Common Contributors to Tooth Loss

Posted on Sep 11, 2023 by William J. Claiborne, DDS MS

Our natural teeth seem hard and solid, able to endure much over the span of a lifetime. However, as we all know, teeth can be knocked out due to accidents or injury and lost due to becoming overly decayed, fractured, infected and – the leading cause – periodontal (gum) disease.

Your gum tissues serve as protection for the tooth structures you cannot see – the tooth roots and bone and tissues supporting the roots. And, teeth need these bone structures to stay healthy and vice versa; the bone structures beneath the gums need the presence of the roots to stay healthy.

The jaw bones are kept healthy by tooth roots that provide stimulation to the bone as well as nourishment that runs 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, 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.

According to the Center for Disease Control & Prevention (CDC), 69% of adults between ages 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% are missing all of their natural teeth. That’s over one-fourth of the adult population over age 65.

Because of the strength and seemingly rock-solid presence of teeth, it may be assumed they’ll last for a lifetime. And, they can. Natural teeth can and should last a lifetime with proper maintenance and care. However, certain things can contribute to tooth loss; some of these may not be well known.

These include:

GUM DISEASE – Signs and symptoms of gum disease are:

• Red, swollen or tender gums
• Seeing blood in the sink when brushing
• Receded gums
• Loose or separating teeth
• Pus pockets on gum tissues
• Sores in the mouth
• Persistent bad breath

When these indications exist, it is important to seek periodontal treatment as soon as possible. Gum disease only worsens without treatment, requiring more time and expense to rid this serious, even deadly, inflammatory disease.

NOT FLOSSING – While tooth brushing helps to keep oral bacteria levels in the mouth to manageable levels, daily flossing is also recommended as a preventative way to keep cavities and gum disease at bay. Still, 70% of the American adult population do not floss daily. Even worse, about a third of Americans admit to never flossing (39% of men and 27% of women who do not).

SMOKING – According to the Centers for Disease Control & Prevention (CDC), a smoker has twice the risk for gum disease compared with that of a nonsmoker. (

AGING – With age, the body becomes less efficient in maintaining itself. Due to hormone changes and being less hydrated, joints wear down, skin loses subtlety and muscle mass and strength declines. The same is true with teeth, especially as gum tissues dry out. This means their tight, protective grip around the base of teeth loosens and pockets can easily for between teeth. All these factors contributor to higher risks of gum disease and tooth loss.

ORAL DRYNESS – The tissues inside the mouth need to be kept moist. Saliva flow is designed to do this. However, with age, the flow of saliva is less plentiful. Just as the skin and hair get drier with age, the mouth endures this same consequence. When saliva flow is less efficient at rinsing bacteria from the oral cavity (inside of the mouth), bacteria grow at a more rapid rate. This means bacteria accumulation occurs more frequently than twice-a-day brushing can control.

MEDICATIONS – The average adult in the 65-79 age group has over 27 prescriptions filled each year. ( Many meds have the side effect of oral dryness or increased bleeding, including some herbal supplements. For example, Ginkgo Biloba and Vitamin E can act as blood thinners. When combined with aspirin, the combination may cause difficulties in blood clotting.

To halt the potential for tooth loss if you are already missing teeth, dental implants are recommended. They actually protect the health of neighboring teeth. In addition to helping the supportive bone structures retain bone mass, teeth supported by implants do not rely on the support of crowned (or ‘capped’) teeth on both sides. This means the integrity of adjacent teeth is preserved.

Dental implants come in over 40 different types designed to accommodate various challenges and preferences. This is one reason (of many) that a periodontist is an ideal choice for the diagnosis and placement of your implants. Our speciality understands the complete spectrum of implant systems. While some implant systems may be ideal for your needs, others may not. And, the choice of which will achieve your goals is not limited to just those types a non-specialist knows how to place.

For example, some dental implants provide you with a non-removable (“fixed”) option while others may involve removable teeth. Additionally, the proper selection of your dental implants may greatly save you in treatment fees.

For example, the All-On-4 dental implant system needs only 4 implants per arch, and can be placed in shallow bone. The treatment fees are less since the number of implants is low and the need for bone regeneration for severe bone loss may not be required. For these reasons, a periodontist may be able to help you achieve your tooth replacement goals within a budget you can manage.

