Dental Implants Not ‘One Size Fits All’


Posted on Sep 21, 2021 by William J. Claiborne, DDS MS

A periodontist specializes in the diagnosis and placement of dental implants, in addition to the treatment of all stages of periodontal disease.

For people who are considering dental implants to replace teeth, this level of expertise provides greater reassurance of successful treatment outcomes. A periodontist can also offer patients with a wider choice of implant systems.

How can patients have more dental implant options through a periodontist?

When general dental offices offer dental implants, some general dentists offer implant selection and placement along with the restoration of the implant. (“Restoration” refers to the replacement crown that is attached to the implanted portion.)

Although generalists complete training in dental implants, most courses are offered by particular implant manufacturers. This means that the course focuses on the systems available through this one maker, which may or may not include the one most appropriate for your individual needs.

This is why most generalists 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 (due to missing natural teeth for many years) benefits from the specialized skills of our Asheville periodontal office. A periodontist can incorporate bone rebuilding procedures into treatment to a proper depth. This specialist can help to restore bone that has occurred in the mandible (lower jaw) or maxilla (upper jaw), which may also require a sinus lift.

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 have an added advantage when it comes to treatment success.

For many reasons, dental implants have become the preferred tooth replacement option. There are over 40 different implant systems, each designed to accommodate various challenges and preferences. Some of the more common types include:


Traditional Dental Implants: In this process, dental implant treatments is done in a couple of stages. In the first stage, placement of each implant is performed. This involves small incisions in pre-selected placement points. In our Asheville periodontal dental office, these points are determined through computerized imaging, taking the guesswork out of the depth and angle of each implant placed. Once the implant is in proper position, the gum tissue is closed over the implant sites.

Several implants can often hold a full arch of teeth

The second stage involves a “healing period” of 3 – 6 months. During this phase, the bone grows around the implant(s) to secure each in place. The patient’s denture or partial denture can be comfortably worn during this time. This process is known as osseointegration, which describes the jaw bone growing around the implanted portion. This is what secures the implant so it provides stable, dependable biting and chewing strength.

After osseointegration is complete, the implant sites are uncovered and a post is positioned in the implant’s interior. Onto the posts, replacement teeth are attached. Once the final teeth are secured, patients can enjoy their confident smile along with the biting and chewing comfort like that of natural teeth.


Non-Removable Teeth Attached To Implants: In the past, the more affordable ‘full arch’ systems were typically those designed to support removable teeth. (An ‘arch’ is a full arrangement of all upper or all lower teeth.) However, some people feel removable teeth are too similar to the denture they wish to replace. Although firmly secured, the chore of having to remove teeth to clean them is a task many people want to eliminate.

A number of affordable implant systems are now available, designed to provide non-removable options that are more affordable. For example, the All On 4 dental implant system is made to support non-removable teeth on just 4 implants. With the implanted portions placed at unique angles, these longer implants can fully distribute biting and chewing forces.
 Another advantage of All On Four is their ability to be placed in minimal bone.

This is good news for people who are long-time denture wearers and were told they have too little bone to support implants. Or, they may have been advised to have bone grafts to rebuild the bone to an adequate height. This adds time and expense to implant treatment. Often, the All On 4 design is able to overcome this obstacle.


‘Same-Day’ Dental Implants: Advancements in dental implant systems and technology have evolved into implant placement and teeth attachment that can be accomplished in a single day. Some implant designs can position implants in the jaw bone in a way that they are able to support replacement teeth immediately.

With the replacement teeth created prior, the teeth may be attached without delay.
 In some cases, a previously-made denture or partial can be reconfigured to attach to newly placed implants. However, mounting replacement teeth to a just-placed implant isn’t wise for certain situations. This option should be diagnosed and performed by an experienced, skilled and highly-trained dental specialist in order to achieve a successful outcome. While “same-day” procedures can sound appealing, choose care where your individual needs are a priority.


