Gum therapy

Periodontal (gum) disease is a contiditon in which bacteria attack the tissues that surround and and support teeth. Simply put, it is an infection that can result in tooth loss if not treated. Because it is often painless, you may not be aware that you have a problem until your gums and bone are seriously affected. The good news is that periodontal diseases often can be treated in the early stages with a treatment called scaling and root planing.

The first line of defense is prevention. This includes a good oral hygiene routine at home. Brushing and cleaning between teeth once a day with floss or an interdental cleaner helps prevent plaque from accumulating. The dental office staff may provide instructions on additional cleaning methods or oral hygiene products to use at home.

Regular dental checkups and cleanings are important in preventing periodontal diseases. If these measures are not taken, the likelihood of disease increases. In some cases, even with these measures, a certain percentage of patients experience, some form of periodontal disease that must be treated.

When your dentist diagnoses periodontal disease, one of the treatments is scaling and root planning. Depending on the extent of the disease, your dentist may recommend that one or more sections (quadrants) of the mouth be treated. Treatment may require one or more visits.

Scaling is used to remove plaque and tartar beneath the gumline. A local anesthetic may be given to reduce any discomfort. Using a small scaler or ultrasonic cleaner, plaque and tartar are carefully removed down to the bottom of each periodontal pocket. The tooth's root surfaces are then smoothed or planed to allow the gum tissue to heal and reattach to the tooth.

Once the scaling and root planing treatment is complete, another appointment will be made so the dentist can check how your gums have healed an dhow the periodontal pockets have decreased. When pockets greater than 3 mm persist after root planning and scaling, additional treatment may be needed.

You'll be given instructions on how to care for your healing teeth and gums. Caring for your teeth and gums after treatment is critical. Practicing good oral hygiene every day will reduce the risk of recurring periodontal disease.

Periodontal disease will not go away by itself. Left untreated, surgery may be needed to save affected teeth. Preventing and treating the disease in the early stages are the best ways to keep your smile healthy.

If you've already lost a tooth to periodontal disease or other reasons, you may be interested in dental implants – the permanent tooth replacement option.
In addition to procedures to treat periodontal disease, many periodontists also perform cosmetic procedures to enhance your smile. Oftentimes, patients who pursue cosmetic procedures notice improved function as well.

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Pit & fissure sealants

Almost 9 out of every 10 cavities in children occur on the biting surfaces of the teeth. There are two reasons for this:

• fluoride is not very effective in these pit and fissure areas as it is on smooth surfaces, such as between the teeth;
• the grooves in some teeth are often so deep as to prevent the bristles of a brush from cleaning the area of food and bacteria.

Food and plaque gain access deep into the groove where a toothbrush bristle simply won't reach, and a cavity develops easily. The pit and fissure sealant is a bonded plastic that essentially "plugs up" the groove and therefore, prevents a cavity. The procedure is simple. No anesthetic or drilling is required and the cost is generally about 1/2 that of a silver filling. Research has demonstrated a retention rate of approximately 90% after 3 years.

Because permanent molars typically have the deepest grooves and the highest decay rates, these teeth are often treated with sealants. However, other teeth may be benefited by sealant also.

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Tooth extraction

Teeth are extracted for a variety of reasons:

• Decay has reached deep into the tooth
• Infection has destroyed a large portion of the tooth or surrounding bone
• There is not enough room for all the teeth in your mouth

Many dentists recommend extracting impacted teeth that are only partially erupted. Bacteria can enter around a partially erupted tooth and cause an infection, which can extend into the surrounding bone and become extremely serious. Impacted teeth continue trying to break through the gum tissue even if there is not enough room to accommodate them. The continued pressure caused by this attempted eruption can eventually damage the roots of nearby teeth. Removing a tooth that is impacted can often prevent infection, damage to adjacent teeth and bone, and save pain in the years to come.

Before a tooth is removed, your dentist will thoroughly review your medical and dental history and take the appropriate X-rays.

X-rays reveal the length, shape, and position of the tooth and surrounding bone. From this information, your dentist can estimate the degree of difficulty of the procedure and decide whether to refer you to a specialist called an oral surgeon.

