Many Reasons To Repair Gum Recession
Posted on May 19, 2022 by William J. Claiborne, DDS MS
If you are occasionally experiencing sensitivity around one or more teeth, especially when eating ice-cream or drinking hot coffee, this is likely due to receded gums.
While using a sensitivity toothpaste can somewhat minimize these sensations (which can become painful jolts), the problem will remain. The source of sensitivity, most often, is because the highly-sensitive tooth’s root area has been exposed by the pulling away of gum tissues.
The gum tissues are designed to provide a tight seal around the base of each tooth, which blocks bacterial entry to the sensitive tooth root area. In addition to sensitivity, recession means oral bacteria can penetrate beneath the gum’s surface. Once beneath the surface, the accumulating presence of this bacteria can lead to inflammation of the gums.
Eventually, the infectious bacteria attack the structures that support natural teeth. This bacteria indicates the presence of periodontal (gum) disease. Signs and symptoms of gum disease in its first stage include:
• Gum tissues that turn red
• Gums that become tender or swollen
• Gums that bleed when brushing
• Persistent bad breath
Obviously, it’s important to ensure the gums are healthy so the grip they have around teeth is snug. It’s also important to be aware of the causes of gum recession. These are:
The aging process – As people age, their gums become drier. This causes them to shrink and be less capable of keeping a secure grip around the base of teeth.
Periodontal (gum) disease – As mentioned above, gum disease destroys oral tissues and the bone that supports natural tooth roots. A sign of periodontal disease is gum recession. Gum disease is also the nation’s leading cause of adult tooth loss.
Poor dental hygiene – When twice-daily brushing, daily flossing, and keeping the mouth moist are insufficient to rid the mouth of bacteria, their accumulation can result in the sticky film you feel on teeth. This is plaque. In just a day or so, plaque can harden on teeth into tartar. This is a cement-hard bacterial colony that cannot be removed by brushing or flossing . It can only be removed during a professional tooth cleaning. If not removed, teeth, gums and the structures below the gum line can be damaged.
Brushing too hard – Brushing teeth rigorously doesn’t mean you are doing a good job. Using a scrubbing, back-&-forth motion can wear away tooth enamel and cause the gums to recede. Other damaging actions when brushing are or using a hard bristled toothbrush or abrasive substances, such as baking soda.
Hormones – Females experience fluctuations in estrogen levels during puberty, menstrual periods, pregnancy and menopause. During these times, the gums can be more sensitive and vulnerable to gum recession.
Tobacco use – In addition to the many health hazards smokers risk, they are more likely to develop plaque due to the oral drying effects of smoking. This dryness can lead to gum recession (not to mention brown teeth and bad breath).
Bite misalignment – When teeth don’t come together evenly, too much force can be exerted on the gums and surrounding bone, allowing gums to recede. Bite misalignment can also lead to grinding or clenching teeth. These harsh forces on teeth can cause the gums to loosen their grip.
If you have mild sensations of sensitivity, desensitizing toothpastes can help soothe the nerves by forming a protective barrier over teeth while blocking sensitivity signals. Although this type of toothpaste can be helpful, it should be used as a temporary aid.
The goal should be to repair recession and halt the problem from recurring. To do this, we begin by determining why the gum recession is occurring. The next step is to restore the gums to their proper positions.
The corrective procedure most often performed is a “gingivectomy” performed by a periodontal specialist. In addition to treating all stages of gum disease, a periodontist specializes in contouring gum tissues. Using advanced skills, a periodontist is able to create a natural look and restore your oral health.
A gingivectomy can reposition or graft gum tissues over the area of recession to restore a healthy seal and protect the tooth structures below the surface.
Another advantage of a gingivectomy is to help save a natural tooth. When a tooth breaks near the gum line, a “crown lengthening” procedure may be advised. In this, a periodontist may be able to expose enough of the tooth structure for the placement of a crown.
A crown lengthening procedure is an ideal accompaniment to many cosmetic dentistry treatments. When there are different heights of gum tissues framing the teeth most visible in a smile. This tends to create a jumbled looking smile, when when the teeth are straight.
Crown lengthening rebalances the height of gum tissues that arch the teeth to restore a smile that is balanced. From this, the eye is drawn to the smile as a whole rather than one or two teeth with varying heights of gum tissue.
A gingivectomy is also performed for individuals who wish to correct a “gummy smile.” This is when a smile shows too much gum tissue above upper teeth when smiling fully.
Gingivectomies are performed while the patient is comfortably numbed. For some people, sedation may be a preference for enhanced relaxation. Oral sedation is available in pill form, which allows patients to ‘doze’ through procedures. I.V. sedation, also known as “twilight sleep”, is available for patients who prefer a deeper level of sedation.
