Periodontal disease, which is also known as gum disease and periodontitis, is a progressive disease which, if left untreated, may result in tooth loss.  Gum disease begins with the inflammation and irritation of the gingival tissues which surround and support the teeth.  The cause of this inflammation is the toxins found in plaque which cause an ongoing bacterial infection.

The bacterial infection colonizes in the gingival tissue, and deep pockets form between the teeth and the gums.  If treated promptly by a periodontist, the effects of mild inflammation (known as gingivitis) are completely reversible.  However, if the bacterial infection is allowed to progress, periodontal disease begins to destroy the gums and the underlying jawbone, promoting tooth loss.  In some cases, the bacteria from this infection can travel to other areas of the body via the bloodstream.

Common Causes of Gum Disease

There are genetic and environmental factors involved in the onset of gum disease, and in many cases, the risk of developing periodontitis can be significantly lowered by taking preventative measures.

Here are some of the most common causes of gum disease:

• Poor dental hygiene – Preventing dental disease starts at home with good oral hygiene and a balanced diet.  Prevention also includes regular dental visits which include exams, cleanings, and x-rays.  A combination of excellent home care and professional dental care will preserve the natural dentition and support of bony structures.  When bacteria and calculus (tartar) are not removed, the gums and bone around the teeth become affected by bacterial toxins and can cause gingivitis or periodontitis, which ultimately lead to tooth loss.
• Tobacco use – Research has indicated that smoking and tobacco use are some of the most significant factors in the development and progression of gum disease.  In addition to smokers experiencing a slower recovery and healing rate, smokers are far more likely to suffer from calculus (tartar) build-up on teeth, deep pockets in the gingival tissue, and significant bone loss.
• Genetic predisposition – Despite practicing rigorous oral hygiene routines, as much as 30% of the population may have a strong genetic predisposition to gum disease.  These individuals are six times more likely to develop periodontal disease than individuals with no genetic predisposition.  Genetic tests can be used to determine susceptibility and early intervention can be performed to keep the oral cavity healthy.
• Pregnancy and menopause – During pregnancy, regular brushing and flossing is critical. Hormonal changes experienced by the body can cause the gum tissue to become more sensitive, rendering them more susceptible to gum disease.
• Chronic stress and poor diet – Stress lowers the ability of the immune system to fight off disease which means bacterial infection can beat the body’s defense system.  Poor diet or malnutrition can also lower the body’s ability to fight periodontal infections, as well as negatively affecting the health of the gums.
• Diabetes and underlying medical issues – Many medical conditions can intensify or accelerate the onset and progression of gum disease including respiratory disease, heart disease, arthritis and osteoporosis.  Diabetes hinders the body’s ability to utilize insulin which makes the bacterial infection in the gums more difficult to control and cure.
• Grinding teeth – The clenching or grinding of teeth can significantly damage the supporting tissue surrounding the teeth.  Grinding one’s teeth is usually associated with a “bad bite” or the misalignment of the teeth.  When an individual is suffering from gum disease, the additional destruction of gingival tissue due to grinding can accelerate the progression of the disease.
• Medication – Many drugs including oral contraceptive pills, heart medicines, anti-depressants, and steroids affect the overall condition of teeth and gums, making them more susceptible to gum disease.  Steroid use promotes gingival overgrowth, which makes swelling more commonplace and allows bacteria to colonize more readily in the gum tissue.

Treatment of Gum Disease

Periodontists specialize in the treatment of gum disease and the placement of dental implants.  A periodontist can perform effective cleaning procedures in deep pockets such as scaling and root planing; they can also prescribe antibiotic and antifungal medications to treat infection and halt the progression of the disease.

In the case of tooth loss, the periodontist is able to perform tissue grafts to promote natural tissue regeneration, and insert dental implants if a tooth or several teeth are missing.  Where gum recession causes a “toothy” looking smile, the periodontist can recontour the gingival tissue to create an even and aesthetically pleasing appearance.

Preventing periodontal disease is critical in preserving the natural dentition.  Addressing the causes of gum disease and discussing them with your dentist will help prevent the onset, progression, and recurrence of periodontal disease.

If you have any questions or concerns about the causes or treatments pertaining to gum disease, please ask your dentist.

The term “periodontal”means “around the tooth.”  Periodontal disease (also known as periodontitis and gum disease) is a common inflammatory condition which affects the supporting and surrounding soft tissues of the tooth; also the jawbone itself when in its most advanced stages.

Periodontal disease is most often preceded by gingivitis which is a bacterial infection of the gum tissue.  A bacterial infection affects the gums when the toxins contained in plaque begin to irritate and inflame the gum tissues.  Once this bacterial infection colonizes in the gum pockets between the teeth, it becomes much more difficult to remove and treat.  Periodontal disease is a progressive condition that eventually leads to the destruction of the connective tissue and jawbone.  If left untreated, it can lead to shifting teeth, loose teeth and eventually tooth loss.

Periodontal disease is the leading cause of tooth loss among adults in the developed world and should always be promptly treated.

Treatment for Periodontal Disease

There are many surgical and nonsurgical treatments the periodontist may choose to perform, depending upon the exact condition of the teeth, gums and jawbone.  A complete periodontal exam of the mouth will be done before any treatment is performed or recommended.

Here are some of the more common treatments for periodontal disease:

• Scaling and root planing – In order to preserve the health of the gum tissue, the bacteria and calculus (tartar) which initially caused the infection, must be removed.  The gum pockets will be cleaned and treated with antibiotics as necessary to help alleviate the infection.  A prescription mouthwash may be incorporated into daily cleaning routines.
• Tissue regeneration – When the bone and gum tissues have been destroyed, regrowth can be actively encouraged using grafting procedures.
  A membrane may be inserted into the affected areas to assist in the regeneration process.
• Pocket elimination surgery – Pocket elimination surgery (also known as flap surgery) is a surgical treatment which can be performed to reduce the pocket size between the teeth and gums.  Surgery on the jawbone is another option which serves to eliminate indentations in the bone which foster the colonization of bacteria.
• Dental implants – When teeth have been lost due to periodontal disease, the aesthetics and functionality of the mouth can be restored by implanting prosthetic teeth into the jawbone.  Tissue regeneration procedures may be required prior to the placement of a dental implant in order to strengthen the bone.