Our Western NC periodontal dental office features some of the industry’s most advanced technology, which helps to optimize success rates, shorten treatment time, and enhance comfort. This includes 3-D Cone Beam imaging, which is ideal for diagnoses and treatment planning. These amazing images provide a clear view of the upper and lower jaw (including nerve canals) in a process that is quick, painless and at minimal radiation levels.

We also have a computerized Dental Implant Placement system for pre-surgical positioning of dental implants. Using a 3D model of the patient’s jaw, a template is developed for the most conservative treatment process needed, even for complex cases. This minimizes disruption of gum tissues and targets implant placement at ideal depths and angles.

Because we make patient comfort one of our highest priorities, we offer several sedation options, including oral and IV sedation. 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 (also known as “twilight sleep”) places the patient in a deeper sleep state and erases memory of the procedure. It is administered by a Medical Doctor (MD) who is a board certified Anesthesiologist.

If you have lost teeth (or struggle with a denture or partial) and are considering dental implants, begin with a consultation appointment. Call 828-274-9440. New patients are always welcome.

Grow Older With A Confident Smile That Is An Asset To Your Well-Being

Posted on Jul 27, 2023 by William J. Claiborne, DDS MS

Oliver Wendell Holmes, an associate justice of the U.S. Supreme Court from 1902 – 1932, once said, “Old age is always fifteen years older than I am.” 

For people who’ve reached “a certain age,” it becomes clear that the advantages of aging (such as having more confidence and living life at a slower pace) are mixed with many challenges, mostly regarding health. 

From aching joints to loss of muscle strength to poor eyesight and hearing loss, the aging process comes with health challenges that seem to grow in number and severity with each passing year. Sadly, increased risk of tooth loss is also part of the process.

Depending on the retention of wisdom teeth, a full set of adult teeth should be 28 to 32. However, in a five-year study by the National Health & Nutrition Examination Survey, Americans ages 75 and over were missing over 22 natural teeth with over 26% having no remaining teeth (known as being edentulous).

While tooth loss is often perceived as a normal part of the aging process, it is not. Keeping one’s teeth throughout a lifetime is very possible. The health benefits of maintaining  natural teeth include, among many others, living a longer life.

Healthy teeth rely on a healthy foundation — your gums. Good oral health has been shown to reduce risks for serious health conditions (including heart disease, stroke, and some cancers) elsewhere in the body. In addition to lowering a number of health risks, keeping your natural teeth is necessary for proper biting, sufficient chewing, digestional health and nutritional intake.

It has also been shown that wearing dentures is a poor method of replacing natural teeth. Even though they recreate the appearance of teeth and restore function (to varying extents), dentures can actually contribute to long-term problems.

Natural tooth roots help to nourish and stimulate the jaw bones that are the supporting structures of teeth. Without them, the bones begin to shrink. Known as “resorption,” this process of bone mass decline can eventually lead to tooth loss. Once resorption begins,, it continues at an ever-increasing cases year after year.

Tooth loss also causes a domino effect of sorts. Statistics show that adjacent teeth beside an area of tooth loss have the highest risk of being the next to be lost.

And the problems associated with dentures continue. The gum-colored base of dentures is porous. This surface provides oral bacteria with tiny hideouts that are breeding grounds for high levels of bacteria. Denture wearers have higher incidences of respiratory problems, including susceptibility to pneumonia. Studies have shown that senior adults who also sleep in their dentures have even higher risks.

Wearing your dentures for prolonged periods of time (such as while you sleep) coupled with the aging process itself can lead to Denture Stomatitis. This condition causes redness, swelling and tenderness in the mouth. While it is most common among denture wearers, it can also occur from a broad spectrum of antibiotics.

Nearly 89% of adults ages 65 and older report they are currently taking any prescription medicine. More than half of adults 65 and older (54%) report taking four or more prescription drugs (compared to 32% of adults 50-64).

While a number of both prescribed and OTC medications include the side effect of oral dryness for any age, age-related reductions in salivary production are more severe for older adults, causing irritation to oral tissues.

Medications including antihistamines, blood pressure medications, decongestants, pain medications, diuretics and antidepressants typically cause dry mouth, which can create inflammation and higher susceptibility to infection.

