Reshaping Gum Tissues To Protect Oral Health & Enhance Smiling Appearance


Posted on Mar 21, 2024 by William J. Claiborne, DDS MS

When people think about the appearance of their smiles, it’s typically the teeth that are the focus. Everyone wants a smile that enhances appearance, instills self-confidence and gets compliments. Yet, the appearance of a smile involves more than just teeth. The “frame” of gum tissues that arch the teeth most visible in a smile have a lot to do with how a smile looks.

As a periodontal specialist in Asheville, NC, part of my specialty involves the treatment of all stages of periodontal (gum) disease, the placement of dental implants, and the contouring of gum tissues. Gum contouring is generally done for esthetic reasons but may also be advised for oral wellness.

Gums most often pull away from the base of teeth (or “recede”), exposing darker areas of the tooth. This darker area is part of the tooth’s root and highly vulnerable to damage. Recession also causes teeth to look longer and expose darker tooth root areas of the tooth. Being sensitive to hot or cold – causing a sudden jolt of pain – is often the final warning sign that the gums are not protecting tender root segments of the tooth.

Gum recession is commonly due to:

Gum disease, which destroys gums tissues, causing them to loosen their firm grip around the base of teeth. This enables oral bacteria to penetrate beneath the gum line, reaching vulnerable bone and tissues.

Over-vigorous toothbrushing can wear away precious gum tissues that surround the base of teeth. When using a back-&-forth scrubbing motion, or a hard toothbrush, gum tissues can be scrubbed off. Too, using abrasive substances to brush (such as baking soda) not only wear down gum tissues, they wear away tooth enamel.

• The aging process lessens hydration in the body. Because the gum tissues are moist layers that require continual hydration (supported by saliva), oral dryness can cause the gums to draw up as they become drier. Unfortunately, this creates more challenges in maintaining healthy teeth.

While gum recession is an oral health concern, it is a cosmetic issue as well. For an attractive smile, teeth should be arched by a balanced level and shape of gum tissues. When there is too much gum tissue showing above teeth or varying heights of gums arching teeth, the height and symmetry of gum tissues can be corrected by a periodontist.

For example, in a gummy smile, too much of the gum line is visible. This makes teeth look short and draws the eye to the gums rather than the teeth. Gum tissues should complement teeth with a balanced line of gum tissues. While a gummy smile is not generally problematic for one’s oral health, many people find it makes them “hold back” on smiling fully.

Before & After Of A Gummy Smile

The procedure to correct a gummy smile is a gingival lift, also known as a gum lift or gum contouring. This in-office procedure is performed to reduce and reshape highly visible gums.

In our Western NC periodontal dental office, we use a dental laser to perform a gingival lift. Our dental laser gives a precision line while only removing specific areas of the gums, leaving all surrounding tissue unharmed. This allows us to reshape the gums to create better balance in the smile.

A laser gingival lift also offers patients a more comfortable experience since it causes very little pain and therefore requires only topical anesthesia. In addition, laser treatments result in almost no bleeding and tissues tend to heal more quickly than after traditional surgery.

We also perform gum grafting that recovers areas where gum recession has occurred. This helps to protect the tooth roots and improves the appearance of the smile.

In gum grafting, we normally take a small area of tissue from the roof of the mouth and place it in the area of recession. When there is not sufficient tissue available, a graft may be from a donor source. The graft is attached to the natural gum tissue and gently sutured into the position where it corrects a smile’s appearance and reduces further recession and the potential for gum disease.

Several teeth may be involved in gum grafting when used to even out the gum line or reduce the risk of gum and bone collapse after a tooth has been lost. In these cases, cosmetic gum surgery is beneficial in reshaping excess gum and bone tissue. It also reduces sensitivity from exposed roots to hot or cold foods.

As a periodontist, I most commonly see gums that cover too much of the teeth as being due to genetics. When gums fail to cover sufficiently over the base of teeth, it’s typically the cause of recession, which can occur from several reasons (as listed prior). Regardless of why it has occurred, our goal is to provide the patient with the most healthy and esthetic outcome in a procedure that is comfortable, successful, and requires minimal healing time.