Ask your dentist if you have questions or concerns about periodontal disease, periodontal treatment, or dental implants.

Periodontal treatment methods depend upon the type and severity of the disease.  Your dentist and dental hygienist will evaluate for periodontal disease and recommend the appropriate treatment.

Periodontal disease progresses as the sulcus (pocket or space) between the tooth and gums gets filled with bacteria, plaque, and tartar, causing irritation to the surrounding tissues.  When these irritants remain in the pocket space, they can cause damage to the gums and eventually, the bone that supports the teeth!

If the disease is caught in the early stages of gingivitis, and no damage has been done, one to two regular cleanings will be recommended.  You will also be given instructions on improving your daily oral hygiene habits and having regular dental cleanings.

If the disease has progressed to more advanced stages, a special periodontal cleaning called scaling and root planing (deep cleaning) will be recommended.  It is usually done one quadrant of the mouth at a time while the area is numb.  In this procedure, tartar, plaque, and toxins are removed from above and below the gum line (scaling) and rough spots on root surfaces are made smooth (planing).  This procedure helps gum tissue to heal and pockets to shrink.  Medications, special medicated mouth rinses, and an electric tooth brush may be recommended to help control infection and healing.

If the pockets do not heal after scaling and root planing, periodontal surgery may be needed to reduce pocket depths, making teeth easier to clean.  Your dentist may also recommend that you see a Periodontist (specialist of the gums and supporting bone).

The objective of scaling & root planning is to remove etiologic agents which cause inflammation to the gingival (gum) tissue and surrounding bone.  Common etiologic agents removed by this conventional periodontal therapy include dental plaque and tartar (calculus).

These non-surgical procedures which completely cleanse the periodontium, work very effectively for individuals suffering from gingivitis (mild gum inflammation) and moderate/severe periodontal disease.

Reasons for scaling and root planing

Scaling and root planning can be used both as a preventative measure and as a stand-alone treatment.  These procedures are performed as a preventative measure for a periodontitis sufferer.

Here are some reasons why these dental procedures may be necessary:

• Disease prevention – The oral bacteria which cause periodontal infections can travel via the bloodstream to other parts of the body.  Research has shown that lung infections and heart disease have been linked to periodontal bacteria.  Scaling and root planing remove bacteria and halts periodontal disease from progressing, thus preventing the bacteria from traveling to other parts of the body.
• Tooth protection – When gum pockets exceed 3mm in depth, there is a greater risk of periodontal disease.  As pockets deepen, they tend to house more colonies of dangerous bacteria.  Eventually, a chronic inflammatory response by the body begins to destroy gingival and bone tissue which may lead to tooth loss.  Periodontal disease is the number one cause of tooth loss in the developed world.
• Aesthetic effects – Scaling and root planing help remove tartar and plaque from the teeth and below the gumline.  As an added bonus, if superficial stains are present on the teeth, they will be removed in the process of the scaling and root planning procedure.
• Better breath – One of the most common signs of periodontal disease is halitosis (bad breath).  Food particles and bacteria can cause a persistent bad odor in the oral cavity which is alleviated with cleaning procedures such as scaling and root planing.

What do scaling and root planing treatments involve?

Scaling and root planing treatments are only performed after a thorough examination of the mouth.  The dentist will take X-rays, conduct visual examinations and make a diagnosis before recommending or beginning these procedures.

Depending on the current condition of the gums, the amount of calculus (tartar) present, the depth of the pockets and the progression of the periodontitis, local anesthetic may be used.

Scaling – This procedure is usually performed with special dental instruments and may include an ultrasonic scaling tool.  The scaling tool removes calculus and plaque from the surface of the crown and root surfaces.  In many cases, the scaling tool includes an irrigation process that can also be used to deliver an antimicrobial agent below the gums that can help reduce oral bacteria.

Root Planing – This procedure is a specific treatment which serves to remove cementum and surface dentin that is embedded with unwanted microorganisms, toxins and tartar.  The root of the tooth is literally smoothed in order to promote good healing. Having clean, smooth root surfaces helps bacteria from easily colonizing in future.

Following these deep cleaning procedures, the gum pockets may be treated with antibiotics.  This will soothe irritation and help the gum tissues to heal quickly.

During the next appointment, the dentist or hygienist will thoroughly examine the gums again to see how well the pockets have healed.  If the gum pockets still measure more than 3mm in depth, additional and more intensive treatments may be recommended.

If you have any concerns or questions about scaling and root planing, or periodontal disease, please ask your dentist.

It only takes twenty four hours for plaque that is not removed from your teeth to turn into calculus (tartar)!  Daily home cleaning helps control plaque and tartar formation, but those hard to reach areas will always need special attention.

Once your periodontal treatment has been completed, your dentist and dental hygienist will recommend that you have regular maintenance cleanings (periodontal cleanings).  At these cleaning appointments, the pocket depths will be carefully checked to ensure that they are healthy.  Plaque and calculus that is difficult for you to remove on a daily basis will be removed from above and below the gum line.

Good oral hygiene practices and periodontal cleanings are essential in maintaining dental health and keeping periodontal disease under control!

A composite (tooth colored) filling is used to repair a tooth that is affected by decay, cracks, fractures, etc.  The decayed or affected portion of the tooth will be removed and then filled with a composite filling.