The aging process causes the condition of “dry mouth.” Saliva plays an important role in maintaining good oral health. A healthy saliva flow makes it easy to talk, swallow, taste, and digest food. A reduction in saliva flow can increase plaque accumulation as well as the risk of developing periodontal disease. 

Referred to as gum disease, this bacteria accumulation can lead to tooth decay, mouth sores and oral infections. Inadequate saliva can contribute to bad breath, dry and cracked lips, cause the fit of dentures to become uncomfortable, and result in higher oral infection risk.

An emphasis on maintaining good oral health needs to be front and center for older adults along with their overall health care commitment. Fortunately, good oral health is easy to achieve. Twice-daily brushing, daily flossing and having 6-month dental exams and cleanings can help to minimize problems and address those that do occur at their earliest stages.

It is also important to keep your mouth moist. Drink plenty of water throughout the day. Limit foods and beverages that are caffeinated, which are drying to oral tissues. These include coffee, tea, colas and chocolate as well as spicy foods. If you take medications that have drying side effects, use an oral rinse designed to replenish moisture. Also, chew sugarless gum to help promote saliva flow.

Your diet is an important part of a healthy mouth. Evaluate your food intake carefully. Begin by limiting carbs and sugar. While all foods trigger an acid attack in the mouth for nearly 30 minutes after eating, sugar and carbs super-charge the reproduction of oral bacteria.

When teeth are lost, adults encounter a complicated set of issues – and costly challenges that can reach far beyond the mouth. As a Periodontist, I’ve seen how simple measures can save people greatly in treatment time and expense AND prevent problems like gum disease, cavities and tooth loss.

According to Woody Allen, “You can live to be a hundred if you give up all things that make you want to live to be a hundred.” Your smile should be one of your best assets throughout your lifetime, complementing appearance and as an advantage to your overall health. Don’t let the detrimental impact of tooth loss and risks associated with gum disease make you look and feel old.

If you have begun to lose natural teeth, let us help you halt the process! We can also discuss replacing them with dental implants with our specialized skills in the diagnosis and placement of dental implant.

Call 828-274-9440 to schedule a consultation to discuss how you can regain your oral health for a lasting, healthy smile!


AI in Dentistry – A Good Thing.

Posted on Jul 05, 2023 by William J. Claiborne, DDS MS

I remember when microwave ovens first appeared on the market. My mom wouldn’t even go near one in operation. Now, we know how to use them and the good things that come from their use.

Shoot forward 50 years and, like it or not, AI (artificial intelligence) is here. Self driving cars and round vacuums that move along floors are no longer Jetson-like imaginings. They’re blending into our lives in ways that are beneficial and non-threatening.

Like the microwave oven easing its way into day-to-day living, it’s logical that some people fear AI as a bad thing. After all, movies made decades ago prompted a vision of robots meandering among the human race as a new, threatening species.

As an Asheville periodontist, I’ve already seen – and incorporated in use – the positive aspects of breakthrough technology. Understanding its detection capabilities and accuracy, I’m particularly excited about the potential AI brings to the medical and dental fields.

You may be surprised to know that dentists are already beginning to turn to AI technology to quickly and accurately detect and prevent periodontitis, decay, bone loss and other gum health issues.

For example, a medical technology company in Boston has developed an AI platform that can assess X-ray images to an extent of over 50 times what can be detected by dentists through visual reviews. This allows dentists to give more effective treatment recommendations for patients while supporting the potential to avoid (or minimize) existing problems from developing or worsening.

For patients, AI assessments can also be reassuring. For those who anticipate particular treatment needs – a root canal, for instance – these assessments can zero in on exact issues so treatment planning is as conservative and as minimal possible, while being fully effective for the particular need.

Not just in medical and dental offices, but we’ll likely see AI used mainstream in many sectors. It can optimize accuracy in organizational materials, financial and budget projections, construction, farming, etc. For those of us in the periodontal dental field, AI has a vast potential to greatly improve the oral – and overall – health of our population.

Gum disease affects over 47% of American adults. With the help of AI, we can identify a higher percentage of cavities in earliest development stages while cutting the rate of misdiagnosis in half (thus curtailing over-treatment, in some cases). AI analysis will also aid in early detection of abscesses, lesions and oral diseases. It can prove to be a remarkable asset in catching oral cancer, helping to increase its poor survival rate or minimize the severity of treatment.