In our Asheville periodontal dental office, we offer some of the most advanced dental technology available. In addition to amazing imaging, such as Cone Beam 3D imaging, we provide Laser-Assisted New Attachment Procedure (or LANAP). This is a cutting-edge protocol to more efficiently and effectively treat periodontitis (advanced gum disease) with the PerioLase® MVP-7™ laser. Treatment is minimally invasive and helps to minimize both discomfort and recovery time. It has also been found to stimulate bone regrowth in damaged areas.

Additionally, our office offers both oral and I.V. sedation (“twilight sleep”) for complete relaxation during treatment. Sedation is administered safely by a doctor of anesthesia to provide optimal safety and comfort.

If finances have kept you from seeking out the care you need or the beautiful smile you desire, feel free to contact our friendly staff and arrange a consultation appointment. During this time, we can discuss the best options for you, cost estimates, and predicted treatment time.

We can also review several payment plans that make treatment affordable through extended, interest-free payment periods with no down payment required. These often help our patients enjoy their confident, new smiles while making easy monthly payments that are budget friendly.

Call 828-274-9440 to schedule.

How A Periodontist Can Help Cancer Patients


Posted on Mar 18, 2024 by William J. Claiborne, DDS MS
For those who learn they have cancer, regardless of the type, it is a frightening diagnosis. While survival rates have been positively increasing over the years, it is a dreaded disease that requires challenging treatment regimens, even for those who have early stage cancer diagnoses.
Thanks to extensive research and advances in treatment options (including high-tech imaging that catches many cancers in their early stages) the survival statistics are climbing at a steady pace. In 2022, 69% of survivors have lived over 5 years since their diagnosis; 47% have lived over 10 years since their diagnosis; and 18% of survivors have lived over 20.
Encouraging, also, is that the number of cancer survivors is projected to increase by 24.4% by 2032.
Treatment for cancer can be very compromising to the immune system. One of the ways to support the immune system is by having excellent periodontal health. Having a healthy mouth can lower the demands on the immune system. Here’s why…
The mouth is home to millions of bacteria; some bacteria are good and some are bad. When the bad bacteria are well-managed (through proper brushing, flossing and regular dental check-ups), the gums remain healthy and protective to the structures below.
When bad bacteria over-accumulate, the immune system becomes strained as it attempts to combat their rapid reproduction. The bacteria become infectious, destroying healthy tissues. This leads to the loosening of gum tissues that snugly wrap the base of each tooth. Thus, bacteria are able to penetrate below the surface of the gums.
Here, bacteria attack the structures that support teeth, including bone. This destruction can cause teeth to loosen, leading to the need for removal in some cases.
Yet, it is not just the immune system that is challenged by the bacteria. Even for those in good overall states, having gum disease increases the risks for many health problems, such as heart disease, stroke, arthritis, diabetes, dementia and even certain cancers.
In a study by Harvard scientists from data that included almost 150,000 adults with a follow-up after 28 years, those with a history of periodontal disease were 43% more likely to develop esophageal cancer and 52% more likely to develop stomach cancer. The risk was even higher in those with gum disease severe enough to cause tooth loss (periodontitis).
Although the exact mechanism connecting gum disease and some cancers is still uncertain, studies continually show correlations. This can be in the form of triggering the onset or worsening those in development.
In one study from the late 1990s until 2012, study participants with severe gum disease showed a 24% higher risk of developing cancer. For edentulous patients (those who have no remaining natural teeth), there was an even higher risk.
As a periodontist, I have a firsthand view of how destructive the infectious bacteria of gum disease can be. Ridding any level of this can reduce the demands on the immune system. As such, we often care for cancer patients to relieve the problems in the mouth that some medications and radiation can cause (such as tissue infections and sores, pain or swelling in the mouth, and sensitivity to hot and cold). This is often done using a dental laser. Laser therapy is very comfortable and is safe for cancer patients and the process can expedite healing greatly.
