A Periodontal Specialist Explained


Posted on Dec 13, 2019 by William J. Claiborne, DDS MS

Occasionally, I meet someone new who is unfamiliar with my specialty. Although a periodontist may seems to be a “behind the scenes” specialist, our focus actually has an upfront role in your oral health, and beyond.

A periodontist is a dentist who specializes in the prevention, diagnosis, and treatment of periodontal disease, and in the placement of dental implants. Periodontists are also experts in the treatment of oral inflammation. Periodontists receive extensive training in these areas, including three additional years of education beyond dental school.

In addition to having advanced training in the latest techniques for diagnosing and treating periodontal disease, a periodontal specialist is also trained in performing cosmetic procedures that involve gum tissues, such as correcting a “gummy smile”.

Periodontists often treat more problematic periodontal cases, such as people with severe gum disease or have a complex medical history. A periodontist offers a wide range of treatments, such as scaling and root planing (cleaning the infected surface of the root) or root surface debridement (removing damaged gum tissue).

Periodontal specialists can also treat patients with severe gum problems using a range of surgical procedures.

In addition, periodontists are specially trained in the placement, maintenance, and repair of dental implants.

During the initial appointment in our Asheville periodontal office, we typically begin with a review of the patient’s medical and dental histories. This information is important so we are aware of medications being taken or if the patient is being treated for any condition that can affect periodontal care, such as heart disease, diabetes, or pregnancy.

During the examination, we check the patient’s gums to look for gum line recession. We will also assess how the teeth fit together when biting, and check for any loose teeth. An important part of this exam is in the measuring of spaces between gum tissues at the base of teeth.

Using an instrument called a probe that is gently positioned between specific points surrounding each tooth, we determine the depth of periodontal “pockets”. These measurements help us assess the health of your gums. Images (x-rays) may also be taken to revealsthe health of the bone below the gum line.

Periodontal disease, also referred to as “gum disease,” often exists without an individual being aware of its presence. In its early stage, gingivitis, some people even assume that symptoms, such as seeing blood in the sink when brushing, are normal.

Obvious symptoms, such as pain, may not appear until the disease has reached an advanced stage. This is why it is important to be familiar with the signs and symptoms, which include:

• Red, swollen or tender gums or other pain in your mouth
• Bleeding while brushing, flossing, or when eating certain foods
• Gums that are receding (pulling away from the teeth) or make the appear teeth longer than normal
• Loose or separating teeth
• Pus between your gums and teeth
• Sores in your mouth
• Persistent bad breath
• A change in the way your teeth fit together when you bite
• A change in the fit of partial dentures

If you notice any of these symptoms, be sure to contact your dentist or periodontist without delay. Gum disease will only worsen without treatment.

Who Should See a Periodontist?
Some patients’ periodontal needs can be managed by their general dentist. However, patients who are experiencing signs and symptoms of moderate or severe levels of gum disease or have more complex cases receive the most efficient and effective care through team treatment between a general dentist and periodontist.

Restoring your gums to a healthy state is important! As research continually shows, gum health is intricately connected to overall health. Oral bacteria of periodontal disease has been linked as a trigger for more and more chronic diseases, including heart disease, some cancers, stroke, memory loss, diabetes, and arthritis. Having prompt periodontal treatment by a trained periodontal specialist may lower the risk for more serious, and even deadly, diseases and health conditions.

If you are experiencing any of the symptoms associated with periodontal disease, a referral is not required. Call 828-274-9440 and we will be happy to assist you.

If you do not have a general dentist, we can also refer some who are near to you and we know to provide gentle, thorough and appropriate care for their patients’ needs.

Obesity Increases Risk Of Gum Disease.


Posted on Nov 20, 2019 by William J. Claiborne, DDS MS

Imagine one-third of your body being made up of maple syrup.

Sounds pretty absurd, doesn’t it? Yet, for Americans who are categorically obese, this imagery is actually a good description.

