My Blog
By Daysy Pinero, DMD.
February 22, 2018
Category: Oral Health
Tags: gum disease  
AssessingYourRiskforSevereGumDisease

We’re all susceptible to gum disease when we fail to practice effective daily brushing and flossing. But you may have a greater risk of gum disease (and more severe forms of it) if any of the following categories pertain to you:

Aging. Gum disease risk naturally increases with age. We can lower the risk with an effective daily hygiene regimen, along with a minimum of two office cleanings and checkups each year. Brushing and flossing removes bacterial plaque and food particles which accumulate on tooth surfaces. The longer plaque remains in contact with gum tissues, the greater the chances of infection.

Pregnancy. Although women tend to take better care of their teeth than men, they still face unique issues that increase their risk. During pregnancy, for example, certain hormone levels rise, which cause the gums to become more responsive to bacteria. Other hormonal fluctuations throughout a woman’s life, including taking certain drugs for birth control or during menopause, can cause similar situations.

Family History. You could be at higher risk if members of your immediate family have a history of gum disease. Researchers estimate that 30% of the U.S. population has a genetic predisposition to the disease; it’s also possible for family members to transfer bacteria to other family members by way of saliva contact or shared eating utensils.

Smoking. Nicotine, the active ingredient in tobacco smoke, causes changes in the blood vessels of the mouth that could inhibit the flow of antibodies (produced by the body to fight infection) in the bloodstream. As a result, smokers experience more rapid disease development and greater detachment between teeth and gums than non-smokers.

Other Inflammatory Conditions. A number of studies indicate people with other inflammatory conditions like heart disease, arthritis or diabetes have a higher risk for gum disease. Some researchers have even suggested that bacteria associated with gum disease pass into the blood stream and threaten other parts of the body — an added incentive to seek treatment and stop the disease’s advancement.

If you fall into any of these risk categories, it’s even more urgent that you practice effective daily hygiene with regular office checkups. Additionally, if you begin to notice bleeding gums, tenderness and swelling, or loose teeth, contact us as soon as possible for an evaluation.

If you would like more information on the diagnosis and treatment of 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 “Assessing Risk for Gum Disease.”

TreatingGumDiseaseImportanttoSavingtheUnderlyingBone

If you've had periodontal (gum) disease, you've no doubt experienced gum inflammation, bleeding or pain. But your gums may not be the only mouth structures under assault — the disease may be damaging the underlying support bone.

Although easing soft tissue symptoms is important, our primary focus is to protect all your teeth's supporting structures — the gums, the attaching ligaments and, of course, the bone. To do so we must stop the infection and reduce the risk of reoccurrence.

Stopping gum disease depends on removing its source — plaque, a thin biofilm of bacteria and food particles accumulating on tooth surfaces, due to poor oral hygiene. We must remove it mechanically — with hand instruments known as scalers or ultrasonic equipment that vibrates the plaque and calculus (hardened plaque deposits) loose.

It's not always a straightforward matter, though, especially if the diseased gum tissues have pulled away from the teeth. The slight natural gap between teeth can widen into voids known as periodontal pockets; they fill with infection and can extend several millimeters below the gum line. We must thoroughly cleanse these pockets, sometimes with invasive techniques like root planing (removing plaque from the roots) or surgical access. You may also need tissue grafting to regenerate gum attachment to the teeth.

One of the more difficult scenarios involves pockets where roots divide, known as furcations. This can cause cave-like voids of bone loss. Unless we treat it, the continuing bone loss will eventually lead to tooth loss. Besides plaque removal, it may also be prudent in these cases to use antimicrobial products (such as a mouthrinse with chlorhexidine) or antibiotics like tetracycline to reduce bacterial growth.

Perhaps the most important factor is what happens after treatment. To maintain gum health and reduce the chances of re-infection, you'll need to practice diligent daily hygiene, including brushing, flossing and any prescribed rinses. You should also keep up a regular schedule of office cleanings and checkups, sometimes more than twice a year depending on your degree of disease.

