned to the dentist and bonded into the mouth.

    A dental laboratory model of a patient who has had their four front teeth restored with all porcelain crowns. The crowns will be returned to the dentist and bonded into the mouth.

    Depending on the condition of your teeth, the use of full crowns may be necessary to achieve a desirable cosmetic result. Remember, veneers do not cover the entire tooth, and if any of your teeth have had large composite fillings that extend to the “back” of your tooth, a full crown may be needed to cover the old, defective composite restorations. If your teeth are crooked and you’re not interested in having your teeth straightened through orthodontia (see Braces), the teeth can be either partially or completely realigned by the way the teeth are prepared and how the crowns are constructed. There are a number of different types of porcelain crowns that can be used to cosmetically restore a smile (see Crowns and Bridges).

  6. Braces (orthodontic treatment)

    Orthodontic treatment, or “braces,” is most often thought of as cosmetic; however, one of the primary goals of this type of treatment is the correction of proper function. Proper function of the teeth preserves the beauty of your teeth over a lifetime. Overall, cosmetic dentistry implies the correction of physical defects only; unfortunately, if appropriate function is not considered, the cosmetics may fail over time. To learn more about the advantages of orthodontics, (see Braces).

  7. Inlays and Onlays

    See article Inlays and Onlays.

Root Canal Treatment

Overview

Two teeth that have been treated with root canal treatments. Note the screw-like structure on the left: this is a dental implant.

Two teeth that have been treated with root canal treatments. Note the screw-like structure on the left: this is a dental implant.

Inside every normal, healthy tooth is a space, containing a nerve, artery, and vein, called the pulp. Inside the part of the tooth that can be seen above the gums (clinical crown) is the pulp chamber. Inside the part of the tooth below the gums (tooth roots) are the root canals (see Parts of the Tooth). When damage to the nerve, artery or vein occurs, the tooth begins to die. If the tooth becomes sensitive or painful, a root canal treatment is recommended to save the tooth.

What is a root canal treatment?

The death of a tooth can occur for a number of reasons, resulting in the need for root canal treatment. Conditions such as:

  • deep decay close to the ‘nerve chamber’ or pulp whereby bacteria involved in the decay process are now entering the pulp chamber and setting up infection.
  • fracture
  • tooth grinding (bruxism)
  • too rapid tooth movement during treatment with braces can result in the death of the tooth and require treatment of the root canal.
  • accidental trauma

When a patient receives a root canal treatment, the tooth is numbed (anesthetized) and an opening is made to allow access to the pulp chamber and root canals. The contents inside the tooth are removed, the walls on the inside of your tooth are smoothed and disinfected. The inside of your tooth is then filled and sealed to prevent bacteria from entering in the filled canals.

A root canal treatment involves removing damaged tissue inside your tooth and filling the space with a material that is very compatible with your body.

Symptoms leading to root canal treatment

The symptoms indicating the need for root canal treatment vary. Typically, when a patient reports a toothache, there are five questions that can help determine whether or not the tooth requires root canal treatment. This list of questions is a guideline in helping to determine if a root canal treatment is needed.

  1. Is any tooth sensitive to heat or cold?
  2. If yes, does the sensitivity linger for 3-5 minutes or does it subside quickly?
  3. Is the tooth pressure sensitive (does it hurt to chew or bite)?
  4. Does the tooth hurt without being disturbed? Does it hurt spontaneously?
  5. Does it wake you when sleeping?

Sometimes only sensitivity to cold occurs, but lingers for five minutes or more. Sometimes only pressure sensitivity occurs, but pain without touching the tooth, that wakes the patient up at night, and extreme heat sensitivity are strong indications that the tooth is dying.

Cold sensitivity and pressure sensitivity could mean something other than pulpal death, such as a filling that is too high or a microscopic crack in your tooth. Pain that wakes someone from a sound sleep could be from an intense episode of Clenching and Grinding. Teeth clenching and grinding (bruxism) is a potentially damaging habit that can cause intense pain that wakes the patient from a sound sleep.

Sometimes patients have no symptoms, but a dark spot around the tip of the root is found on an x-ray, indicating that the tooth has died.

A pulp tester may help the dentist in the diagnosis of the pulp health; however, this device only indicates if there is live tissue inside the tooth. Since the pulp tissue doesn’t die all at the same time, a pulp tester may not be as reliable as an x-ray to answer the questions above.