I’d also like to take this opportunity to address, specifically, oral and oropharyngeal cancers since April is National Oral Cancer Awareness month. While some other cancers seem to be more present in the public eye, awareness of oral and neck/throat cancers needs to be greater. Oral cavity and oropharyngeal cancers occur most often in the following sites:
• tongue
• tonsils and oropharynx (the part of the throat behind the mouth)
• gums, floor of the mouth, and other parts of the mouth
The rest are found in the lips, the minor salivary glands (which often occur in the roof of the mouth), and other sites.
The American Cancer Society’s most recent estimates for oral cavity and oropharyngeal cancers in the U.S. are for 2024:
   – About 58,450 new cases of oral cavity or oropharyngeal cancer
   – About 12,230 deaths from oral cavity or oropharyngeal cancer
The average age of people diagnosed with these cancers is 64, but they can occur in young people. Just over 20% (1 in 5) of cases occur in people younger than 55.
Adult males are at the highest risk for oral cancer, with black males being the most susceptible. The risk also increases with age, especially after age 50. Although the risk typically peaks between the ages of 60 – 70, males between ages 50 – 59 tend to have the highest numbers.
It is important to be aware of the warning signs of oral cancer, including:
• A sore, irritation, lump or thick patch in the mouth, lip, or throat
• White or red patch inside the mouth
• Feeling something is stuck in the throat
• Difficulty chewing or swallowing
• Difficulty moving the jaw or tongue
• Numbness in the tongue or other areas of the mouth
• Unexplained swelling of the jaw
• Pain in an ear without hearing loss
While these symptoms do not always indicate oral cancer, any that do not clear up on their own within 2 weeks should be examined without delay.
This dental exam is painless. Many patients, if not told, are not aware that the dentist is performing it. During this, the dentist does a visual examination of oral tissues, checking the lips and inside of the mouth (including under the tongue). The dentist will also check the roof and floor of your mouth.
If suspicious areas are noted during the exam, the dentist will order a biopsy. In this, a small sample of tissue from the area of concern is removed and examined under a microscope. This will determine whether further tests are needed.
Unfortunately, the CDC reports that about 35% of adults over the age of 18 did not have a dental visit in 2019. This leaves those who are vulnerable or developing oral cancer at higher risk of it advancing. Those regular dental checkups go beyond the cleaning of teeth and lowering the risk of oral cancers adds greatly to the need to be committed to these appointments.
If you are experiencing symptoms of gum disease, please know that this disease will only worsen without treatment. If you have any of those listed below, please contact our Asheville periodontal dental office as soon as possible to schedule an examination.
Watch for:
Swollen or puffy gums
Bright red, dark red or dark purple gums
Gums that feel tender when touched
Gums that bleed easily
Seeing pink in the sink or toothbrush after brushing
Spitting out blood when brushing or flossing teeth
Bad breath that won’t go away
If fear has kept you from having regular dental care, our Western periodontal dental office offers both oral and I.V. sedation (twilight sleep). Feel free to call 828-274-9440 to arrange a consultation appointment to discuss any concerns you have regarding treatment or payment plans.
Sources:

As You Age, Avoid A ‘Melting’ Face With Dental Implants


Posted on Feb 26, 2024 by William J. Claiborne, DDS MS

It seems the older one gets, the more conscious he or she is to the need for good health practices. While periodic exams and check-ups are part of this, eating healthy and getting ample exercise are practical ways to support a healthy body.

The same principles apply to oral health. While annual physical exams are needed, regular check ups and dental hygiene cleanings are as well. Through decades of research, “bad” bacteria in the mouth can lead to inflammatory reactions that can offset or worsen a number of health problems far beyond the mouth.

For now, let’s focus on your gum health and the presence of teeth. While natural teeth are the ideal structure for biting, chewing and speaking, the rigors of age – the natural wear and tear – can take its toll on teeth. Decay, gum disease, accidents and certain illnesses can lead to losing a tooth or teeth over the span of a lifetime.