There are many types of filling materials available, each with their own advantages and disadvantages.  You and your dentist can discuss the best options for restoring your teeth. Composite fillings are the most widely used filling material today, because they are mercury free and they are tooth colored, so they can be closely matched to the color of existing teeth, to achieve aesthetically pleasing results.

As with most dental restorations, composite fillings are not permanent and may someday have to be replaced.  They are very durable, and will last many years, giving you a long lasting, beautiful smile.

Reasons for composite fillings:

• Chipped teeth.
• Closing space between two teeth.
• Cracked or broken teeth.
• Decayed teeth.
• Worn teeth.

It is normal to experience sensitivity to hot and cold when composite fillings are first placed, however this will subside shortly after your tooth acclimates to the new filling.

You will be given care instructions at the conclusion of your treatment.  Good oral hygiene practices, eating habits, and regular dental visits will aid in the life of your new fillings.

An inlay restoration is a custom made filling made of composite material, gold, or tooth-colored porcelain.  It is made by a professional dental laboratory and is permanently cemented into the tooth by your dentist.

Inlays can be utilized to conservatively repair teeth that have large defective fillings or have been damaged by decay or trauma.  Inlays are an ideal alternative to conventional silver and composite fillings.  Also, they are more conservative than crowns because less tooth structure is removed in the preparation of inlays.

As with most dental restorations, inlays are not always permanent and may someday require replacement.  They are highly durable and will last many years, giving you a beautiful long lasting smile.

Reasons for inlay restorations:

• Broken or fractured teeth.
• Cosmetic enhancement.
• Decayed teeth.
• Fractured fillings.
• Large fillings.

What does getting an inlay involve?

An inlay procedure usually requires two appointments.  Your first appointment will include taking several highly accurate impressions (molds) that will be used to create your custom inlay and a temporary restoration.

While the tooth is numb, the dentist will remove any decay and/or old filling materials.  The space will then be thoroughly cleaned and carefully prepared, shaping the surface to properly fit an inlay restoration.  A temporary filling will be applied to protect the tooth while your inlay is made by a dental laboratory.

At your second appointment your new inlay will be carefully and precisely cemented into place.  A few adjustments may be necessary to ensure a proper fit and that your bite is comfortable.

You will receive care instruction at the conclusion of your treatment.  Good oral hygiene practices, a proper diet, and regular dental visits will aid in the life of your new inlay.

An onlay restoration is a custom made filling made of composite material, gold, or tooth-colored porcelain.  An onlay is sometimes also referred to as a partial crown.  It is made by a professional dental laboratory and is permanently cemented onto the tooth by your dentist.

Onlays can be utilized to conservatively repair teeth that have large defective fillings or have been damaged by decay or trauma.  Onlays are an ideal alternative to crowns (caps) because less tooth structure is removed in the preparation of onlays.  Onlays are essentially identical to inlays with the exception that one or more of the chewing cusps have also been affected and need to be included in the restoration.

As with most dental restorations, onlays are not always permanent and may someday require replacement.  They are highly durable and will last many years, giving you a beautiful long lasting smile.

Reasons for onlay restorations:

• Broken or fractured teeth.
• Cosmetic enhancement.
• Decayed teeth.
• Fractured fillings.
• Large fillings.

What does getting an onlay involve?

An onlay procedure usually requires two appointments.  Your first appointment will include taking several highly accurate impressions (molds) that will be used to create your custom onlay and a temporary restoration.

While the tooth is numb, the dentist will remove any decay and/or old filling materials.  The space will then be thoroughly cleaned and carefully prepared, shaping the surface to properly fit an onlay restoration.  A temporary filling will be applied to protect the tooth while your onlay is made by a dental laboratory.

At your second appointment, your new onlay will be carefully and precisely cemented into place.  A few adjustments may be necessary to ensure a proper fit and that your bite is comfortable.

You will receive care instruction at the conclusion of your treatment.  Good oral hygiene practices, a proper diet, and regular dental visits will aid in the life of your new onlay.

A crown (or cap) is a covering that encases the entire tooth surface restoring it to its original shape and size.  A crown protects and strengthens tooth structure that cannot be restored with fillings or other types of restorations.

Although there are several types of crowns, porcelain (tooth colored crown) are the most popular.  They are highly durable and will last many years, but like most dental restorations, they may eventually need to be replaced.  Porcelain crowns are made to match the shape, size, and color or your teeth giving you a natural, long-lasting beautiful smile.

Reasons for crowns:

• Broken or fractured teeth.
• Cosmetic enhancement.
• Decayed teeth.
• Fractured fillings.
• Large fillings.
• Tooth has a root canal.

What does getting a crown involve?

A crown procedure usually requires two appointments.  Your first appointment will include taking several highly accurate molds (or impressions) that will be used to create your custom crown.  A mold will also be used to create a temporary crown which will stay on your tooth for approximately two weeks until your new crown is fabricated by a dental laboratory.

While the tooth is numb, the dentist will prepare the tooth by removing any decay and shaping the surface to properly fit the crown.  Once these details are accomplished, your temporary crown will be placed with temporary cement and your bite will be checked to ensure you are biting properly.

At your second appointment your temporary crown will be removed, the tooth will be cleaned, and your new crown will be carefully placed to ensure the spacing and bite are accurate.

You will be given care instructions and encouraged to have regular dental visits to check your new crown.

A denture is a removable dental appliance replacement for missing teeth and surrounding tissue.  They are made to closely resemble your natural teeth and may even enhance your smile.

There are two types of dentures – complete and partial dentures.  Complete dentures are used when all of the teeth are missing, while partial dentures are used when some natural teeth remain.  A Partial denture not only fills in the spaces created by missing teeth, it prevents other teeth from shifting.

A Complete denture may be either “conventional” or “immediate.”  A conventional type is made after the teeth have been removed and the gum tissue has healed, usually taking 4 to 6 weeks.  During this time the patient will go without teeth.  Immediate dentures are made in advance and immediately placed after the teeth are removed, thus preventing the patient from having to be without teeth during the healing process.  Once the tissues shrink and heal, adjustments and a new more definitive denture will have to be made.