Before removal, the area around your tooth will be anesthetized. Dentists use a local anesthetic to numb the area of the mouth where the extraction will take place.

For a simple extraction, once the area is anesthetized, the tooth is loosened with the help of a tool called an elevator, then extracted with dental forceps. Your dentist may also want to smooth and recontour the underlying bone. When he or she is finished, they may choose to close the area with a stitch.

It is critical to keep the area clean and prevent infection immediately following the removal of a tooth. Your dentist will ask you to bite down gently on a piece of dry, sterile gauze, which you must keep in place for up to 30 to 45 minutes to limit bleeding while clotting takes place. For the next 24 hours, you shouldn't smoke, rinse your mouth vigorously, or clean the teeth next to the extraction site.

A certain amount of pain and discomfort is to be expected following an extraction. In some cases, your dentist will recommend a pain killer or prescribe one for you. It may help to apply an ice pack to the face for 15 minutes at a time. You may also want to drink through a straw, limit strenuous activity, and avoid hot liquids. The day after the extraction, your dentist may suggest that you begin gently rinsing your mouth with warm salt water (do not swallow the water). Under normal circumstances, discomfort should lessen within three days to two weeks. If you have prolonged or severe pain, swelling, bleeding or fever, call your dentist at once.

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Regular dental checkup

A regular dental checkup is the most important thing you can do for your dental health, next to brushing and flossing. Check ups are not just to check for cavities and they are not just for kids. Checkups are about stopping or preventing a dental problem before it starts, and to make sure that the problems you have are not getting any worse.

The reason is simple; even if you brush and floss regularly you cannot see your mouth completely. For example there are some things, which you cannot see but your dentist can:

• Fillings, crown and other restorations, which are no longer in good shape
• Root cavities or the cavities, which are formed when gums pull away from teeth
• Cavities around your fillings
• Tiny cracks in teeth
• Wisdom or other teeth that are trapped in bone/gums
• Early sign of gum disease
• Early signs of oral cancer
• Early diagnosis of any orthodontic problem

Target is to catch any problem as early as possible.

A check-up can include some or all of the following:

Dental and medical history

Let your dentist know about any medical or dental problems which you may have.

Tell your dentist:

• About any change in your teeth such as in colors, looseness or position
• If your teeth or gums are getting more sensitive to heat, cold or sweets
• About any change in your gums like change in colors, tenderness or bleeding when you brush or floss
• If your floss catches on rough edges of teeth and shreds
• Any changes in the skin (color, texture) inside of your mouth
• Any pain in your Jaw joint or any tension in your jaw muscles
• You should also tell your dentist if you smoke, if you have any allergy, if you are pregnant etc.

Visual oral examination

Your dentist looks for gum disease, cavities, loose fillings, broken teeth, infections or signs for oral cancer. Many small problems can be treated right away while other problems can be stopped before they get big.

Radiographic examination (X-Rays)

Your dentist will take X-rays only if you need them, he will see the following:

• Cavities between teeth , under the gum and around old fillings
• Bone loss cause by gum disease
• Teeth trapped in gums
• If there is any problem around the root of the tooth.

Advice

When your dentist is finished examining he/she will tell you in detail the problems their treatment and how to prevent any of them in future.

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Fluoride treatments

A fluoride treatment is a mineral solution applied to teeth in order to strengthen them and help prevent cavities. Fluoride containing products include commercially available toothpaste and mouth rinse.

A dentist in his or her office can also apply fluoride to the teeth as a gel, foam, or varnish. These treatments contain a much higher level of fluoride than the amount found in toothpastes and mouth rinses and require a doctor's prescription. Varnishes are painted on the teeth; foams are put into a mouth guard, which is applied to the teeth for 1 to 4 minutes; gels can be painted on or applied via a mouth guard.
Fluoride supplements are also available as liquids and tablets and must be prescribed by your dentist, pediatrician or family doctor.