Both sedations are administered by fully trained team members who use advanced safety monitoring equipment. We believe your safety is as important as your comfort.
In our Asheville periodontal dental office, we also offer a wide array of technology. This often saves the patient time in treatment, enhances comfort, and speeds healing. For example, our dental laser can seal tissues as it contours it. This eliminates or greatly minimizes bleeding.
Pain is how the body indicates that something is wrong. When the gum tissues have receded, they are not going to repair on their own. Let’s discuss your particular needs, whether for improved oral health or to enhance the appearance of your smile (or both) during a consultation appointment.
Call 828-274-9440 to schedule a time.
There Are Good Reasons To Keep The Mouth Moist
Posted on May 11, 2022 by William J. Claiborne, DDS MS
Having good oral health takes a commitment. It requires us to devote time each day for oral hygiene, at least twice per day. However, it’s in-between these brushings that can impact the good that we are doing at the sink.
Nearly everything that causes problems in the mouth has to do with oral bacteria that has gone beyond manageable levels. Although the mouth is home to some very “good” bacteria, an overload of “bad” bacteria is what becomes the origin of many problems.
The reason people are advised to brush at least twice a day and floss daily is to remove accumulated oral bacteria from the mouth. When not removed on a regular basis, a sticky film of bacteria form, which coats the teeth and gums. This film is known as plaque. Without sufficient and frequent removal of plaque, it begins to harden at the base of teeth.
This is tartar (or calculus), which is actually a hardened mass of oral bacteria. Tartar cannot be brushed or flossed away; it requires removal by a dental professional who uses special tools during dental cleanings to scrap tartar from tooth surfaces.
Your periodic dental cleanings are important. If tartar is allowed to further amass, the bacteria can become inflamed, attacking gum tissues. As bacteria continue to reproduce, they create an inflammation that extends beneath the gum line. The infection they trigger can reach down into the structures that support natural teeth, including tooth roots, tissues, ligaments and bone.
Periodontal disease is the leading cause of adult tooth loss. The advanced stage of gum disease, known as periodontitis, creates a bacteria so potent that research has linked it to serious diseases elsewhere in the body. These include some cancers, heart disease, stroke, Alzheimer’s disease, diabetes, arthritis, preterm babies, and impotency.
To help control bacteria in the mouth, saliva serves as a rinse that removes food particles from the mouth. Combined with brushing and flossing, good saliva flow helps to keep bacteria levels under control.
When saliva flow is compromised, oral bacteria are able to reproduce and multiply quickly. As bacteria accumulate, a sticky film forms on teeth and gums from this buildup. As bacteria coat the interior of your mouth, bad breath begins. Then, the sequence of plaque, tartar and potential for gum disease (as mentioned above) begins.
Oral dryness is one of the biggest influences in developing gum disease. Even though poor oral hygiene is a key factor when it comes to bacteria overload, dry mouth is a common contributor because it has many causes.
A dry mouth can occur from:
• The aging process (affecting about 1 in every 5 adults)
• As a side effect of many medications (including prescription and OTC)
• Radiation therapy, especially for head and neck cancer
• Mouth-breathing, which may be due to nasal congestion or snoring
• Medical conditions, such as diabetes, Alzheimer’s disease, stroke and Sjogren’s syndrome
In addition to your twice daily brushing and flossing routines, it is important to know how you can support saliva flow and avoid the risks created by a dry mouth. These include:
• Drink plenty of plain water throughout the day. Leave off the lemon wedge, which is hard on tooth enamel.
• Avoid (or limit) caffeinated beverages, such as coffee, tea and colas. If you drink these beverages, rinse your mouth after or alternate with gulps of water.
• Consider using an oral rinse designed to replenish moisture in the mouth (available OTC).
• Be aware of medications that have a side effect of oral dryness. Some of the worst are antihistamines, depression and incontinence medications, and some that control blood pressure. If you take one of these, ask your doctor about options that may be less drying to the mouth. Or, increase your water intake and use a daily rinse to replenish oral moisture.
• If you snore or breath through the mouth during sleep, oral tissues are dry during these hours. Consider adjusting your sleeping position or adding a side pillow. Your physician may also have some suggestions, including an oral appliance.
• Certain health conditions can cause dry mouth, including acid reflux, sinus infections, diabetes and bronchitis . A bad cold can also force people to breathe more through their mouth. For these conditions, be especially committed to your oral hygiene routine at home (brushing and flossing) and up your water intake.