Through decades of research and extensive studies, keeping good oral health has been shown to be a supporting factor in good overall health. By keeping the “bad” bacteria in the mouth to manageable levels, the immune system operates more efficiently. Too, risk of medical complications from diabetes, heart disease and other illnesses can be significantly decreased.

It is suspected that many people are unaware that they even have periodontal (gum) disease, mainly because gum disease often begins with no obvious symptoms of its presence. Then, once symptoms appear (such as seeing blood in the sink when brushing), people may shrug this off as normal, or merely a sign they are being thorough in their brushing technique.

Gum disease is a particular problem for our aging population. The normal aging process dries out our hair, skin, and yes, the mouth. When the mouth is dry and saliva flow is insufficient, bacteria accumulation is more likely. This, in turn, provides a more welcoming environment for bacteria growth.

Too, many medications on the market – both prescription and OTC – have a side effect or oral dryness. This is double trouble for seniors, who already have “dry mouth” to combat. However, for people who smoke and/or are consumers of caffeine, they fall into this risk group as well.

Caffeine is present in coffee, tea, most colas, and (darn!) even chocolate. It can be in high concentrations in things like energy drinks and “power” bars. Caffeine-fortified foods can surprisingly include marshmallows, some cereals (and breakfast bars), jelly beans, gummy bears and frozen waffles.

Although AI will be an added perk to diagnosing oral health problems, it is the dentist and the patient together who have much more important roles. While regular dental check-ups help to remove existing buildup on teeth (known as plaque, which can harden into tartar), at-home care is what helps to prevent problems between visits.

It is first important to know the signs and symptoms of the various stages of gum disease. Warning signs include:

• Red, swollen, or tender gums or other pain in your mouth
• Bleeding while brushing, flossing, or eating hard food
• Gums that recede or pull away from the base of teeth
• Loose or separating teeth
• Pockets of pus between gums and teeth
• Sores in the mouth
• Persistent bad breath
• A change in the way your teeth fit together when you bite
• A change in the fit of partial dentures

The dentist-patient relationship can never be replaced by AI. Once you find a dental office where you feel respected, comfortable, and have total confidence, technology itself is merely an add-on.

If you have not had regular dental care or feel you have symptoms of gum disease (as listed above), it is recommended that you renew your commitment to your smile and your overall health with a complete periodontal dental examination.

During this time, your periodontist will note any areas that are diseased or at risk of developing such. He or she will explain recommended treatment and discuss a comfortable pace for your individual needs. Payment plans can also be discussed after determining the type of treatment most appropriate for your care.

If dental fear or anxiety has kept you from regular dental care, our NW Carolina periodontal dental office has a reputation for helping adults overcome the obstacles it can pose. Please share your concerns prior to or during your examination appointment. We offer several comfort options (in addition to our reputation for a gentle touch) and can explain what may be best for your care. We offer oral and IV sedation (twilight sleep), which are administered safely and with advanced monitoring equipment.

Too, our vast array of advanced technology often helps to minimize treatment while optimizing comfort. Please learn more about these features at: BiltmorePerio-Technology

We can’t stop progress, nor should we resist it. While most anything can be used with ill-will, I see AI in dentistry as a positive part of providing exceptional oral health to our patients – and our adult population!

But first, we must get you into the office. And that’s your decision. We don’t have technology to coax you in and hope you will take that step on your own before problems force you into a dental chair (which is often the case, unfortunately).

Call 828-274-9440 for an appointment or to have your initial questions answered.



Avoid An Aged Appearance By Keeping Facial Bone Structures Healthy

Posted on Jun 21, 2023 by William J. Claiborne, DDS MS

The aging process can, unfortunately, take quite a toll on appearance. Shoulders may slump, waistlines may widen, and hair may turn gray. As a periodontist in Western NC, I see another telltale sign of aging – resorption. This is the process of bone loss when natural tooth roots are missing from the jaw bones. Facial features affected by resorption can reveal quite a lot, and not in a flattering light.

A natural tooth is held by the upper or lower jaw bone by its roots. Around the base of each tooth, gum tissues wrap snugly to prevent entry of bacteria and protect sensitive tooth roots. These roots help to keep the tooth ‘alive’ by supplying blood and other nutrients to the bone supporting the tooth. Through the presence of these roots, the jaw bones also receive valuable stimulation, which helps the bone retain its mass. 