What creates the need for a root canal treatment?

All living tissues, including teeth, require a blood supply for healing from the damage of trauma. For example, when we get a cavity and the pulp gets irritated, our body has the ability to build up protection from the inside of the tooth, protecting the tooth from the cavity, but too often cavities grow faster than the blood supply can build up protection.

When we cut a finger, there is an enormous blood supply to the wound, allowing it to set up an inflammatory response and begin healing. The problem with teeth is that the blood supply is very small and when the tooth is “injured” badly enough, the resources needed to promote healing cannot get to the injury quickly enough and the tooth can die. A more detailed explanation of causes leading to root canal treatments follows:

  1. Deep tooth decay – Left untreated, Tooth Decay can become severe enough to irritate the pulp, or infect the inside the tooth. Both situations usually lead to death of the tooth. The bacteria involved in this infection grow and reproduce without oxygen. These bacteria produce gases that expand when heated, press on the infected nerve and create intense pain. Bacterial infection usually requires treatment with antibiotics.
  2. Trauma – There are two forms of trauma that may cause your tooth to die: acute trauma (like getting hit in the face with a baseball) or chronic trauma such as tooth grinding. Chronic tooth grinding presses the tooth into the bony socket, compressing blood vessels and choking off the blood supply. Over long periods of time, this habit may cause pulpal death.
  3. Dental treatment – Poor tooth care leading to repeated dental treatment may cause the death of the tooth. Many times, a tooth that has been repeatedly filled and eventually needs a crown, dies after the crown is prepared. Often the patient wants to know what the dentist “did to my tooth”. In reality, the tooth has been repeatedly traumatized (it is harmful for a tooth to be filled over and over) and the crown preparation, which may have been recommended years earlier, causes symptoms to become apparent.
  4. Tooth movement – If a tooth is moved too rapidly, such as with braces (orthodontic treatment), pulpal death can occur. A more important factor in pulpal death during tooth movement is the condition of the tooth prior to treatment with braces. Teeth that have sustained years of trauma from being repeatedly filled or teeth that have suffered years of clenching and grinding can die, even if they are moved slowly. Teeth can only handle a certain amount of stress or trauma before they die.

What are the risks of root canal treatment?

  1. Failure – Sometimes a root canal treatment will simply fail. This means, for some reason, the treatment performed could not completely remove the infection. When this happens, the tooth can be re-treated, usually by a specialist (see Endodontist).
    • Retreatment – This may be attempted if the initial treatment fails.
    • Root Tip Treatment (Apicoectomy) – If the initial treatment fails and the retreatment fails, minor surgery designed to expose the root tip, remove a small portion of it and place a filling into the end of the root may save the tooth from removal (extraction).
    • Extraction – If all treatment fails, removal of the tooth may be necessary.
  2. Perforation – During the opening or filing of the tooth, an instrument can accidentally perforate the tooth from the inside out. This may cause the loss of the tooth if not treated properly.
  3. Broken instruments – If an instrument accidentally breaks inside the tooth, the longevity of the tooth depends on the dentist¬タルs ability to file and fill the tooth beyond the broken tool to the tip of the root.
  4. Tooth Fracture- Once a tooth has died and a root canal treatment has been performed, the tooth is often more brittle. For this reason, a crown is usually recommended to help prevent fracture of the tooth.

The Dental Abscess

Overview

A dental abscess is an infection of a tooth, gums, or the jaw caused by an accumulation of pus and bacteria.

Dental abscesses originate from

  • Tooth Decay: a cavity that has progressed into the nerve chamber, trapping gas and creating inflammation of the nerve inside the tooth
  • Gum disease: deep pockets harbor bacteria that grow under the gum line, trapping gas and creating inflammation
  • Wisdom teeth: trapped bacteria around wisdom teeth that are not completely erupted, but that have a flap of skin partially covering them (the name of this type of abscess is pericoronitis)
  • Trauma: a blow or some type of trauma to the teeth or jaw, causing the death of the tooth

The first two types of abscesses are the result of poor home tooth care and lack of regular dental visits. Untreated tooth decay or periodontal disease will eventually progress to the point where emergency dental care is necessary.