• Alcohol (including beer and wine) are very drying to oral tissues. Wine and mixed drinks have high levels of acidity and sugar that adds extra challenges to oral tissues. You can help to dilute the severity of these by swishing with water between drinks. Or, keep a glass of water nearby for occasional gulps that wash over teeth before swallowing.
• Smoking (cigarettes, cigars, vaping) are all laden with toxic chemicals (including e-cigs). Be aware of the added risks and be highly committed to your at-home care and drinking plenty of water to keep your mouth clean and moist.
It is also important to know the signs and symptoms of periodontal (gum) disease. It begins with gingivitis, which causes the gums to become tender and swollen. When brushing, blood may be present in the sink when rinsing.
Gingivitis, at this stage, can be contained and resolved if quickly addressed. If not, the bacteria will continue to multiply. This creates inflammation in the gums. This means the inflammation has progressed to periodontal disease, which requires treatment since it is now below the gum line.
Beneath the gum line, the bacteria continue their attack on the structures that support natural teeth. This includes the bone structures surrounding tooth roots. At this point, the gums bleed easily and breath odor is persistently bad. The gums become red and swollen and may pull away from the base of some teeth (gum recession).
If the disease is not treated, it will worsen to the stage of periodontitis. This is an advanced level of gum disease that is highly infectious and destructive. Because it leaves the gum tissues in such a weakened state, the infection can easily penetrate the gums and enter the bloodstream.
Periodontitis causes the gums to turn spongy with a putrid breath odor. Pus pockets form on the gums and it may become painful to eat. Some teeth may loosen and eventually need removal.
Periodontal disease is the nation’s leading cause of adult tooth loss. Yet, it becomes even more destructive once in the bloodstream. Researchers have linked these bacteria to a wide range of serious health problems.
The bacteria of gum disease have been correlated to heart disease, stroke, some cancers, diabetes, arthritis, preterm babies, memory loss and even impotency. This is rather telling as to the potency of this harmful bacteria and the destructive nature.
As a periodontal specialist, I find that most cases of dry mouth are due to factors that can be easily controlled with simple changes. If you have delayed or avoided dental care, call 828-274-9440 to request a consultation, or begin with a thorough examination in our Asheville periodontal office.
We offer the latest techniques, technology, and skills while always making patient comfort a top priority.
How Periodontal Health Affects Your Overall Health
Posted on Apr 28, 2022 by William J. Claiborne, DDS MS
There are many benefits to having a clean, healthy mouth… fresh breath, bright teeth, avoiding cavities and preventing periodontal (gum) disease. However, much research shows that the health of your mouth can also affect your overall health to a rather significant extent.
Over the years, numerous studies have been able to pinpoint how certain diseases, such as coronary artery disease, diabetes, arthritis, etc. can be triggered. While there is still much to learn with some of these, the origins often point to internal (or “systemic”) inflammation.
Inflammation in the body has been shown to set actions into play that cause the onset or worsening of a wide variety of health problems. Periodontal disease is a chronic inflammatory disease. This means the bacteria that attack tooth enamel and gum tissues are in a consistently active state.
When the bacteria of gum disease enter the bloodstream (through tears in weakened gum tissues), it can create inflammatory triggers far beyond the mouth. This bloodborne inflammation, in turn, results in higher risks for heart disease, stroke, diabetes, preterm babies, arthritis, respiratory diseases and even impotency.
To clarify, inflammation is not necessarily a bad thing. It’s the body reacting to an overload of bacteria. For example, the redness or slight swelling you see as a cut heals is a sign that the body’s defense system is fighting off bacteria that could create infection.
In chronic inflammation, however, the body’s defense mechanism becomes stuck in the ‘on’ position. This sets into motion a chain of reactions that transform a beneficial response into a harmful one. When an area in the body that stays in an inflammatory setting, there is a risk for damaging reactions.
One of the first correlations between oral bacteria and other serious health problems was found in heart disease. According to information published by the Harvard Medical School:
“In people with periodontitis (erosion of tissue and bone that support the teeth), chewing and toothbrushing release bacteria into the bloodstream. Several species of bacteria that cause periodontitis have been found in the atherosclerotic plaque in arteries in the heart and elsewhere. This plaque can lead to heart attack.
“Oral bacteria could also harm blood vessels or cause blood clots by releasing toxins that resemble proteins found in artery walls or the bloodstream. The immune system’s response to these toxins could harm vessel walls or make blood clot more easily. It is also possible that inflammation in the mouth revs up inflammation throughout the body, including in the arteries, where it can lead to heart attack and stroke.”