There are three primary factors that contribute to dental caries (tooth decay): a susceptible site on a tooth, an infective strain of bacteria (Streptococcus mutans), and sugars or other nutrients that stimulate the bacteria's growth. As these bacteria grow, they produce an acidic byproduct that can dissolve the minerals in the enamel and eventually destroy the tooth.

It is certainly important for infants and children between the ages of 6 months and 16 years to be exposed to fluoride. These are the timeframes during which the primary and permanent teeth come in. However, adults benefit from fluoride too. New research indicates that topical fluoride - from toothpastes, mouth rinses, and fluoride treatments - are as important in fighting tooth decay as in strengthening developing teeth.

In addition, people with certain conditions may be at increased risk of tooth decay and would therefore benefit from additional fluoride treatment. They include people with:

• Dry mouth conditions : Dry mouth caused by diseases such as Sjögren's syndrome, certain medications (such as allergy medications, antihistamines, anti-anxiety drugs, and antihypertensives) and head and neck radiation treatment makes an individual more prone to tooth decay. The lack of saliva makes it harder for food particles to be washed away and acids to be neutralized.
• Gum disease: Also called gingivitis, gum disease can expose more of your tooth and tooth roots to bacteria increasing the chance of tooth decay.
• History of frequent cavities: If you have one cavity every year or every other year, you might benefit from additional fluoride.
• Presence of crowns and/or bridges or braces: These treatments can put teeth at risk for decay at the point where the crown meets the underlying tooth structure or around the brackets of orthodontic appliances.

Ask your dentist if you could benefit from additional fluoride.

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Dental sealants

Almost 9 out of every 10 cavities in children occur on the biting surfaces of the teeth. There are two reasons for this:

• fluoride is not very effective in these pit and fissure areas as it is on smooth surfaces, such as between the teeth;
• the grooves in some teeth are often so deep as to prevent the bristles of a brush from cleaning the area of food and bacteria.

Food and plaque gain access deep into the groove where a toothbrush bristle simply won't reach, and a cavity develops easily. The pit and fissure sealant is a bonded plastic that essentially "plugs up" the groove and therefore, prevents a cavity. The procedure is simple. No anesthetic or drilling is required and the cost is generally about 1/2 that of a silver filling. Research has demonstrated a retention rate of approximately 90% after 3 years.

Because permanent molars typically have the deepest grooves and the highest decay rates, these teeth are often treated with sealants. However, other teeth may be benefited by sealant also.

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Space maintainers

A space maintainer is a removable or fixed appliance designed to maintain an existing space. They are usually fitted in children when they have lost baby teeth early because the gap left from losing this tooth needs to be held open for the permanent tooth to erupt in the correct position.
A baby tooth is sometimes lost prematurely because of tooth decay or injury. If this occurs before the permanent tooth is ready to erupt the nearby teeth can shift or drift into the space where the primary tooth use to be creating a lack of space in the jaw for the permanent teeth. The teeth in the other jaw may also move up or down to fill in the gap, and if this crowding happens there may not be enough room for the new tooth to come in correctly, so it emerges lopsided or is not able to erupt at all.

Deciding to not place a space maintainer to save this space may cause a crowding condition which can make it more difficult:

• To clean the teeth thus increasing your child's risk for tooth decay
• Make chewing difficult causing these teeth to wear down more quickly
• If left untreated, this condition may result in extensive orthodontic treatment

A space maintainer is important to hold or keep this space open for the permanent teeth and to help guide them into position. Surprisingly some baby teeth are not replaced by adult teeth until a child reaches 12 or 14 years old.

The space maintainer is a small metal device that is custom fitted to your child's mouth. It is firmly fixed in the mouth and will be removed when the permanent tooth is in it's proper position.
It may consist of a band attached to the tooth on one side of the space with a wire loop or spring bridging the gap to the tooth on the other side. They steady the remaining teeth, preventing movement until the permanent tooth takes it's natural position.