There are several ways to replace a missing tooth (or teeth). A crown-&-bridge is a longstanding method to replace one or several teeth in one area. Or, a partial denture can replace a “scattering” of teeth in the same arch. However, the downside of these oral prosthetics is what’s beneath the gum line.

Your natural teeth are supported by your upper and lower jaw bone, known respectfully as the maxilla and mandible. With these strong, study bones, tooth roots are held securely. Thus, biting and chewing occurs comfortably.

The jaw bones are actually kept healthy by the presence of tooth roots. These roots provide stimulation to the bone as well as nourishment that feeds through the tooth’s interior.

When a tooth is removed, so is the stimulation and nourishment to that area of the jaw bone. Without it, the bone begins to shrink. As it declines in height, the adjacent teeth are more vulnerable to loss. Statistics show that teeth adjacent to areas where natural teeth are missing will be the most likely to be lost next.

This has a domino effect. Partials can replace the presence of teeth above the gum line, but there is nothing to benefit the jaw bones below. Thus, tooth loss continues and can go from a few missing teeth to losing all teeth (being “edentulous”).

According to the Center for Disease Control & Prevention (CDC), 69 percent of adults between the ages of 35 – 44 have lost at least one permanent tooth. By age 50, Americans are missing an average of 12 teeth. For adults between the ages of 65 – 74, 26 percent are missing all of their natural teeth. That’s over one-fourth of the adult population over age 65.

Although dentures and partials mimic the presence of teeth, the jaw bones below are shrinking away, and at a rather rapid pace. The pressure of wearing a denture or partial actually speeds this process up, known as “resorption.”

As these bones decline in mass, deep wrinkles form around the mouth. The corners of the mouth turn downward. The chin takes on a more pointed form and the mouth sinks into the face. The nose seems to get closer to the chin as the jaw bones thin. Jowls form as facial muscles detach from shrinking bone structure.

Changes in facial appearance also take place when bone structures shrink. For example, as the jaw bone thins, deep wrinkles form around the mouth. The corners of the mouth will start to turn down, even in a smile. Jowls form on each side of the face as facial muscles detach from the shrinking bone structure.

As the jaw bone declines further, the chin becomes more pointed and the nose seems to get closer to it. This leads to a collapsed mouth that is known as a “granny look.” This look ages the appearance of an individual far beyond their actual years.

Not to be overlooked is the ability to comfortably bite and chew food. This is essential for the digestive process, since the first stage of digestion begins in the mouth. When adults struggle to eat with a denture or partial, the efficiency of this initial stage of digestion is compromised.

It’s not unusual for adults who have “rocky” or “slippery” dentures to opt for soft foods that dissolve easily in the mouth. These are often carb heavy and lack the nutritional value of a diet that combines healthy proteins, fruits and vegetables.

However, missing teeth or dentures that move when eating can cause other detrimental problems. When people sense their dentures may cause embarrassment when eating, speaking or laughing with others, social involvement can take a hit. According to a 2012 statement by the World Health Organization:

“Oral health is essential to general health and quality of life. It is a state of being free from mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking, and psycho-social well-being.”

As an Asheville periodontist, my dental specialty includes the diagnosis and placement of dental implants. Dental implants are the closest thing to natural teeth.

Dental implants were designed to recreate the presence of natural teeth both above and below the gum line. Because teeth attached to the implants are supported by the jaw bone, the study foundation restores the ability to bite and chew without movement or fear of embarrassing slips.

For patients who are missing a great deal of bone, we offer bone rebuilding that does not require a bone graft. We also perform sinus lifts (when the upper jaw has declined to a significant level) to restore sufficient bone distance between vital structures.

For many of our dental implant patients, their lives become more active with the restored confidence. They become more socially involved, have more self-confidence and higher self-esteem. And the advantages of dental implants over other tooth replacement options are numerous.

• Dental implants are designed to last your lifetime. They do not decay, need root canals or compromise neighboring teeth or bone structure.

• Because dental implants are positioned in the jaw, they recreate stimulation to the bone. This helps to preserve the bone’s mass, halting the pace of jaw bone shrinkage (known as resorption).