Modern implant dentistry is successful, safe, dependable and can provide nearly immediate benefits. Our office enjoys a reputation for being on the cutting edge of implant dentistry’s techniques, technology and materials. This assures our patients of care that minimizes discomfort and treatment time while optimizing their final results.

Dental implants are designed to last a lifetime, making them an excellent investment. They are the closest thing to the natural teeth you once had, restoring the ability to bite, chew, speak and laugh confidently.

Over the years, I have been a witness to the transformations many implant patients undergo after treatment. They seem to smile and laugh more, become more social, and focus on their oral and overall health to a greater extent.

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.

Please know that, if cost is a concern, payment plans can help you enjoy your beautifully restored smile while making easy monthly payments. Too, in many cases, an implant is not needed to replace each missing tooth. Often, when several teeth are missing in one area, one or two implants can support a “bridge” of several teeth. This curtails the treatment costs by reducing the number of implants needed.

If dental fear or anxiety is a concern, please mention this during our consultation. In our Asheville office, our entire team strives to provide a respectful, compassionate environment. We offer oral and I.V. sedation (twilight sleep) for nearly any procedure as well as a gentle touch at every visit.

Misconceptions Of Oral Health


Posted on Sep 14, 2021 by William J. Claiborne, DDS MS

As a periodontal dental specialist, I have advanced skills in the treatment of gum disease and dental implants. In my specialty, I see patients who have various issues related to oral health. Some of these can be resolved with minor treatment and others require more involved procedures.

In many cases, however, a factor in the severity of certain issues occur because it was assumed the problem would resolve itself. Some patients have also assumed that certain signs or symptoms were “normal”.

The health of the mouth is largely reliant on the condition of the gum tissues. This moist, soft covering of tissues is a protective blanket for the structures underneath. Gum tissues protect the structures that support natural teeth as well as their roots.

Yet, because the gums are not visible as are teeth, it is easy to “back burner” problems. Some of these problems DO resolve on their own. However, in too many cases, what is set aside eventually requires extensive treatment; treatment that may have easily been avoided with early care.

I’d like to address some of the more common issues I see that are misconceptions…

Assuming seeing blood in the sink when brushing teeth is normal: Srubbing teeth so rigorously that they bleed is not a sign of doing a good job. This action not only wears away precious tooth enamel, it wears away the gum tissues that wrap the base of teeth.

Gums that bleed when brushing are also a symptom of periodontal (gum) disease. In addition, gum disease can cause tenderness, swelling or frequent bad breath. Without treatment, gum disease will progress further. This is why it is the nation’s leading cause of adult tooth loss.

Protect tooth enamel and gum tissues by using a soft to medium bristled toothbrush and a non-abrasive toothpaste (never substances such as baking soda). Using a swirling motion (rather than going back-&-forth), avoid applying too much pressure. Make sure that the tips of the bristles are contacting the surfaces of teeth. Hint: If you notice your toothbrush’s bristles flay outward after a month or so of use, you’re pressing too hard.

Ignoring gum recession: The gums are designed to snugly wrap the base of each tooth, serving to seal out bacteria. Although the aging process and oral dryness can shrink gum tissues, a common cause of receded gums is gum disease.

Gum recession is what causes sensitivity to hot, cold or the bristles of a toothbrush. Oftentimes, a bite of ice cream can send a jolt of pain. Even without the sensitivity, recession can leave the darker tooth root areas exposed. This leaves the tooth vulnerable to damage by oral bacteria.

Ignoring frequent bad breath: Bad breath is typically a by-product of bacteria build up. Although certain medical conditions can contribute to bad breath, keeping oral bacteria levels under control will minimize the risk of having smelly breath odor.

Saliva is what controls a significant amount of oral bacteria. However, without regular brushing and flossing, bacteria can quickly exceed what saliva is able to manage.

This is why it is important to brush twice daily and floss daily. These small tasks help to control bacteria by removing the sticky buildup of plaque. If not removed, plaque hardens into what is known as tartar. Tartar is a destructive mass of bacteria that can no longer be brushed or flossed away.