Pericoronitis (peary- core-on-i-tis) occurs when a patient’s wisdom teeth need to be removed but the patient waits until intense pain manifests to schedule the procedure. The flaps of skin over the wisdom tooth prevent your toothbrush from reaching bacteria, allowing them to multiply and spread into the surrounding spaces in your face and around the tooth.

The last type of dental abscess can occur shortly after the trauma (trauma such as a blow to the face) or years later. A patient can have a perfectly intact tooth (no decay, fracture or gum disease) but experience intense pain and swelling indicating that the tooth is dying. The tooth may become loose and extremely tender to touch.

Symptoms of a Dental Abscess

These types of abscesses create pressure with symptoms of swelling and pain. The infection will take the path of least resistance and can progress into the face or neck. The head and neck have spaces where the gas produced by the bacteria can spread (facial spaces), causing swelling. In some cases, the face or neck can also become inflamed over the top of the swollen area, and the lymph nodes under the chin and in the neck can become swollen and tender. In severe cases, the patient can experience fever, chills, malaise, and a general/overall illness.

 

Treatment of a dental abscess:

An abscess caused by the invasion of decay/bacteria into the nerve chamber of the tooth can be treated by one of two procedures:

  • Root canal therapy: depending on the amount of decay or loss of tooth structure, you may have a strong desire to save the tooth.
  • Extraction of the tooth (see Oral Surgery)

Antibiotics and pain medication are often prescribed for this type of infection (different antibiotics are prescribed for different abscesses).

An abscess caused by bacteria infecting deep pockets, found in periodontal disease, can be more difficult to treat. A regime of antibiotics is necessary along with disinfecting the infected pocket. These pockets, once deep down the side of the tooth, can turn and wrap around the root deep under the gum line, making it difficult to disinfect. The use of dental lasers is a highly useful tool in killing bacteria deep in gum disease pockets. Recurrent periodontal abscesses may best be treated by extraction of the infected tooth.

Sometimes a dental abscess can progress rapidly, or the dental patient waits too long to seek treatment, and the infection spreads into the facial spaces, the floor of the mouth, or the neck. At no time should this swelling be lanced or drained unless the infection has “pointed.” This means that the infection has a white head on it like a pimple waiting to be squeezed. Extreme care should be taken when lancing an abscess in the floor of the mouth to avoid damage to the Lingual artery.

 

Receding Gums (Gingival Recession)

Overview

Receding gums or, gingival recession, is a condition where soft tissue or gums around the necks of your teeth shrink away from biting surfaces of your teeth. Gingival recession can be seen on a single tooth or on several teeth, in different areas of your mouth or throughout your entire mouth.

Causes of receding gums

  1. Incorrect tooth position: When a tooth is out of alignment and sits outwardly, away from the inside of your mouth, the bone and gum tissue is thinner than that which is over your teeth that are in alignment. This condition has much to do with two issues:
    • How your teeth grow into your mouth in relation to the space available at the time of emergence. This is why a dentist may recommend a child have an “orthodontic consult” by a dentist who has specialized in straightening teeth. A consult may be recommended as a preventative measure if your general dentist can see that there may not enough room for the tooth to grow into alignment.
    • Your genetic makeup also plays a role in the texture, thickness, and overall ability of your gum tissue to keep your tooth covered. If your tissue is thin and fragile, it will recede more easily than if it is thicker in nature. We all have genetics that determine the color, texture, and thickness of our skin. The inside of your mouth is simply skin with a greater blood supply (thus the pink color).
  2. Clenching and Grinding/ Bruxism: Severe clenching and grinding of teeth can cause gingival fibers (the fibers that hold your gum tissue tight to your tooth) to stretch. If the habit becomes chronic, the fibers can become overly stretched and break which will cause gum tissue to recede. If a tooth is out of alignment and receives a greater than average stress, tissue will thin and tears easily causing recession to happen faster.
  3. Brushing too hard: You may feel that in order to make your teeth clean, a hard toothbrush and/or aggressive brushing is necessary. Excessively hard brushing can contribute to causing gums to recede. When brushing your teeth, always use a soft toothbrush. Since plaque is soft; its removal can be completely accomplished with a soft brush. A hard brush cannot bend and get into the small spaces and indentations around your teeth and can abrade away the soft gum tissue collar around the necks of your teeth. Tooth position and the thickness and texture of your gums, along with the aggressiveness of your brushing, will determine how fast your gums will recede. See Brushing and Flossing.
  4. Time or aging: As we age, our gum tissue naturally recedes a little. As with all other soft tissue changes in the body; the skin in the mouth is no exception. Preventing all of the above will go a long way toward keeping the receding of gums to a minimum.