Obesity is when fat makes up over thirty percent of body mass. According to the Centers For Disease Control & Prevention (CDC), adults in the U.S. who are categorized as obese is at nearly 40 percent! Another 30 percent are categorized at overweight. That’s two-thirds of adults in the U.S. who have too much fat makeup.

And it’s not just adults over the age of 20 who have this problem. Sadly, nearly 30 percent of children are overweight or obese as well.

In North Carolina, over 63 percent of adults are either overweight or obese, according to a study by the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.  (https://onlinelibrary.wiley.com/doi/full/10.1002/oby.20451)

The problems associated with being overweight and obese are many, and can be deadly. Obesity seems to trigger a predisposition to a variety of serious health conditions and diseases. These include increased risk of stroke, certain cancers, coronary artery disease, and type 2 diabetes.

In addition to the added and unnecessary load that strains the back, knees and ankles, the challenges continue. Obesity decreases lifespan, up to an estimated 20 percent of people who are severely obese. (https://www.nejm.org/doi/full/10.1056/NEJMsr043743)

As 2019 holiday indulgences (often sugary and carb-laden) are before us, many of us also follow the season with with the traditional new year’s resolution of “lose weight” at the top of the list. Along with improved health and greater confidence in overall appearance, we’d like to add another reason to reach your goal.

Chronic inflammation is a known side effect obesity. Why does this matter to a Periodontist? Obesity is also known to exacerbate other inflammatory disorders, including periodontitis (advanced gum disease).  To be clear, periodontal disease is also the nation’s leading cause of adult tooth loss.

Research has shown that obese adults have a 6 times higher potential to develop periodontal (gum) disease. As a periodontal specialist my goal is always to help patients achieve optimal oral health. Although discussing the risks of periodontal disease with obese patients can be a sensitive issue, this is without judgement of why they are overweight but rather how we can help them enjoy a healthier smile.

Most of us know – losing weight is not a process that is either easy or quick. Add to this that research has shown that factors such as sleep quality and what we eat (as much as how much we eat) can cause the brain to make the challenges of weight loss even greater.

For one, studies have shown that sugar can be addictive. Sugar consumption even activates the same regions in the brain that react to cocaine. For individuals who admit to having a “sweet tooth,” trying to stay within the recommended 6 teaspoons per day limit can be a battle when we are truly “addicted.”  (https://www.brainmdhealth.com/blog/what-do-sugar-and-cocaine-have-in-common/)

Insufficient sleep also complicates the brain’s ability to regulate hunger hormones, known as ghrelin and leptin. Ghrelin stimulates the appetite while leptin sends signals of feeling full. When the body is sleep-deprived, the level of ghrelin rises while leptin levels decrease. This leads to an increase in hunger.

The National Sleep Foundation states that “people who don’t get enough sleep eat twice as much fat and more than 300 extra calories the next day, compared with those who sleep for eight hours.” (https://www.sleepfoundation.org/sleep-topics/the-connection-between-sleep-and-overeating)

As difficult as losing weight can be, it is important to be aware of risk factors that can make you more suspectible to gum disease. Initial symptoms include gums that are tender, swollen, and may bleed when brushing. This stage, known as gingivitis, is actually reversible with prompt, thorough oral hygiene.

As gum disease worsens, however, the inflammation of oral bacteria can lead to persistent bad breath, receded gums that expose sensitive tooth roots, and gums that darken in color. If untreated, pus pockets can eventually form and the base of some teeth and tooth loosening can require removal.

Armed with this information, we want to help all patients, with overweight or obese adults especially, to take added precautions to maintain good oral health, both at home and through regular dental check-ups.

Avoiding periodontal disease is particularly important since its infectious bacteria have been linked to serious health problems. These include heart disease, diabetes, arthritis, some cancers, preterm babies, impotency, and Alzheimer’s disease.

If you are experiencing symptoms of gum disease, however, it is vital to be seen by a periodontist as soon as possible to halt further progression. A periodontist is a dental specialist who has advanced training in treating all stages of gum disease as well as in the placement of dental implants. The earlier the treatment, the less involved treatment requirements will be. Gum disease will not improve without professional care.