Another good example is in the similarities between the tissues of gum disease and those taken from arthritic joints (another inflammatory disease). For decades, it was perceived that RA (rheumatoid arthritis) patients had such a high risk of gum disease due to poor oral hygiene because of dexterity problems with using a toothbrush. However, continued studies showed that gum disease is actually a risk factor for arthritis.
And, it was found that one can contribute to the other. Gum disease is a risk factor for developing RA and having arthritis patients have a greater risk for gum disease.
While genetic factors certainly contribute to greater RA susceptibility, the true source has been determined to be inflammatory reactions. This inflammation is triggered primarily by bacterial infections and the list of damaging outreach of oral bacteria seems to get longer and longer.
Studies have shown that pregnant women with periodontal disease have a greater risk of having pre-term and low birth weight babies. These indications have been found in amniotic fluid and in fetal cord blood samples of infants.
Also alarming is research that revealed that the bacteria of periodontal disease may contribute to a higher risk of pancreatic cancer. For years, researchers at the National Cancer Institute and the American Cancer Society have conducted a cancer prevention and screening study.
By studying oral samples, notably higher levels of two types of oral bacteria were measured in study participants with pancreatic cancer. One oral bacteria was found to create a 50 percent increased risk for pancreatic cancer and the second oral bacteria led to a 59 percent greater likelihood.
Chronic inflammation, in any area of the body, is a health risk that poses severe challenges. Not surprisingly, we occasionally see patients who have been advised by their surgeons to have their gum health checked prior to surgery. This proactive measure is to reduce risk factors that could complicate surgical outcome.
If you have symptoms of gum disease, please be seen by a periodontist promptly. Symptoms include tender gums that bleed easily when brushing, frequent bad breath, swollen and tender gums and gums that redden in color from a healthy pink. Remember, gum disease will only worsen without treatment and is the nation’s leading cause of adult tooth loss.
Maintaining good at-home care of your oral health is easy and takes just minutes a day. Follow a thorough oral hygiene regimen by brushing twice a day (two minutes each time) and floss daily. Drink plenty of plain water throughout the day and limit sugar. Have dental cleanings every six months and follow your dental hygienist’s recommendations to keep oral bacteria at minimal levels between visits.
If you suspect you have gum disease or have delayed (or avoided) having regular dental care, call our Asheville periodontal dental office to schedule an examination. Or, ask to begin with a consultation appointment. During this time, we can discuss any concerns and I’ll gladly answer any questions. Call 828-274-9440.
Dental Implants – Lower Risks Of Failure With These Tips
Posted on Apr 21, 2022 by William J. Claiborne, DDS MS
In our Asheville periodontal dental office, we believe our patients appreciate being fully informed about their oral health status and understanding their options for treatment. For those who have lost natural teeth, our specialty dental services include the diagnosis and placement of dental implants.
The specialized skills of a periodontist provides implant patients with a high level of success in treatment outcome. It also offers patients a wider variety of choices when it comes to implant systems.
This is why many general dentists who offer dental implants refer the placement portion to a periodontal specialist. For their patient, this can mean a higher level of success, especially for complex needs.
For example, a patient who is missing a lot of bone mass (often due to missing natural teeth for many years) benefits from the specialized skills of our Asheville periodontal office. Another example is a patient who has lost teeth due to periodontal (gum) disease. Because a periodontist combines advanced skills in treating gum disease as well as in dental implants, these patients are given a ‘leg up’ when it comes to treatment success.
In making your decision to opt for dental implants vs. crown-&-bridge, dentures or partials, it is important to understand the basics of how dental implants work. Although there are different types of implant systems, all work in in a similar fashion.
An implant is similar to a screw-like cylinder that is hollowed out in the center. This segment is what is placed into the bone to serve as a tooth root replacement.
Selecting the most appropriate type of implant and how many are needed is based on specific needs and goals. Our Western NC periodontal office plans for your placement procedure using computerized technology to determine the precise angles and depths for each implant before the placement procedure begins. This minimizes disruption to the gum tissues and bone structures, which in turn reduces healing time and optimizes comfort.
Once placed, each implant is covered over with gum tissue. For several months after, the implant goes through a process known as “osseo-integration.” During this phase, the bone grows around the implant, securing it into the bone. This recreates the foundation of natural tooth roots to give biting and chewing stability. Throughout this time, you can wear a denture or temporary so you are never without teeth.
Once healing is complete, a post is secured inside the hollow core of the implant. This post (or “abutment”) will support your final replacement tooth or teeth.
An important aspect of implant success also relies on the proper assessment of bone mass. When the upper or lower jaw has insufficient bone to support the implant being placed, there is a risk of failure.