How the procedure is done:

1. A mold of your child's mouth is taken at one appointment
2. The mold is sent to a laboratory that makes the space maintainer
3. At the second appointment the metal band is placed around the tooth that is behind the missing one
4. Next a loop or brace is placed that goes over the gum where the missing tooth was and rests against the tooth in front of this space
5. When the band is cemented on the tooth, it prevents the teeth from moving into the space where the missing tooth was and allows the adult tooth enough space to grow into the proper position

Benefits of this procedure:

• May reduce or eliminate the need for braces
• Eat comfortably
• Save space for proper eruption of adult teeth

Care of Space Maintainers

To avoid the cost and time of replacement, please:

• Avoid sticky sweets, popcorn, ice and or chewing gum
• Don't tug or push on the space maintainer with your fingers or tongue
• Keep it clean with brushing and flossing
• At night carefully clean around all wires, bands and other areas of the appliance, as it tends to trap food
• After cleaning, please inspect the appliance carefully for damage
• Keep your 6 month check up appointments to monitor oral health and to evaluate the space maintainer to determine when it needs to be removed

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Hygiene instruction and continuing care visits

The first line of defense is prevention. This includes a good oral hygiene routine at home. Brushing and cleaning between teeth once a day with floss or an interdental cleaner helps prevent plaque from accumulating. The dental office staff may provide instructions on additional cleaning methods or oral hygiene products to use at home, as well as answering all of your questions about your oral care.

Practicing good oral hygiene every day will reduce the risk of recurring oral disease.

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Coordination of Orthodontic referral and treatment

Most dentists are trained to treat some minor orthodontic problems. If the dentist thinks the patient should see a specialist for treatment, he or she will provide a referral to an orthodontist. Orthodontics is a specialty area of dentistry that is officially known as Orthodontics and Dentofacial Orthopedics.
The purpose of orthodontics is to treat malocclusion through braces, corrective procedures and other “appliances” to straighten teeth and correct jaw alignment. An orthodontist is a dentist who specializes in the diagnosis, prevention, and treatment of dental and facial irregularities.

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TMJ Treatment

TMJ syndrome is a condition that occurs when the temporomandibular joint (TMJ) that connects the upper and lower jaw is misaligned or stressed. This can cause pain in the jaw, the face, and in extreme cases, the neck and shoulders. The causes of TMJ syndrome require careful analysis. Once the causes have been determined, there are a multitude of TMJ treatment options available from dentists, including pain relief through the application of mouth guards, bite therapy, and TMJ exercises.

TMJ treatment, referred to by some dentists as TMJ therapy, includes many options. The first step is to relieve the pain with the application of mouth guards, also known as dental splints. The next step in TMJ treatment is to apply bite therapy principles and tools to analyze the cause of the misalignment or stress that is causing the problem. If necessary, a routine of jaw exercises will be created to eliminate the clenching or grinding that is contributing to the stress on the lower jaw.

TMJ Mouth Guards for Pain Relief

TMJ mouth guards are soft plastic protectors that slip over the upper and lower teeth to prevent grinding of the teeth. Guards make it more difficult to clench the jaws, an important first step in TMJ pain relief. Your dentist will take a mold of your upper and lower teeth to custom-fit your TMJ mouth guards for maximum comfort and efficiency.

Jaw Exercises for TMJ

TMJ exercises are designed to relax the jaw and eliminate clenching, and also to help in the correction of alignment problems. After careful analysis, your dentist may provide you with an appropriate series of very simple exercises to be performed in front of a mirror. The use of a mirror in TMJ exercises helps you see the misalignment that is one of the factors in TMJ syndrome. Gradually, the exercises will teach you control of the jaw muscles and eliminate clenching.

TMJ Bite Therapy

A process known as TMJ therapy, or bite therapy, is used by dentists to help find the causes of TMJ syndrome and provide long-term pain relief. TMJ bite treatment begins with a careful, detailed analysis of your mouth and jaw to find the causes of your disorder. For some, the issue may be jaw clenching; this can usually be attributed to stress or simply a bad habit. For others, the teeth may not come together evenly, a condition known as malocclusion. This can cause uneven use of the jaw and result in muscle pain. Dentists have several tools at their disposal to measure bite pressure throughout the mouth and formulate a plan for dental work that will correct malocclusion and provide TMJ pain relief.

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