Correction of receding gums

  1. Orthodontic treatment (see Braces), or having your teeth aligned properly, will help reduce the possibility of gums receding.
  2. Wearing a night guard to reduce the stress on your teeth while you are sleeping and awareness of the habit while awake will help reduce the possibility of gum recession. See TMJ/TMD.
  3. Learn and practice the appropriate method for cleaning your teeth at home. See Brushing and Flossing for more details.
  4. Soft tissue grafting, done by a gum surgeon (see Periodontist), is an outstanding method of repairing areas where your gums have receded.

Dental Plaque

Overview

Dental plaque (sometimes referred to as “biofilm”) is an accumulation of organized bacteria that forms around teeth and matures in 24 hours where it can begin the damage of Tooth Decay and Gum Disease. This film is constantly forming on the teeth, tongue and soft tissue of the mouth, and on any dental devices – such as dentures, partials, or orthodontic appliances – that we place in our mouths. It is made up of bacteria that form on any tooth surface, above or below the gum line.

Most people think that plaque is hard, but plaque is soft and sticky, though removable with a toothbrush, floss, and/or a waterpik. Dental plaque forms and matures to a point where it can harm the mouth in about 24 hours. By this stage, a mature ecosystem has formed, with the most mature and damaging bacteria next to the tooth surface or deep in a pocket next to the area where the gums are attached to your teeth.

Bacterial Plaque: Tooth Decay and Gum Disease

The plaque that forms above the gum line is made up of bacteria that require oxygen to thrive and multiply. These bacteria predominately cause tooth decay. When this type of bacteria is allowed to sit on the tooth for long periods of time, it uses food (predominately sugars) to make acid. The acid dissolves the tooth and creates a cavity called tooth decay.

Dental plaque that forms just under or deep below the gum line is made up of bacteria that do not require oxygen to multiply. When this type of mature plaque is allowed to sit up next to the gum tissue, the beginning stages of gum disease are seen as bleeding, sore, swollen gum tissue.  Eventually the skin attachment gets loose and the pocket deepens (the disease progresses), the bacteria that live deep below the gum line are responsible for the destructive process of bone loss associated gum disease.

When dental plaque forms in a deep pocket (as found in uncontrolled moderate to severe gum disease), brushing and flossing is usually not effective in removing the deepest bacteria. An anti-bacterial mouth mixed in the waterpik water reservoir will reach down the pocket and kill bacteria.

Plaque that is allowed to form and sit for long periods of time can harden into a barnacle-like compound called calculus or tartar  that builds up on a tooth, denture, or any appliance used in the mouth. Although calculus is not harmful, it is covered by live bacteria that is harmful. Once dental plaque has hardened, it is labor intensive to remove, requiring the attention of a dental professional to assure proper removal.

The bacteria that are found in the mouth are “acquired” and from a number of sources. As a newborn, our mouths are considered almost sterile (without bacteria). However, oral bacterial is acquired as we pass through the birth canal, from whoever feeds us as they first test the temperature of our food before placing it in our mouths, through sharing drinks, food, kissing, nail biting…and any other exposure our mouth may encounter. The moist, warm atmosphere creates an ideal environment for them to thrive.

We now know that dental plaque also harbors a variety of viruses, especially the plaque found deep in periodontal pockets.

Oral Surgery

Overview

Oral surgery can be a simple tooth removal or a lengthy operating room procedure as pictured here.

Oral surgery can be a simple tooth removal or a lengthy operating room procedure as pictured here.

The phrase “oral surgery” is an umbrella term for a range of procedures to surgically treat a variety of mouth, head and/or neck issues. These surgeries may be performed by a specialist in oral surgery (Oral Surgeon), a dentist who specializes in gum disease (Periodontist), a root canal specialist (Endodontist), a specialist in treating children (Pedodontist), or a general dentist. Each specialist is licensed to work within of his or her area of expertise, training and experience.