Call 828-274-9440 to schedule an initial examination or begin with a consultation.

Using A Manual Or Electric Toothbrush Could Make A BIG Difference.


Posted on Sep 11, 2019 by William J. Claiborne, DDS MS

If you use an electric toothbrush, that can help in the prevention of tooth loss. However, it’s but one part of the steps needed for thorough oral hygiene at home.

Findings of an 11 year study published in the Journal of Clinical Periodontology tracked the oral health of over 2800 adults. Their use of electric toothbrushes was monitored to watch for periodontal disease, cavities, and the number of natural teeth.

Participants were examined in 2002 – 2006, with 18 percent being electric tooth brush users. Follow ups were conducted after six and 11 years. At the time of their 11 year follow up, 37 had converted to using electric toothbrushes.

The study showed electric brushing promoted better gum health and slower progression of gum disease. Electric tooth brushing also related to a reduction in tooth loss by 20 percent (compared to those who brush with manual toothbrushes). The study did not reveal measurable reduction in cavities, however.

Although more adults are using them, their long-term effectiveness has not been proven to be significant. It is suspected that this is due to technique more than the brushing tool itself. For manual brushers, a major hazard with manual brushes is one’s choice of bristles. Stiffer bristles can be very damaging.

If you use a hard bristle tooth brush, you may be damaging tooth enamel and gum tissues. People often feel they need to press down firmly as they brush and use a scrubbing, ‘back & forth’ motion. This action can wear down the protective shell of tooth enamel, leaving teeth more vulnerable to decay.

Another problem with using a hard bristle tooth brush is its ability to damage tender gum tissues. If the bristles on your toothbrush are fanned out after a couple of months, it’s because you are applying too much pressure when brushing.

The ideal technique for brushing teeth is applying gentle pressure on the brush in a swirling motion. By using a circular pattern over both sides of each tooth and along the tops, teeth are cleansed without wearing away gum tissues.

This is where electric toothbrushes can help greatly. Many of the newer models include timers to indicate the time needed for each quadrant of your mouth. This is your teeth divided into 4 sections. They also warn you when you are using too much pressure.

While tooth enamel is important, equally so are the health of your gum tissues. The gums provide a seal around the base of each tooth. This seal helps to prevent the entry of bacteria that can lead to periodontal (gum) disease, which the nation’s leading cause of adult tooth loss.

As devastating as tooth loss can be to one’s overall health, as we now know that the bacteria of gum disease can enter the bloodstream. Research has shown this infectious bacteria can trigger inflammatory reactions elsewhere in the body, correlating to heart disease, stroke, high blood pressure, some cancers, diabetes, arthritis, impotency, preterm babies and more.

Whether using a manual or electric tooth brush, it is necessary to brush twice a day for effective results. In order to thoroughly remove the sticky film of plaque from teeth, you should also brush at least two minutes each time.

Plaque is a buildup of oral bacteria that coats teeth and gums. If not removed daily, it forms a hardened mass of calculus (or tartar) that attaches to teeth. This is what you may feel your hygienist scraping off teeth during cleanings since it cannot be brushed or flossed away.

Another place for oral bacteria to thrive are the grooves in the tongue. These offer a dark, warm and moist environment for bacterial reproduction. To uproot these organisms (that reproduce rapidly), use your toothbrush to brush your tongue after brushing teeth. Be sure to reach the back of the tongue where the majority of oral bacteria are embedded. Swish with water several times after.

Another way to improve gum health, lower cavity risk, and prevent tooth loss is through flossing. It is estimated that only 31 percent of American adults floss on a daily basis. Because brushing cannot dislodge all food particles caught between teeth, daily flossing should be a part of oral hygiene routines.

Flossing removes trapped bits of food remain in the mouth, which feeds oral bacteria and helps them to quickly multiply. Proper flossing is easy for those who are in the habit of it and takes under a minute each day. For those who have problems with manual dexterity or find the maneuver awkward, water flossers are effective alternatives and easy to use.

