Posts for: May, 2017
If you've suddenly noticed your smile looking more “toothy,” you may have a problem with your gums. They may have lost their normal attachment to your tooth and begun to shrink back — or recede.
Millions of people have some form of gum recession. The most common cause is periodontal (gum) disease, but it's not the only one. You may be more susceptible to gum recession because of heredity — you have thin gum tissues passed down to you from your parents. You may also be brushing too hard and too often and have damaged your gums.
Healthy gums play an important role in dental health. The crown, the tooth's visible part, is covered with a hard, protective shell called enamel. As the enamel ends near where the root begins, the gums take over, forming a tight band around the tooth to protect the roots from bacteria and acid.
Receding gums expose these areas of the tooth meant to be covered. This can lead to another tell-tale sign — tooth sensitivity. You begin to notice pain and discomfort while you consume hot or cold foods. And because it leaves your teeth and gums looking much less attractive, it can affect your confidence to smile.
Fortunately, though, we can help restore receded gums. If you have gum disease, it's imperative we treat it as early as possible. We do this by removing plaque, a thin film of bacteria and food particles that triggers the infection. We use special techniques and hand instruments to remove plaque and calculus (hardened plaque deposits) from all tooth surfaces including along the roots.
Gum disease treatment can help stop and even reverse gum recession. In some cases, though, the recession may have advanced too far. If so, we may need to consider surgically grafting donor tissue to the recessed areas. Depending on the site and extent of recession, this can be a very involved procedure requiring microscopic techniques.
The best approach, though, is to take care of your gums now. Daily brushing and flossing removes harmful plaque; regular dental visits take cleaning a step further and also give us an opportunity to detect disease early. By looking out for your gums now you might be able to avoid gum recession in the future.
Dental implants can do more than replace individual teeth — a few well-placed implants can support other restorations like a fixed bridge. The natural integration that occurs between the bone and the implant's titanium post creates a strong, durable hold for both implant and the supported restoration.
But if a bone-implant connection weakens, the implant could be in danger of failing. This can occur because of periodontal (gum) disease caused by dental plaque, a thin film of built-up food particles and bacteria on the teeth. Untreated, the infection can ultimately spread from the gums to the bone and cause it to diminish in volume. If the bone loss occurs around an implant the threaded surface of the post may be exposed, inviting more plaque buildup. This can trigger more bone loss and eventually implant failure.
That's why you must brush and floss daily to remove plaque on and around your fixed bridge just as you do your natural teeth. Brushing around a bridge could be difficult with a traditional brush, so you may want to use an interproximal brush designed for just such situations. Be sure any utensil you use contains only plastic parts — metal creates microscopic scratches in the restoration materials that could harbor plaque.
You should also floss between the bridge and gums as well as between any natural teeth. While this can be difficult with traditional flossing methods, there are some tools to make it easier.
One is a floss threader, a small tool with a loop on one end and a stiff plastic edge on the other. With floss threaded through the loop, you gently guide the edged end between the bridge and gums. Once it passes through, you wrap the two ends of the floss with your fingers as you would normally and work it along each side of the nearest implants.
You can also use pre-cut floss sections with stiffened ends to pass through the gap, or an oral irrigator that loosens and flushes away plaque with a pressurized water stream. Just be sure you flush debris away from the gum and not toward it.
Keeping all surfaces of your implant-supported bridgework clean of plaque is necessary for its longevity. Be sure you also visit your dentist regularly for more thorough cleanings.
A half million people are diagnosed every year with oral cancer. While other cancers are more prevalent, oral cancer is among the most dangerous with only a fifty percent five-year survival rate.
A major reason for this low rate is because this fast growing cancer is difficult to detect early — diagnosis comes far too often after the disease has already well advanced. In an effort to detect cancer earlier many dentists visually screen for oral abnormalities during checkups, especially patients over fifty, tobacco or heavy alcohol users, patients with a family history of cancer or a medical history of exposure to the sexually transmitted human papilloma virus, HPV-16.
If they detect an abnormality, the dentist often refers the patient to an oral surgeon or other specialist for a possible biopsy. In this procedure the surgeon removes a sample of the abnormal tissue, which is then examined microscopically for cancer cells. A biopsy remains the most effective way to diagnose oral cancer.
Because of the disease's aggressive nature, many dentists lean to the side of caution when referring patients for biopsy. As a result 90% of oral biopsies reveal no cancer. Reducing the number of biopsy referrals is highly desirable, especially for the patient undergoing the procedure. Tissue samples tend to be large to ensure complete detection of any cancer cells. Depending on the size and location of the sample, there may be a risk for loss of function or disfigurement.