Throughout this article keep in mind the main message is of tooth preservation. Our teeth begin the digestion process; without teeth doing their job, we cannot properly begin the digestion of fats and carbohydrates.

Common Oral Surgery Procedures

Extractions involve the removal of teeth. These could be teeth that have fractured, decayed, or impacted teeth. In simple extractions, the teeth can usually be removed without much effort. An exception would be if the tooth had become fused to the jaw bone or “ankylosed”  (ank-ill-ohst).

These extracted teeth are used in dental schools to study dental anatomy.

These extracted teeth are used in dental schools to study dental anatomy.

If the tooth to be extracted is severely decayed, it is considered weak and brittle and may require the gum tissue to be moved out of the way and a small portion of bone removed to ease tooth removal. Often, these teeth fracture and a portion remains attached in the bony socket. The broken piece should be retrieved and only left behind if it carries a greater risk vs. benefit; an example would be accidental pushing of the root tip from an upper molar into the sinus cavity. Any tooth part that enters the sinus should be removed. The patient should always be informed when needing to leave a fractured root tip in place.

Impactions are usually “wisdom teeth” that are completely covered by bone (full boney impaction), partially covered by bone (partial boney impaction), or covered only by soft tissue (soft tissue impaction). Oral surgeons are highly trained in the area of third molar (wisdom teeth) extractions, as it is one of the most common procedures they perform.

Implant placement for the replacement of missing teeth. (See Dental Implants)

Biopsy of suspicious oral lesions and diagnosis of Oral Cancer.

Bone grafting is the transplanting of bone tissue in areas where bone is not wide enough or thick enough; this bone grafting or addition would then permit completion of other dental procedures (such as implant placement).

Denture Preparation

  • Alveolpoplasty (al-vee’-lo-plas-tee)-  An alveoloplasty involves shaping of the jaw bone following tooth removal to prepare for the placement of dentures or partials. The gum tissue is laid back and the bone exposed for smoothing and shaping, removing any irregularities or undercuts. This allows a more comfortable fit to the dentures following healing.
  •  Vestibuloplasty (ves-tib’-u-low-plas-tee)- A vestibuloplasty involves increasing the “attached tissue”. If you pull your lower lip out, you can see where the pink tissue is loose and where it is attached firmly to bone. If the loose tissue is loose up onto the area where the denture sits, the denture will become unseated whenever the muscles in the face are used i.e. eating and talking.

A final stage to braces as a correction of a jaw problem called Protrusion or Retrusion of the upper and lower jaws. An orthodontist moves the teeth into a position that readies the patient for the jaw surgery; an oral surgeon performs the surgery only after all growth is complete.

Facial fractures due to accidents or physical trauma may require surgical intervention; these types of injuries usually require an oral surgeon as a member of a medical team.

Congenital defects such as cleft lip and cleft palate generally require a team approach which can consist of an oral surgeon and a team of medical professionals, including a plastic surgeon.

Gum Disease Treatment (periodontal pocket elimination) is a type of surgery performed by specialists (see Periodontist) to treat gum disease. This surgery is done when non-surgical procedures, such as scaling and root planning, have failed to provide the desired reduction in the pocket depths around the teeth. Periodontal treatment, whether surgical or non-surgical, is intended to make the cuff of gum tissue around the neck of the tooth shallow enough for the patient to keep it clean.

Soft tissue grafting is done to cover areas that have lost their gum tissue covering. The “donor site” is usually the roof of the mouth. A small piece of gum tissue is removed from the roof of the mouth and transferred to the area that lacks coverage.

Root Tip Treatment (Apicoectomy) is the surgery most performed when conventional root canal treatment has failed to bring about the desired results, a procedure called an apicoectomy is recommended. The word comes from apico (at the tip of the root) and ectomy (removal), or the removal of the tip of the root. Apicoectomies are typically performed by an Endodontist.

This procedure involves laying the gum tissue back and making a small window in the bone adjacent to the tip of the root in question. A portion of the root tip is removed by beveling the root tip and placing a filling material to close the opening at the root tip. The gum tissue is replaced and stitched closed.

Extraction of “baby teeth” in preparation for braces (see Braces (Orthodontics), is a common procedure performed by a children’s dentist (Pedodontist).