Dentures are very durable appliances and will last many years, but may have to be remade, repaired, or readjusted due to normal wear.

Reasons for dentures:

• Complete Denture – Loss of all teeth in an arch.
• Partial Denture – Loss of several teeth in an arch.
• Enhancing smile and facial tissues.
• Improving chewing, speech, and digestion.

What does getting dentures involve?

The process of getting dentures requires several appointments, usually over several weeks.  Highly accurate impressions (molds) and measurements are taken and used to create your custom denture.  Several “try-in” appointments may be necessary to ensure proper shape, color, and fit.  At the final appointment, your dentist will precisely adjust and place the completed denture, ensuring a natural and comfortable fit.

It is normal to experience increased saliva flow, some soreness, and possible speech and chewing difficulty, however this will subside as your muscles and tissues get used to the new dentures.

You will be given care instructions for your new dentures.  Proper cleaning of your new dental appliance, good oral hygiene, and regular dental visits will aid in the life of your new dentures.

A dental bridge is a fixed (non-removable) appliance and is an excellent way to replace missing teeth.

There are several types of bridges.  You and your dentist will discuss the best options for your particular case.  The “traditional bridge” is the most popular type and is usually made of porcelain fused to metal.  This type of bridge consists to two crowns that go over two anchoring teeth (abutment teeth) and are attached to pontics (artificial teeth), filling the gap created by one or more missing teeth.

Dental bridges are highly durable and will last many years, however they may need replacement or need to be re-cemented due to normal wear.

Reasons for a fixed bridge:

• Fill space of missing teeth.
• Maintain facial shape.
• Prevent remaining teeth from drifting out of position.
• Restore chewing and speaking ability.
• Restore your smile.
• Upgrade from a removable partial denture to a permanent dental appliance.

What does getting a fixed bridge involve?

Getting a bridge usually requires two or more visits.  While the teeth are numb, the two anchoring teeth are prepared by removing a portion of enamel to allow for a crown.  Next, a highly accurate impression (mold) is made which will be sent to a dental laboratory where the bridge will be fabricated.  In addition, a temporary bridge will be made and worn for several weeks until your next appointment.

At the second visit, you permanent bridge will be carefully checked, adjusted, and cemented to achieve a proper fit.  Occasionally your dentist may only temporarily cement the bridge, allowing your teeth and tissue time to get used to the new bridge.  The new bridge will be permanently cemented at a later time.

You will receive care instructions at the conclusion of the procedure.  Proper brushing, flossing and regular dental visits will aid in the life of your new permanent bridge.

Dental implants are a great way to replace missing teeth and also provide a fixed solution to having removable partial or complete dentures.  Implants provide excellent support and stability for these dental appliances.

Dental implants are artificial roots and teeth (usually titanium) that are surgically placed into the upper or lower jaw bone by dental surgeon. The teeth attached to implants are very natural looking and often enhance or restore a patient’s smile!

Dental implants are very strong, stable, and durable and will last many years, but on occasion, they will have to be re-tightened or replaced.

Reasons for dental implants:

• Replace one or more missing teeth without affecting adjacent teeth.
• Resolve joint pain or bite problems caused by teeth shifting into missing tooth space.
• Restore a patient’s confident smile.
• Restore chewing, speech, and digestion.
• Restore or enhance facial tissues.
• Support a bridge or denture, making them more secure and comfortable.

What does getting dental implants involve?

The process of getting implants requires a number of visits over several months.

X-rays and impressions (molds) are taken of the jaw and teeth to determine bone, gum tissue, and spacing available for an implant.  While the area is numb, the implant will be surgically placed into the bone and allowed to heal and integrate itself onto the bone for up to six months.  Depending on the type of implant, a second surgery may be required in order to place the “post” that will hold the artificial tooth in place.  With other implants the post and anchor are already attached and placed at the same time.

After several weeks of healing the artificial teeth are made and fitted to the post portion of the anchor.  Because several fittings may be required, this step may take one to two months to complete.  After a healing period, the artificial teeth are securely attached to the implant, providing excellent stability and comfort to the patient.

You will receive care instructions when your treatment is completed.  Good oral hygiene, eating habits, and regular dental visits will aid in the life of your new implant.

 Tooth extractions, or the removal of one or more teeth, are usually used as a last resort in dentistry, as keeping the natural tooth in the mouth is ideal. There are many reasons why single or multiple extractions may be performed, including pervasive tooth decay, the impaction of wisdom teeth, or the need to create space for orthodontic devices.

The most significant short-term benefit associated with tooth extraction is the elimination of pain. If a tooth is severely decayed or an infection is present, removing the affected tooth almost immediately alleviates discomfort. However, it should be noted that further procedures are necessary to replace the extracted tooth. Leaving a gap is not a viable option as the other teeth tend to twist out of alignment to fill the space.

Why might I need to have a tooth extraction?

Tooth extractions are incredibly common procedures. It should be reiterated that an extraction is used as a procedure of last resort, when nothing more can be done to save the tooth.

Here is a brief overview of some of the main reasons for tooth extraction:

Deep decay – This is easily the most common reason for tooth extraction, accounting for around two-thirds of all extraction procedures performed. When decay affects the surface of the tooth as well as the pulp, root canal procedures cannot be performed. Root canal therapy is only viable where the general structure of the tooth is in stable condition.

Extra teeth –There are a variety of explanations associated with extra teeth, but most commonly they are baby teeth that do not shed. Extra teeth take up space on the arch, causing nearby teeth to twist out of place. A tooth extraction is necessary in this case to provide enough space for the teeth to properly realign.