• Resorption is what causes changes in one’s facial appearance, aging one’s appearance far older than their actual age.

• Dental implants do not move or slip when eating, speaking or laughing. A denture is designed to fit the contours of one’s gum ridge; contours that exist at the time the denture is made. However, as resorption reduces bone height, the ridge that holds the denture flattens out over time. This is why a denture becomes ‘wobbly’ or ‘slippery.’

• Dental implant treatment is largely determined by the number of implants placed. In most cases, one implant can support more than one tooth. A full arch (all upper or lower) of teeth are typically supported by several strategically-placed implants.

• Unlike a crown-&-bridge, dental implants so not need the support of adjacent teeth. Therefore, it is not necessary to have teeth shaved down for crowning simply to serve as supports for a bridge.

In our Asheville periodontal dental office, we have highly-advanced technology that aids in the diagnosis and placement process of dental implants. These features help to enhance patient comfort, shorten treatment time, and provide optimal results. Advanced technology includes:

– Computerized Dental Implant Placement – an advanced system for pre-surgical positioning of dental implants using a 3D model of the patient’s jaw. Once the implant type is selected, a template is developed for optimal treatment success.

– Cone Beam Imaging – is ideal for diagnoses and treatment planning through images that provide a clear view of the upper and lower jaw (including nerve canals), with rotations that show sagittal, axial, and coronal planes in a process that is quick, painless and at minimal radiation levels.

– Dental Laser – This small, hand-held device is a tremendous asset when it comes to both the health and appearance of gum tissues. Not only does the laser eliminate or greatly minimize bleeding during procedures, it reduces numbing requirements, removes bacteria and easily uncovers gum tissue where dental implants have been placed. Additionally, laser dentistry can beautifully re-contour or repair gum tissue with a precision line.

As a periodontal specialist serving Western NC, I take great pride in the diagnosis and placement of dental implants with each selected based upon the patient’s individual needs and goals. We provide oral or I.V. sedation to ensure a comfortable experience and a friendly, respectful environment.

To schedule an examination appointment or to begin with a consultation, call 828-274-9440. A referral is not always necessary.

Dental Fear Can Be Detrimental To More Than Your Smile


Posted on Feb 15, 2024 by William J. Claiborne, DDS MS

There are varying figures on the prevalence of dental fear in the U.S. However, there is no argument that it exists and affects a rather substantial number of adults.

A 2018 study shared by Dental Products Report listed the results of a study of things that keep adults from going to the dentist. Over 60% of the 18,000 polled admitted to having dental fear. Four percent shared they had never gone to a dentist as a result.

https://www.dentalproductsreport.com/view/study-finds-more-60-percent-people-suffer-dental-fear

Another study by the Cleveland Clinic stated that about 36% of people in the U.S. have a fear of dental treatment, with 12% having an extreme fear (known as “dental phobia”). 

While traumatic experiences in the past (often as a child) cause some people to be fearful of dental visits, others are not aware of why or how their fears began.

The Cleveland Clinic cites the top reasons that cause people to avoid or delay dental care are:

• Fear that the anesthetic won’t be sufficient or fear of the side effects (such as numb lips) after treatment

• Fear of bleeding during a dental procedure

• Fear gagging, choking or not being able to breathe or swallow during treatment

• Fear of dentist (often due to a bad experience in the past)

• Fear of pain

• Fear of needles

• The noise made by drills or other instruments used by the dentist or hygienist

• The smells of antiseptics or other chemicals used in a dental office

https://my.clevelandclinic.org/health/diseases/22594-dentophobia-fear-of-dentists

Having the jitters at the dental office is not all that difficult to understand. During these visits, patients are positioned on their backs on a narrow recliner with a bright light shining in their faces. Add to that having to maintain an open mouth (which is full of sensitive nerves) without really knowing what is being done. It’s not surprising that there are some uneasy feelings.

Fear or anxiety are normal reactions of the brain’s “fight or flight” response. For instance, some people have an intense fear of spiders or heights. Their reactions are automatic. Yet, in many cases of dental fear, some learn to override these reactions once they develop a sense of trust in being treated gently and respectfully.