If you would like more information on treatments for 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 “Treating Difficult Areas of Periodontal Disease.”

ANo-PrepVeneerCouldEliminatetheNeedtoRemoveToothEnamel

Porcelain veneers are one of the best ways to transform your teeth’s appearance with only a small amount of tooth preparation. But even that small amount could leave a veneered tooth permanently altered.

As the name implies, veneers are thin layers of custom-designed porcelain bonded to the outside of a tooth to cover defects. They’re usually ideal for minor chipping, staining or even slight tooth misalignments. But although they’re thin—often just a millimeter or so in thickness—they can still make a tooth appear or feel bulky.

To reduce this extra width, we usually need to remove some of the tooth’s surface enamel. Since enamel doesn’t replenish itself, this alteration could mean the tooth will require a restoration from then on.

But now, you may be able to take advantage of new advances in this popular restoration: No-Prep or Minimal Prep veneers that involve little to no tooth alteration. In most cases they’re simply bonded to the teeth with only slight enamel reshaping.

Because of their ultra-thinness, No-Prep veneers (usually between 0.3 to 0.5 mm, as thin as a contact lens) are bonded directly to teeth that are practically untouched beforehand. A Minimal Prep veneer usually requires only enamel reshaping with an abrasive tool before it’s placed. And unlike traditional veneers, they can often be removed if needed to return the teeth to their original form without another restoration.

These new veneers are best for people with small teeth, often from wear due to teeth grinding, narrow smiles (the side teeth aren’t visible while smiling), or slightly misshapen teeth like underdeveloped teeth that can appear peg-shaped. But people with oversized teeth, some malocclusions (bad bites) or similar dental situations may still require enamel removal to avoid bulkiness even with ultra-thin veneers.

If you don’t have those kinds of issues and your teeth are reasonably healthy, we can apply No-Prep or Minimal Prep veneers in as few as two appointments. The result could be life-changing as you gain a new smile you’re more than happy to share.

If you would like more information on no-prep veneers, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor article “No-Prep Porcelain Veneers.”

ARetainer-LikeDevicecanPreservetheSpaceLeftbyaLostPrimaryTooth

Children losing their primary (“baby”) teeth is both natural and necessary. So, is it really that much of a concern if they lose one early?

The answer is yes — premature primary tooth loss could have long-term consequences for the permanent teeth as they develop within the jaw before eruption. Primary teeth play a crucial role in this development: as the permanent teeth form and grow the primary teeth serve as placeholders until they’re ready to erupt. A natural process then takes place in which the primary tooth’s roots dissolve (resorb) to allow them to fall out. Once they’re out of the way, the permanent teeth can then erupt.

If, however, they’re lost before the permanent teeth are ready, it leaves a space in the child’s bite. The dynamic mechanism between teeth and the periodontal ligament causes adjacent teeth to move or “drift” into the space. This can crowd out the permanent tooth intended for the space, causing it to come in improperly forming a malocclusion (bad bite), or it may become impacted and remain partially or fully below the surface of the gums.

This poor dental development could lead to extensive orthodontic treatment later in life, which is why we seek to preserve even decayed primary teeth for their entire natural lifespan. If the tooth is lost, however, we need to take action to preserve the space for the permanent tooth and avoid costly treatment later.

This usually calls for a “space maintenance” appliance — a type of orthodontic “retainer” — worn by the child to prevent other teeth from drifting into the space. Designed by your orthodontist, the appliance can also perform a cosmetic and social function by causing the space to appear unnoticeable.

Maintaining that space requires monitoring — especially by an orthodontist — and continued dental hygiene and care both at home and at the dentist’s office. The extra care preserving the space caused by premature tooth loss will help to ensure your child’s dental structure develops properly and their future smile will be an attractive one.

If you would like more information on the care and treatment of 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 articles “Early Loss of Baby Teeth” and “Losing a Baby Tooth.”

By Daysy Pinero, DMD.
January 28, 2018
Category: Dental Procedures
Tags: gum disease  
GumInfectionAroundToothRootsCallsforImmediateAction

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?





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