Periodontal disease – Often teeth have to be extracted because the gums and underlying bone are so severely eroded that they can no longer hold the tooth in place securely. The cause of bone and gum recession is almost always advanced periodontal disease (gum disease). Poor bone density means that the chance of restoring the natural tooth is minimal.

Prior to braces – Traditional orthodontic braces require enough space to for the teeth to move into ideal alignment. If space cannot be created naturally, a tooth may be extracted as an alternative.

Fractured teeth – Fortunately, dentists are able to save injured teeth in most circumstances with the aid of root canal therapy. However, there are some instances where the tooth has become fractured in a way that makes repair impossible. Your oral health professional will remove the tooth and use a prosthetic replacement in most cases.

How is the extraction procedure performed?

Generally, tooth extraction can be simple in nature or involve more complex surgical processes. Simple extractions are performed on fully emerged teeth after applying local anesthetic to the treatment site. Instruments are used to elevate the tooth and then sever the periodontal ligament. The tooth is then carefully removed with dental forceps.

Surgical extractions are performed on teeth that are either invisible or inaccessible, like un-erupted wisdom teeth. An incision is usually made in the gum tissue and a drill is used to precisely remove some of the adjacent bone tissue. Sometimes, the tooth has to be split into several pieces to completely remove it.

If you have any questions or concerns about tooth extraction, please contact your oral health care provider.

Sleep apnea is a serious, sometimes fatal medical disorder that affects around 10% of American men over the age of 40, and 6% of American women of the same age.  Sleep apnea sufferers completely stop breathing during sleep, sometimes hundreds of times in a single night.  Normal breathing ceases because the airway becomes obstructed, causing a serious reduction of airflow to the lungs.

There are a number of dental devices that can be used to alleviate this condition. The goal of most of these devices is to separate the jaws and push them forward slightly.  This slight repositioning opens up the airway, and allows oxygen to flow freely again.  Wearers of sleep apnea dental devices report that they stop loud snoring, feel more rested in the daytime, and are much more comfortable going to sleep.  Sleep apnea appliances work best on patients who are not significantly overweight. They offer a viable alternative to Continuous Positive Airway Pressure (CPAP).

Sleep apnea appliances fall into two categories: fixed and adjustable.  Here are brief descriptions of some commonly used sleep apnea dental appliances:

TAP^® 3 (Thornton Adjustable Positioner)

The TAP^® 3 is the smallest, most comfortable member of the TAP family.  It is a two-part custom-created sleep apnea appliance that fits over the teeth in much the same way as a sports mouthguard.  The TAP^® 3 projects the jaw forward to prevent the tongue and soft tissues from impeding the airway.  The lower jaw positioner is adjustable, which means that it can be altered to suit the comfort level of the wearer.  The TAP^® 3 appliance can accommodate the three main types of malocclusion, and allows the lips to fully close.

OASYS Appliance

The OASYS appliance is designed to move the base of the tongue toward the front of the mouth by gently repositioning the jawbone (mandible).  This shift opens the oropharynx and strengthens the upper airway.  An extension of the upper shield projects toward the nose, creating a larger nasal opening and less resistance to normal airflow.  This adjustable appliance is comfortable to wear and extremely patient friendly.

Klearway^TM Appliance

The Klearway^TM Appliance is generally used to alleviate obstructive sleep disorder and eliminate snoring.  The patient or dentist can project the jaw forwards in increments of .25mm at a time.  This ensures maximum comfort for the sleeper.  The Klearway^TM appliance is made from Variflex^TM heat softening acrylic, which makes it easier to insert.  Running warm water over the appliance makes it pliable, but once placed in the desired position, the acrylic hardens again.

Herbst Telescopic Appliance

The Herbst appliance is held in the mouth by clasps and friction grips.  It is made of acrylic, and contains adjustable metal wiring.  The advantage of this appliance is that the wearer is able to move vertically and laterally without dislodging the appliance.  The Herbst appliance is usually used in mild and moderate cases of sleep apnea, and can also alleviate loud snoring effectively.

If you have questions or concerns about sleep apnea appliances, please ask your dentist.

Bone grafting is often closely associated with dental restorations such as bridge work and dental implants. In the majority of cases, the success of a restoration procedure can hinge on the height, depth, and width of the jawbone at the implant site. When the jawbone has receded or sustained significant damage, the implant(s) cannot be supported on this unstable foundation and bone grafting is usually recommended for the ensuing restoration.

There are several major factors that affect jaw bone volume:

• Periodontal Disease – Periodontal disease can affect and permanently damage the jaw bone that supports the teeth. Affected areas progressively worsen until the teeth become unstable.
• Tooth Extraction – Studies have shown that patients who have experienced a tooth extraction subsequently lose 40-60% of the bone surrounding the extraction site during the following three years. Loss of bone results in what is called a “bone defect”.
• Injuries and Infections – Dental injuries and other physical injuries resulting from a blow to the jaw can cause the bone to recede. Infections can also cause the jaw bone to recede in a similar way.

Reasons for bone grafts

Bone grafting is a highly successful procedure in most cases. It is also a preferable alternative to having missing teeth, diseased teeth, or tooth deformities. Bone grafting can increase the height or width of the jawbone and fill in voids and defects in the bone.

There are essentially two basic ways in which bone grafting can positively impact the health and stability of the teeth:

Jaw Stabilization – Bone grafting stabilizes and helps restore the jaw foundation for restorative or implant surgery. Deformities can also be corrected and the restructuring of the bone can provide added support.

Preservation – Bone grafting can be used to limit or prevent bone recession following a tooth extraction, periodontal disease, or other invasive processes.

Oral Examination

Initially, the dentist will thoroughly examine the affected area in order to assess the general condition of the teeth and gums. If periodontal disease is present or the adjacent teeth are in poor condition, these factors will be fully addressed before the bone grafting procedure can begin. The dentist will also recommend panoramic x-rays in order to assess the precise depth and width of the existing bone. On occasion, a CAT scan may be recommended to determine the bone condition. Depending on these results, the dentist may also anesthetize the area and explore into the gum in order to determine what kind and how much bone is required.