In addition to avoiding care due to fear, some of the oral health problems we see occur from:

– Insufficient oral hygiene
– Avoiding regular dental check-ups and cleanings
– Ignoring symptoms of gum disease, such as seeing blood in the sink when brushing
– Brushing too rigorously or using abrasive substances to brush
– Age-related problems, such as oral dryness
– Oral dryness due to snoring or sinus problems
– Eating a high-carb diet or snacking frequently
– Smoking (including cigarettes, vaping, marijuana, and chew)
– Regular alcohol consumption

Certainly, some people are merely more susceptible to dental decay and bacterial buildup in the mouth. It can be due to genetics or some illnesses and diseases. Yet, the majority of reasons for having oral problems can be dealt with through proper at-home care and having regular dental exams.

When dental care is delayed or avoided due to fear, small problems that could have been prevented (or easily resolved) become big problems. Big problems require more extensive procedures, more expense and more time in treatment. When dental needs become more significant, fearful patients are actually adding to their reasons to dread the dentist.

Too, when regular dental check-ups and cleanings are avoided, the result can lead to periodontal (gum) disease, which is the nation’s leading cause of adult tooth loss. Periodontal disease occurs when an over-accumulation of oral bacteria become infectious. As it penetrates gum tissues, it also attacks the bone structures underneath the gums. This disease requires treatment that is more extensive. 

Additionally, tooth loss can create an entirely new set of procedural needs and costs.

For the individual who has high anxiety or fear associated with dental visits, how are they supposed to set aside these obstacles in order to receive the dental care they need? Obviously, problems in the mouth can easily exacerbate when the signs and symptoms of gum disease are back-burnered.

At our Asheville periodontal dental office, we believe that an informed patient is a healthier patient. Understanding what the problems are and what we are doing to attend to them often helps to keep the patient involved with their oral health. It also tends to help the patient relax. 

As a periodontist, I feel it’s important for every adult to know the signs and symptoms of gum disease:

Gums that bleed easily

Red, swollen, tender gums

Persistent bad breath

Gums that pull away from the teeth (recede)

Changes in the way teeth fit together when biting

Changes in the fit of partial dentures

Permanent teeth that loosen or separate

When any of these emerge, prompt treatment can minimize treatment time and costs. However, ignoring the warning signs merely allows the disease to progress further – requiring more time in treatment and greater expense.

In addition to the related problems of cavities, bad breath and tooth loss, the inflammatory bacteria of gum disease can impact overall health. Years of studies have found frightening correlations between oral bacteria and the worsening or development of serious diseases.

Research has found that the oral bacteria of gum disease (which affects over 47% of the nation’s adult population) can enter the bloodstream. Once bloodborne, this bacteria has been found to trigger inflammation that has been associated with a wide range of serious health problems. Research has shown links between these infectious bacteria to heart disease, stroke, diabetes, arthritis, some cancers, preterm babies, erectile dysfunction (ED) and even Alzheimer’s disease.

I am very proud of the relationship of trust my team and I have with our patients. They know our goal is to never cause them discomfort. Although we cannot always guarantee they’ll have no discomfort at all, we take extra steps to provide optimal comfort at every visit. 

In addition to this commitment, we offer oral sedation and I.V. sedation (also referred to as “twilight sleep”).

Oral sedation is a pill that helps patients relax. It also has an amnesiac effect, leaving most with little or no memory of treatment afterward. I.V. sedation places the patient in a deeper sleep state, also erasing memory of the procedure. It is administered by a doctor of anesthesiology, overseen by Dr. Brad Stone, a Medical Doctor (MD) and a board certified Anesthesiologist & Pediatric Anesthesiologist.

https://www.biltmoreperiodontics.com/comprehensive-care-team/

With both sedation options, patients are closely monitored with advanced safety equipment throughout treatment.

If fear has prevented you from a healthy smile, schedule a consultation in our Western NC periodontal dental office. During this time, we can discuss comfort options that may be best for your individual needs. Call 828-274-9440.

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