Losing a tooth can trigger a domino effect, of sorts. Statistics show that tooth loss is most likely to occur in an area next to that of a missing tooth. Without the stimulation of tooth roots, the bone in that area will begin to resorb, or shrink in mass. This increases risks for adjacent teeth.

The process of resorption begins slowly the first year. However, the rate of bone loss accelerates more and more each year. For people who wear a denture or partial, the pressure of wearing these appliances can speed up the rate bone loss even more. Eventually, facial features change due to the declining bone structure, changes that tend to age one’s appearance far beyond their actual age.

Initially, the changes may be subtle, such as deep wrinkles around the mouth. The corners of the mouth begin to turn downward, even when smiling. Jowls form as facial muscles detach from shrinking bone structures. As the bone declines further, the chin becomes more pointed and the mouth seems to collapse into the face. The chin moves closer to the nose, creating what’s referred to as a ‘granny look.’

Dental function also takes a hit when it comes to tooth loss. The strength of the bite becomes challenged. Jaw bone breaks are more likely. Wearing a denture or partial becomes challenging due to its declining ‘ridge’ that is relied upon for support. Dental prosthetics begin to slip while eating, or even speaking. Eventually, frequent applications of denture pastes and adhesives are needed. After a time, even relines help very little.

As a periodontal specialist, one of my advanced skills (in addition to the treatment of all stages of gum disease) is in the diagnosis and placement of dental implants. For adults who are missing one or more natural teeth, we recommend dental implants for a number of reasons. 

Why should you have your dental implants placed by a periodontist?

There are over 40 different implant systems, each designed to accommodate various needs and goals. For example, one consideration in determining the type of dental implant is in the assessment of jaw bone mass.

An implant needs a particular amount of bone structure to support it. After several years of missing tooth roots, the amount of existing bone may eliminate some types of dental implants or indicate the need for additional procedures prior to placement.

With adequate bone mass to support the implant(s), the choice of implant can be made based upon your needs and preferences. Without the necessary bone mass, we may advise a bone rebuilding process prior to implant placement. Typically, this does not require a bone graft. In many cases, we are able to apply a bone rebuilding material that regenerates ample bone mass. Or, we may advise an implant system that uses unique implant lengths and placement angles (the “All-On-4”) that can function dependably in minimal bone.

The benefits of dental implants are many. These include:

A lifetime solution – When properly selected and placed, dental implants are designed to last a lifetime. This is why a periodontist is an ideal choice for your selection and placement. 

A healthy choice for remaining teeth – Although each natural tooth seems to “stand alone”, individually, they provide support for the teeth on each side and the one above or below. This helps to keep teeth in their proper positions. However, dental implants provide stimulation to the bone to help retain bone mass. And, teeth supported by implants do not rely on the support of crowned (or ‘capped’) teeth on both sides. Thus, preserving the integrity of adjacent teeth.

Restoring biting and chewing stability – Because dental implants are anchored by the jaw bone, biting and chewing stability is restored. People who have dental implants are able to eat healthy, fibrous, and chewy foods once avoided due to ill-fitting dentures or partials. 

The feel of your “own teeth” – Rather than have clunky dental prosthetics in your mouth, dental implants act like your own teeth. You can brush them in your mouth and eat foods you love and laugh with friends. Unlike dentures or partials, no more sore spots rubbed on tender gum tissues and no more piercing seeds caught between the gums and denture base.

A wise investment – Dental implants, unlike crown-&-bridge, dentures or partials, will not break, develop a cavity, require periodic “relines,” or need a root canal. Made of titanium, an implant will last your lifetime without requiring the upkeep of other types of restorative options.

In our Asheville periodontal dental office, we offer some of the most advanced dental technology available. This allows our patients to enjoy optimal comfort with minimal treatment time. We are also committed to patient comfort through oral and I.V. sedation (“twilight sleep”). These are administered safely with continual monitoring by trained team members.

If you are considering dental implants to replace missing teeth, begin with a consultation appointment. This will take place in a private room where we can discuss your needs and concerns. Call 828-274-9440 to schedule, or tap here for contact information.

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