What Does Bone Grafting Involve?

There are several types of bone grafts. Your dentist will determine the best type for your particular condition.

Autogenous Bone Graft – Harvested from the patient’s own body (usually from the posterior part of the lower jaw or the chin).

Allograft Bone Graft – Cadaver or synthetic bone is used in this type of graft.

Xenograft – Cow bone is used in this type of graft.

The bone grafting procedure can often take several months to complete. This bone will fuse with the existing bone and the migration of cells will cause firm adhesion and cell growth. Supplementing the jaw with bone will result in greater bone mass to help support and anchor the implant(s).

During the surgery, the dentist will numb the grafting and extraction sites using local anesthetic. A small incision will be made to prepare the site for the new bone and it will be anchored into place. On occasion, a synthetic membrane may be used to cover the new bone. This membrane prevents soft tissue and bacterial invasions, and encourages new bone growth. The surgery does not require an overnight stay, and you will be provided with comprehensive instructions for your post-operative care. The dentist will prescribe medications to help manage infection, discomfort and swelling.

Third molars, commonly referred to as wisdom teeth, are usually the last four of 32 teeth to erupt (surface) in the mouth, generally making their appearance between the ages of 17 to 25. They are located at the back of the mouth (top and bottom), near the entrance to the throat. The term “wisdom” stems from the idea that the molars surface at a time typically associated with increased maturity or “wisdom”.

In most cases, inadequate space in the mouth does not allow the wisdom teeth to erupt properly and become fully functional. When this happens, the tooth can become impacted (stuck) in an undesirable or potentially harmful position. If left untreated, impacted wisdom teeth can contribute to infection, damage to other teeth, and possibly cysts or tumors.

Reasons to remove wisdom teeth

While not all wisdom teeth require removal, wisdom teeth extractions are most often performed because of an active problem such as pain, swelling, decay or infection, or rarely as a preventative measure to avoid problems in the future. If impaction of one or more wisdom teeth is present, and left untreated, a number of potentially harmful outcomes can occur, including:

• Damage to nearby teeth: Second molars (the teeth directly in front of the wisdom teeth) can be adversely affected by impacted wisdom teeth, resulting in tooth decay (cavities), periodontal disease (gum disease) and possible bone loss.
• Disease: Although uncommon, cysts and tumors can occur in the areas surrounding impacted wisdom teeth.
• Infection: Bacteria and food can become trapped under the gum tissue, resulting in an infection. The infection can cause considerable pain and danger.

Wisdom teeth examination

As with any dental procedure, your dentist will want to initially conduct a thorough examination of the wisdom and surrounding teeth. Panoramic or digital x-rays will be taken in order for your dentist to evaluate the position of the wisdom teeth and determine if a current problem exists, or the likelihood of any potential future problems. The x-rays can also expose additional risk factors, such as deterioration or decay of nearby teeth. Only after a thorough examination can your dentist provide you with the best options for your particular case.

What does the removal of wisdom teeth involve?

Wisdom teeth removal is a common procedure, generally performed under local anesthesia, intravenous (IV) sedation, or general anesthesia by a specially trained dentist. The surgery does not require an overnight stay, and you will be released with post-operative instructions and medication (if necessary), to help manage any swelling or discomfort.

Temporomandibular Joint Dysfunction Syndrome (TMJ) is a common condition affecting a wide variety of people. TMJ is characterized by severe headaches, jaw pain of varying degrees, grinding teeth, and an intermittent ringing in the ears. The vast majority of TMJ sufferers are unaware that the root cause of these problems is something that a dentist can effectively treat.

The symptoms of TMJ are debilitating and can greatly interfere with every day life. The comfort and general well being of the patient is at the heart of the dental practice, so pain relief is the first consideration of the dentist. The dentist is able to test, diagnose, and devise an immediate plan to treat the underlying causes of the TMJ disorder.

Reasons for treating TMJ

TMJ sufferers report that their symptoms generally worsen during periods of prolonged or unexpected stress, and that intense outbreaks of the condition can lead to neck pain and dizziness.

The most common cause of TMJ is the misalignment of the teeth, often called “bad bite.” It is possible for the dentist to realign or adjust the teeth without the need for painful or expensive surgeries. The realignment/adjustment will stop the pounding headaches and jaw pain.

The grinding teeth symptom is particularly common and usually occurs at night. The grinding will eventually erode the structure of the teeth and lead to much more severe dental problems in the future. Untreated TMJ is one of the prime underlying factors in eroded jawbones and loose teeth.

It is important for anyone experiencing the symptoms of TMJ to visit the dentist for an exact diagnosis.

What does treating TMJ involve?

TMJ could be a result of several different problems. Bad bite is the most common, but an injury resulting from a blow to the meniscus cartilage is also a possibility. Initially, the dentist will thoroughly examine the jaw area, the patient’s bite, take X-rays, and review the patient’s history in order to make an accurate diagnosis and recommend necessary treatment.

Once a firm diagnosis is attained, there are several ways in which relief can be provided. A specially molded bite guard can be created to stop teeth grinding during the night. A bite relationship analysis may be recommended by the dentist. The dentist can also provide advice on relaxation techniques which will lessen the effects of stress. As a last alternative, the dentist is also able to prescribe muscle relaxants.

A better option is to change the shape of the teeth and get rid of the bad bite completely, often called “realignment.” This is especially useful because it alleviates TMJ symptoms and may improve the aesthetic appearance of the teeth as well. Realignment involves adjusting the relationship between how the upper teeth come together with the lower teeth. This may require new restorations and/or adjusting the natural teeth as well. It is not a painful procedure, and it is one the dentist has performed with great success numerous times. As with any procedure, the dentist will be happy to answer questions and discuss symptoms, options, and treatments.