Practice the recommended techniques mentioned above and you’ll not only do a better job at having a clean mouth, you’ll find your time at the sink requires less effort. If you feel you may be experiencing symptoms of periodontal disease, however, don’t delay. You should be seen at your earliest convenience for treatment since this disease will only worsen over time.

Signs of gum disease include tender gums that bleed easily when brushing, gums that darken in color to red (versus a healthy pink), frequent bad breath, and gums that pull away from teeth (receded gums) and expose darker root areas of the tooth.

If you’ve noticed any of these, please know that the condition will only worsen without treatment. As a periodontist, I specialize in gum tissues (as well as dental implants). Our environment optimizes patient outcomes and comfort throughout treatment.

Call 828-274-9440 to learn more.

Gag Reflex? Some Tips To Help.


Posted on Sep 04, 2019 by William J. Claiborne, DDS MS

For people who have a sensitive gag reflex, going to the dentist can be a trying experience. After all, the suction tube that removes water spray and saliva accumulating in the back of the mouth can trigger it. Once activated, gagging becomes all the more likely.

A gag reflex is a protective reaction that helps prevent foreign bodies from entering the trachea. While gagging is an involuntary and natural response, over thirty percent of otherwise healthy adults have an abnormal gag reflex.

For those who have a severe gag reflex, the mere thoughts of a suction tube or having a dental impression taken can create both dread and fear of embarrassment. After all, gagging triggers a spasm, which causes some people to have dry heaves or even regurgitate. Gagging may also be caused by acid reflux. For some, it can be triggered by certain smells and even anxiety.

Having a severe gag reflex is nothing to be ashamed of; it’s a common occurrence. If you feel this is a concern, feel free to mention this prior to any procedure (including dental cleanings). If you have avoided dental care because of gagging worries, we can discuss ways to help minimize the response and make procedures more comfortable.

The tips offered below may also help you reduce the severity of your gagging reflex as well.

• Breathe through your nose – Breathing through the nose can alter your focus from the potential to gag. Some patients find it beneficial to count their breaths to distract their minds. Breathing through the nose can also help your ability to relax. Concentrate on taking deep breaths in and out as you relax the jaw muscles.

• Go to your ‘happy place’ – When the fear of gagging is replaced by pleasant thoughts, patients are less likely to gag or the severity of the reflex is reduced. Think about things and people who make you happy. Your grandchildren? Your best friend? Relive a terrific vacation in your mind. Relaxing on a beach? Hiking a beautiful mountain? Think about foods that bring back memories. Peach cobbler with ice cream melting on top?

• Occupy your mind with tasks – A great distraction is to think of to-do’s in our head. For example, make a grocery list or the birthdays you need to remember for the next few months. The goal is to take your focus away from what’s going on in your mouth.

• Ask about sedation options – Having a severe gagging reflex may be helped greatly with an added sedative. In our Asheville periodontal office, we offer oral and IV sedation. Oral sedation is in pill form and has a quick recovery. I.V. sedation (referred to often as twilight sleep), provides a deeper level of sedation.

• Know you can take a break – Our patients are not prisoners in a chair, at any point – We realize some procedures can be long and are happy to provide a break to sit up, or move your mouth around, or get up and walk around. An opportunity to move your head and neck muscles around may revive you and provide just the relaxation you need.

• Don’t think of drooling as awkward – Saliva is a natural flow of moisture in the mouth. Drool is simply saliva that gets past the lips. As dental professionals, drool is not something that bothers us If drooling helps to relax your gag reflex, then go for it. If you do, we’ll help keep you comfy with suction and dabbing with tissues as needed.

Remember, gagging is rather common occurrence in a dental office. If gagging has caused you to avoid or delay having regular dental care or lengthy procedures, consider scheduling a consultation appointment in our beautiful Asheville periodontal dental office.

Call 828-274-9440 to schedule.

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