Again, an implant requires careful selection and placement to be able to support the replacement teeth being attached. In some cases, as few as 4 – 6 implants can support a complete arch of teeth. This decision is best left in the hands of a periodontal specialist.
Severe bone loss can require bone rebuilding procedures prior to implant placement. This can be done by bone grafting or the application of a bone-rebuilding material. In some cases, dental implant systems designed with unique angles (such as the “All On 4”) can support a fulll arch of upper or lower teeth using minimal bone depth with no bone rebuilding necessary.
Another perk of the All On 4 is the forces of chewing and biting require only 4 implants on the upper and/or lower. Because implant costs are largely based on the number of implants placed, this can be a great savings for people who are candidates.
Why does successful placement rely so greatly on assessing bone mass? An implant must be placed in adequate bone that does not risk interfering with adjacent structures.
Without proper placement in sufficient bone, an implant risks coming in contact with a nerve that extends horizontally through the lower jaw. Upper implants placed too close to the sinus cavity can, over time, penetrate that area. Removing an implant in either of these situations, of course, is no simple task.
The ability to select the proper implant type for available bone depth is equally important.
Dental implant diagnosis and placement skills can vary greatly from one dentist to another. While some have taken extensive courses in implant dentistry, others may have taken a weekend course here and there. These are typically ‘hosted’ by a particular manufacturer who provides ‘training’ in a limited selection of implant types. In turn, this can limit the patient’s choices when relying on appropriate recommendations for his or her unique needs.
Obviously, a qualified doctor can enhance your potential for a successful outcome, which is where a periodontal specialist is a wise choice. A Periodontist has particular expertise in the diagnosis and placement of all types of Dental Implants. As a matter of fact, many general dentists prefer to have a Periodontist place implants in their patients. The patient then returns to their dentist for the attachment of teeth to the implants.
Rest assured – in our office, comfort is always a priority. For our patients, we offer oral or I.V sedation to accompany many procedures. While both are beneficial to calm anxiety, tension, stress or even intense feelings of fear, each has its advantages as well as limitations.
Oral sedation is in pill form and provides a fully relaxed state. It often erases most memory of the procedure after and has a quick recovery.
While oral sedation provides a very relaxed state, I.V. sedation puts you in a complete sleep state. This is sometimes referred to as “twilight sleep.” I.V. sedation is ideal for people with dental fear or phobia. This sedation is delivered through an I.V. drip, or intravenously. It takes effect rather quickly and patients nod off within minutes. This sedative erases memory of treatment afterward.
Whether given oral or I.V. sedation, comfort and safety are important to us at all times. And, while sedation is helpful when fear or anxiety exist, some people who have no fears at all request sedation for its ability to relax them during lengthy appointments.
While the doctor involved in your treatment is important, much of the potential for a successful result falls into the patient’s hands after the placement process. As a patient, having a successful outcome begins as soon as your implants are placed.
First, closely follow your post-placement instructions. For a few days following placement, most patients are advised to eat only cool, soft foods. This helps to minimize swelling and bleeding, which helps gum tissues to more quickly seal incision sites. This can lower your risk for infection.
Once home, other factors can also place your implants at risk. For example, smokers have a higher risk for implant failure. Because the chemicals in cigarette smoke are very drying to oral tissues, the healing process takes longer. Delayed healing creates a greater risk for infection to occur.
An element of risk that may surprise you is grinding or clenching teeth during sleep, which is typically a symptom of a misaligned bite. Some clenching is so intense the force can be likened to that used to crack a walnut. A sign of night-time clenching or grinding may be worn, chipped or broken teeth. However, even without signs, if you suspect you grind or clench, mention this to your implant dentist prior to treatment. This way, proactive measures can be taken to resolve the problem before complications result.
Most important of all is the patient’s commitment to maintaining good oral hygiene. Although Dental Implants themselves do not experience decay, the gum tissues and bone supporting the implants are as susceptible to oral bacteria as before. When oral bacteria infection (gum disease) penetrates to the implant site positions, the only way to treat the infection may require removing the implant.
In addition to being highly committed to your oral hygiene at home, your dental check-ups may be scheduled for every four months rather than twice a year. During these visits, a hygienist will remove accumulated oral bacteria to reduce risk to your Dental Implants. The condition of your gums will also be assessed.
Dental implants are designed to last a lifetime and are the closest thing to the natural teeth you once had. Too, the restored ability to bite, chew, speak and laugh without worry can be a tremendous boost to one’s self-esteem and self-confidence.
The type of dental implant best suited for you can be determined after an examination and review of x-rays (we use Cone-Beam digital imaging). Call 828-274-9440 to begin with a private, no obligation consultation to discuss your best options.