If you are experiencing any symptoms of TMJ, we encourage you to contact our office today to schedule an appointment.

Humans have two upper canines and two lower  canines. Canine teeth are sometimes referred to as cuspids, fangs, or “eye teeth” because of their direct positioning beneath the eyes. Canine teeth have thicker and more conical roots than incisors and thus have an especially firm connection to the jaw. Canine teeth often have the longest root of all teeth in the human mouth and the last to fully erupt and fall into place; often around age 13.

An impacted tooth essentially means that it is blocked, stuck, or unable to fully erupt and function properly. Third molars (wisdom teeth) most commonly fall victim to impaction, but the upper canine is the second most common tooth to become impacted. Wisdom teeth serve no important function in the mouth and are frequently removed; however, impacted canines are critical to the bite and require treatment for the following reasons:

• Closing Gaps – Canines are the last of the front teeth to fall into place and therefore close any unsightly gaps between the other upper teeth.
• First Touch – Canines play a vital role in the “biting” mechanism of the teeth. They touch first when the jaw closes, and guide the other teeth into position.
• Proper Alignment & Function – Canine teeth are essential to the correct alignment and function of the other teeth on the dental arch. Missing or impacted canines can greatly affect the function and aesthetic appearance of the smile.

What causes canine teeth to become impacted?

There are several main causes for impacted canine teeth:

Extra Teeth – If extra teeth are present, the natural eruption of the canine teeth may be inhibited. The eruption progress of the canine may be directly blocked by an extra tooth or the subsequent overcrowding might leave no room on the dental arch for the canine.

Overcrowding – In some cases, poor alignment of the front teeth can lead to overcrowding. The existing teeth compete for space which means that the canines do not have sufficient room to become functional.

Unusual Growths – On rare occasions, unusual growths on the soft tissue of the gums can restrict the progress of canine teeth, which leads to later impaction.

Oral Examination

The dentist initially conducts a thorough visual examination of the teeth, accompanied by x-rays. Once the cause of the impaction has been determined, there will be several treatment options available depending upon the age of the patient. The objective is to aid the eruption of the impacted canines.

What does the treatment of impacted canines involve?

If your mouth is overcrowded for any reason, the dentist may recommend extraction of teeth. The extraction will generally be performed under local anesthetic. The un-erupted canine will then be exposed by lifting the gum, and guided into place using a special bracket.

In the case of younger patients, an orthodontic brace may be fitted to create a space on the dental arch for the impacted canine. Surgery for impacted canines usually does not require an overnight stay. Pain medication will be prescribed as necessary, and you’ll be given post treatment advice for your recovery.

Root canal therapy is needed when the nerve of a tooth is affected by decay or infection.  In order to save the tooth, the pulp (the living tissue inside the tooth), nerves, bacteria, and any decay are removed and the resulting space is filled with special, medicated, dental materials, which restore the tooth to its full function.

Having a root canal done on a tooth is the treatment of choice to save a tooth that otherwise would die and have to be removed.  Many patients believe that removing a tooth that has problems is the solution, but what is not realized is that extracting (pulling) a tooth will ultimately be more costly and cause significant problems for adjacent teeth.

Root canal treatment is highly successful, although on occasion, a tooth will have to be retreated due to new infections.

Signs and symptoms for possible root canal therapy:

• An abscess (or pimple) on the gums.
• Sensitivity to hot and cold.
• Severe toothache pain.
• Chronic infections with no symptoms present.
• Swelling and/or tenderness.

Reasons for root canal therapy:

•  Decay has reached the tooth pulp (the living tissue inside the tooth).
• Infection or abscess have developed inside the tooth or at the root tip.
• Injury or trauma to the tooth.

What does root canal therapy involve?

A root canal procedure requires one or more appointments and can be performed by a dentist or endodontist (a root canal specialist).

While the tooth is numb, a rubber dam (a sheet of rubber) will be placed around the tooth.  An access opening is made on top of the tooth and a series of root canal files are placed into the opening, one at a time, removing the pulp, nerve tissue, and bacteria.  If tooth decay is present, it will also be removed with special dental instruments.

Once the tooth is thoroughly cleaned, it will be sealed with either a permanent filling or, if additional appointments are needed, a temporary filling will be placed.

At the next appointment, usually a week later, the roots and the inside cavity of the tooth will be filled and sealed with special dental materials.  A filling will be placed to cover the opening on top of the tooth.  In addition, all teeth that have root canal treatment should have a crown (cap) placed.  This will protect the tooth and prevent it from breaking, and restore it to its full function.

After treatment, your tooth may still be sensitive, but this will subside as the inflammation diminishes and the tooth has healed.

You will be given care instructions after each appointment.  Good oral hygiene practices and regular dental visits will aid in the life of your root canal treatment.

In rare cases, root canal therapy fails to work as expected. The treated tooth might not heal properly or a patient might experience post-surgical complications that jeopardize the tooth. Root canal retreatment involves the removal of the previous crown and packing material, the cleansing of the root canals, and the re-packing and re-crowning of the tooth. In short, root canal retreatment is almost identical to the original procedure, aside from the structural removal. The success rate for a root canal retreatment runs at around 75%.

Why is root canal retreatment required?

Though the prospect of more endodontic surgery might not be pleasant, root canal retreatment is usually completed in 1-3 visits.

There are a number of reasons why root canal therapy unexpectedly fails, including:

•  Cracked crown leaking filling material.
•  Curved or narrow canals not treated during the original procedure.
•  Delay in the placement of restorative devices following the procedure.
•  New decay to the tooth.
• New fracture in the treated tooth.
•  Saliva entering the restorative structure.
• Undetected complex canal structures.

What does root canal retreatment involve?

On the day of the retreatment procedure a local anesthetic will be administered, and the affected tooth is isolated with a rubber dam. The amount the dentist can do within a single appointment will much depend on the amount of inflammation present, and the complexity of the treatment.