A new screening tool using a sample of a patient's saliva could help reduce the number of biopsy referrals. Besides DNA, saliva also contains dormant genes called biomarkers that activate in response to the presence of a specific disease. This particular saliva test identifies those biomarkers for oral cancer if they're present.
A sample with a low score of biomarkers indicates no cancer present (with a statistical confidence of 99%). A medium or high score indicates cancer may be present, but only a biopsy can determine for sure. Using this test, dentists might be able to reduce the number of biopsy referrals and instead be able to employ watchful waiting in certain cases. Because of its simplicity and non-invasiveness, saliva screening could help identify oral cancer earlier.
Proactive dental care is an essential part of childhood growth. But that care can be much harder for children with chronic health issues than for healthier children.
“Chronic condition” is an umbrella term for any permanent and ongoing health issue. Asthma, Down’s syndrome, cystic fibrosis, congenital heart defects and many others fall under this umbrella, with varying symptoms and degrees of intensity. But they all have one common characteristic — a long-term effect on all aspects of a child’s health.
That includes the health of a child’s teeth and gums. Here, then, are a few areas where a chronic health condition could impact dental care and treatment.
Ineffective oral hygiene. Some chronic conditions like autism or hyperactivity disorder (ADHD) that affect behavior or cognitive skills can decrease a child’s ability or willingness to brush or floss; some conditions may also limit their physical ability to perform these tasks. Parents and caregivers may need to seek out tailored training for their child’s needs, or assist them on a regular basis.
Developmental defects. Children with chronic conditions are also more likely to have other developmental problems. For example, a child with Down, Treacher-Collins or Turner syndromes mayÂ be more likely to develop a birth defect called enamel hypoplasia in which not enough tooth enamel develops. Children with this defect must be monitored more closely and frequently for tooth decay.
Special diets and medications. A child with a chronic condition may need to eat different foods at different times as part of their treatment. But different dietary patterns like nutritional shakes or more frequent feedings to boost caloric intake can increase risk for tooth decay. Likewise, children on certain medications may develop lower saliva flow, leading to higher chance of disease. You’ll need to be more alert to the signs of tooth decay if your child is on such a diet or on certain medications, and they may need to see the dentist more often.
While many chronic conditions raise the risk of dental disease, that outcome isn’t inevitable. Working with your dentist and remaining vigilant with good hygiene practices, your special needs child can develop and maintain healthy teeth and gums.
If you would like more information on dental care for children with chronic health conditions, 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 “Managing Tooth Decay in Children with Chronic Diseases.”
Primary (baby) teeth might not last long, but their impact can last a lifetime. Their first set of teeth not only allows young children to eat solid foods, but also guide permanent teeth to form and erupt in the proper position.
Unfortunately, primary teeth aren't immune to tooth decay. If the decay is extensive, the tooth may not last as long as it should. Its absence will increase the chances the permanent teeth won't come in correctly, which could create a poor bite (malocclusion) that's costly to correct.
If a primary tooth is already missing, we can try to prevent a malocclusion by installing a “space appliance.” This keeps nearby teeth from drifting into the empty space intended for the permanent tooth. The best approach, though, is to try to save a primary tooth from premature loss.
We can often do this in much the same way as we would with a permanent tooth — by removing decayed material and filling the prepared space. We can also perform preventive applications like topical fluoride or sealants that strengthen or protect the tooth.
It becomes more complicated, though, if the pulp, the interior of the tooth, becomes decayed. The preferred treatment for this in a permanent adult tooth is a root canal treatment. But with a primary tooth we must also consider the permanent tooth forming below it in the jaw and its proximity to the primary tooth. We need to adapt our treatment for the least likely damage to the permanent tooth.
For example, it may be best to remove as much decayed structure as possible without entering the pulp and then apply an antibacterial agent to the area, a procedure known as an indirect pulp treatment. We might also remove only parts of the pulp, if we determine the rest of the pulp tissue appears healthy. We would then dress the wound and seal the tooth from further infection.
Whatever procedure we use will depend on the extent of decay. As we said before, our number one concern is the permanent tooth beneath the primary. By focusing on the health of both we can help make sure the permanent one comes in the right way.
If you would like more information on caring for children's primary teeth, 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 “Root Canal Treatment for Children's Teeth.”