Many people learn they have periodontal (gum) disease after noticing gum swelling, soreness or bleeding. But what you can see or feel may be only the tip of the iceberg — the damage may extend much deeper.

Gum disease is caused mainly by dental plaque, a thin film of bacteria and food particles built up on teeth due to ineffective brushing and flossing. Infection of the visible gums is only the beginning — left untreated, it can advance well below the gum line and even infect supporting bone.

One critical concern in this regard is the areas where the roots of a tooth separate from each other, known as furcations. Here an infection known as a furcation invasion can cause the bone to weaken and dissolve.

This usually occurs in stages (or classes) we can detect through manual probing and/or with x-rays. In the earliest stage, Class I, we might only notice a slight pocket in the gums with no significant bone loss. In Class II, though, the pocket between the roots has become a horizontal opening of two or more millimeters, indicating definite bone loss with increased pocket depth getting “under” the crown of the tooth. Class III, the last and most serious stage, describes an opening we can probe under the crown all the way to the other side of the tooth; the bone loss now extends “through and through” the furcation.

The basic goal of gum disease treatment is to remove plaque and calculus (tartar) from all tooth and gum surfaces. But removing plaque below the gum line, especially “into” the furcations, can be challenging. We will need instruments called scalers to clean root surfaces, assisted sometimes by ultrasonic equipment to vibrate plaque loose. With furcations we may also need to employ surgery to aid gum or bone tissue regeneration or to make the area easier to access for future cleaning.

Of course, the best way to protect against furcation invasions is to prevent gum disease in the first place. Be sure to brush and floss daily and visit us for thorough dental cleanings and checkups at least every six months.

And don’t delay contacting us if you see any signs of teeth or gum problems. The sooner we can identify gum disease, the more likely we’ll be able to prevent it from doing serious damage to your gums, bone and teeth.

If you would like more information on treating gum disease, 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 “What are Furcations?”

During your lifetime you’ll eat thousands of meals — and generate a lot of force from chewing over the years. But thanks to a support system of gum tissues and bone, your teeth can normally handle it.

What your teeth can’t handle, though, are higher than normal chewing forces on a continual basis. This can happen if you grind your teeth, which can produce 20-30 times the normal force. The habit often arises in adults because of high stress and often occurs during sleep.

These abnormal forces can stretch the periodontal ligaments that hold teeth in place, cause the teeth to become loose and at increased risk for loss. The best treatment strategy is to reduce clenching with, for example, muscle relaxants or anti-inflammatory drugs or lower the effects with a mouth guard that won’t allow the teeth to make solid contact during clenching.

Your teeth can also become loose even with normal chewing forces if you have advanced periodontal (gum) disease. Gum disease arises from dental plaque, a thin film of bacteria and food particles left on teeth due to poor oral hygiene. As it builds up, it causes inflammation of the gum tissues resulting in bone loss and causing the gums to detach from the teeth, increasing pocket depth.

Our first step in this case is to treat the gum disease by removing plaque and calculus (tartar) from all tooth and gum surfaces. This includes infected areas below the gum line and around the roots, a circumstance that could require surgical access.

As treatment progresses in either of these scenarios the gum tissues heal and often regain their attachment to the teeth. But that can take time, so we may need to stabilize any loose teeth in the short term. The most common way is to splint them to other secure teeth. This is done by using a clear acrylic bonding material to join the loose teeth together with a strip of metal or other rigid material (like joining pickets in a fence).

When symptoms arise, quick action is the key to preventing lost teeth. If you notice swollen, painful or bleeding gums or especially loose teeth, don’t delay — contact us so we can begin treatment as soon as possible.

If you would like more information on the causes and treatments for loose 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 “Loose Teeth.”

If you’re in the initial planning stages for a dental implant, you may already be encountering a number of options to consider. One that may come up is how the visible crown will attach to the metal implant imbedded in the bone.

Generally speaking, implants are composed of two parts: a metal post most often made of titanium placed into the bone that serves as the “root” for the new tooth; and a visible, life-like crown made of dental porcelain that attaches to an abutment on the titanium post. The crown can be attached in one of two ways: either with a small screw through the biting surface of the crown into a receiving hole in the abutment or cemented to it.

The major advantage of a screwed crown is that it allows for easy removal of the crown if needed. While the titanium post can often last a lifetime, porcelain crowns more often need repair or replacement since they receive the brunt of the biting forces in the mouth. A screw-attached crown is much easier to remove than a cemented one.

On the other hand, screwed crowns have a small access hole that must be restored with a tooth-colored filling to help the crown appear natural. This isn’t too great an issue with back teeth but does make achieving a natural appearance in the front more difficult. Cemented crowns look more like a natural tooth and are thus more flexible in achieving the desired appearance.

Besides the possibility the cement may cause gum inflammation or bone loss, the chief detraction from cemented crowns is the difficulty in removing them. Crowns are often damaged in this process so it’s highly likely it will have to be replaced rather than repaired. It’s possible to use weaker cement, but this raises the risk of the crown coming loose at some point from the abutment.

As we plan for your implant, we’ll discuss which type of attachment will work best for you, depending on the tooth to be replaced and other conditions with your oral health. The end result, though, should be the same — a new, natural-looking tooth that serves you well for many years to come.

If you would like more information on dental implants, 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 “How Crowns Attach to Implants.”