The first step in a root canal retreatment is to gain access to the inner tooth. If a crown and post have been placed, these will be removed.

Next, filling material and obstructions that block the root canals will be removed. This removal is conducted using an ultrasonic handpiece. The advantage of using this tool is that any unwanted material is vibrated loose. Tiny instruments will then be used to clean and reshape the root canals. X-rays may be taken to ensure that the roots are thoroughly clean. If this part of the treatment proves to be complex, medicated packing material will be applied, and the rest of the cleansing procedure will be done at the next visit.

When the dentist is confident that the root canals are completely clean, gutta-percha is used to pack the space. This rubbery material seals the canals to prevent bacterial invasion. Finally, a temporary crown or filling is applied to tooth. At a later date, the permanent crown will be placed.

If you have any questions or concerns about root canal retreatment, please ask your dentist.

The teeth are held firmly in place by strong roots that extend into the jawbone. Molars and premolars tend to have several roots, whereas the front incisors only have a single root. The end or tip of each root is termed the apex. The apex is where the nerves and blood vessels enter the tooth and aids in the delivery of blood to the crown (the part of the tooth you can see in your mouth).

A root canal treatment refers to the cleaning of the canals and the removal of infected and inflamed tissue within the root. When the inflammation or infection persists after the root canal treatment, an apicectomy may be required. An apicoectomy is essentially the removal of the apex (or root tip), followed by a filling procedure to seal the root from further infection. When left untreated, infected roots can damage other teeth, spread infection, and cause regression of the jawbone.

Reasons for an apicectomy

Infected and inflamed soft tissue around the root of a tooth can be exceptionally painful and debilitating. The purpose of an apicectomy is to eliminate the infection in the tissue and to ultimately preserve the function of the tooth and save it from extraction. An apicectomy will rarely be considered by the surgeon unless a prior root canal treatment has failed.

There are several reasons why an apicectomy may be necessary:

• Small Adjoining Root Branches – Roots are extremely complex and can contain many tiny branches. If these tiny branches cannot be cleaned and sealed when the root canal treatment is performed, inflammation can persist.
• Blocked Root Canal – In some cases, the surgeon is unable to effectively clean a root canal because it is blocked by a fractured file left behind from prior root canal treatment.
• Narrow or Curved Root Canals – When the root canal is poorly shaped, the endodontic files cannot reach the root tip. Continuing infection or re-infection can then occur.

What does getting an apicectomy involve?

Prior to the surgery, the surgeon will generally prescribe an antibiotic or anti-inflammatory medication if necessary.  X-rays will then be taken to enable the dentist to plan the apicectomy, which will be performed under local anesthesia.

The surgeon will make a small incision in the gum and expose the root by lifting away the gum. In some cases, a tiny fraction of the jawbone may be removed to properly expose the root. The edge of the root tip and any infected connective tissue will be removed using ultrasonic instruments. The root will be sealed using a retrofill (filling material), and the dentist will suture the gum with several stitches.  After several days, the surgeon will remove the stitches, and the connective tissues will fully heal several months after the procedure.

If you are experiencing any symptoms, such as pain or swelling associated with a tooth that has had a root canal, we encourage you to contact our office immediately.

If a tooth has been knocked clean out of the mouth, it is essential to see a dentist immediately.  When a tooth exits the mouth, tissues, nerves and blood vessels become damaged.  If the tooth can be placed back into its socket within an hour, there is a chance the tissues will grow to support the tooth once again.

Here are some steps to take:

1. Call the dentist.
2. Pick up the tooth by the crown and rinse it under warm water.  DO NOT touch the root.
3. If possible, place it back into its socket
4. If the tooth cannot be placed in the mouth, put the tooth into a cup of milk, saliva, or water as a last resort.  It is important to keep the tooth from drying out.
5. Get to the dentist, quickly and safely.

The dentist will try to replace the tooth in its natural socket.  In some cases, the tooth will reattach, but if the inner mechanisms of the teeth are seriously damaged, root canal therapy may be necessary.

Usually, a crown or filling comes loose while eating.  Once it is out of the mouth, the affected tooth may be incredibly sensitive to temperature changes and pressure.  Crowns generally become loose because the tooth beneath is decaying.  The decay causes shape changes in the teeth – meaning that the crown no longer fits.

If a crown has dropped out of the mouth, make a dental appointment as soon as possible.  Keep the crown in a cool, safe place because there is a possibility that the dentist can reinsert it.  If the crown is out of the mouth for a long period of time, the teeth may shift or sustain further damage.

The dentist will check the crown to see if it still fits.  If it does, it will be reattached to the tooth. Where decay is noted, this will be treated and a new crown will be made.

The teeth are strong, but they are still prone to fractures, cracks and breaks.  Sometimes fractures are fairly painless, but if the crack extends down into the root, it is likely that the pain will be extreme.  Fractures, cracks and breaks can take several different forms, but are generally caused by trauma, grinding and biting.  If a tooth has been fractured or cracked, there is no alternative but to see the dentist as quickly as possible.

The nature of the break or fracture will limit what the dentist is able to do.  If a fracture or crack extends into the root, root canal therapy may be the only effective way to retain the tooth.  In the case of a complete break, the dentist will usually affix the fragment back onto the tooth as a temporary measure.

When a tooth has been dislodged or loosened from its socket by trauma or decay, it might be possible to save it.  If the tooth remains in the mouth and attached to the blood vessels and nerves, there is a good chance root canal therapy will not be necessary.

It is important to call the dentist immediately to make an appointment.  In the meantime, use a cold compress and over-the-counter medications to relieve pain.  The dentist will reposition the tooth and add splints to stabilize it.  If the tooth fails to heal, root canal therapy may be required.

If you have questions or concerns about dental emergencies, please contact our office.