Having gum depth measurements of four and over: During regular check-ups, hygienists check gum health by gently using a probe along the base of each tooth. This is done to indicate loosening of gum tissues on the front and back sides of teeth. A good check-up will have no depth measurement higher than a three.

If the depth measures a 4 or 5 (or higher), the gums are not sealing out oral bacteria sufficiently. This may be an indication of gum disease. The higher the number, the more advanced it is.

Assuming tooth loss is normal: Some people assume tooth loss is a natural part of the aging process. This is not accurate. Adults lose teeth due to accidents, decay or (most often) gum disease.

Occasionally, a tooth that needs crowning or filling is deemed a “problem” tooth. This causes some people to want the tooth removed rather than repaired. Yet, missing tooth roots in the jaw bone triggers a process of bone shrinkage. This is known as resorption.

Resorption occurs without the stimulating presence of the tooth root. As the bone declines in height and width, neighboring teeth can also be affected. Adjacent tooth roots in areas of insufficient bone structure are at a higher risk of cavities, gum disease, and tooth breaks or fractures. Statistics show that a tooth adjacent to a missing tooth is most likely the next to be lost.

When a tooth must be removed, we recommend replacing it with a dental implant. Because an implant is positioned in the bone, it helps halt bone loss and protect the well-being of neighboring teeth.

Not reacting to spots on the tongue, lips or inside the cheek: People occasionally develop canker sores inside the mouth. These can be caused by stress or having an acidic diet. Both should go away within ten days or so.

Any spot or change inside the mouth or throat that does not resolve on its own within two weeks should be seen immediately. This may be a sign of oral cancer and may appear as a red or white spot. Or, it may cause hoarseness or difficulty swallowing. If caught early, oral cancer can be successfully treated. Acting promptly is highly important as it can lead to disfiguring treatment and be even deadly.

Assuming oral health is contained in the mouth: It has been shown that having good oral health is an advantage to having good overall health. The potent bacteria of gum disease can enter the bloodstream and cause inflammatory reactions elsewhere in the body. Research has correlated a number of serious health problems with the infectious bacteria of gum disease. These include heart disease, stroke, some cancers, Alzheimer’s disease and arthritis.

As an Asheville periodontist, I believe that adults can improve their oral health by being informed patients and committed to having a healthy smile.

A good resource on maintaining good oral health is the web site of the American Academy of Periodontology: www.perio.org (go to Patient Resources). Or, call our Asheville periodontal dental office at 828-274-9440.

 

 

Be “Sweet” To Your Smile By Monitoring Sugar Intake


Posted on Aug 31, 2021 by William J. Claiborne, DDS MS

If Americans truly calculated the amount of sugar they’ve consumed at the end of each day, I believe most would be shocked. Even unintentionally, sugar intake can easily reach levels that are far beyond what is assumed.

For example, in a 2015 Washington Post article, it was reported that 25 percent of catsup is sugar. Alarmingly, one tablespoon has four grams of sugar, which is more sugar than a typical chocolate chip cookie.

https://www.washingtonpost.com/lifestyle/wellness/do-you-know-how-much-sugar-is-in-your-ketchup/2015/06/02/9496b77e-fe5f-11e4-833c-a2de05b6b2a4_story.html?noredirect=on&utm_term=.67cb41e9706b

The World Health Organization (WHO) recommends a maximum of no more than 10 teaspoons of free sugars per day. Regardless of age, the WHO advises keeping daily sugar consumption to less than 10 percent of calories “to reduce the risk of unhealthy weight gain and dental caries.”

https://www.who.int/news/item/04-03-2015-who-calls-on-countries-to-reduce-sugars-intake-among-adults-and-children

However, our goal in limiting sugar is often sabotaged by hidden sugars.

Sugar comes in far more forms than just the white or brown bags of granular “cane sugar” we purchase in the grocery store. If you read the list of ingredients in foods and beverages, you may be surprised at how many forms of sugar are concealed with different names. At this time, there are more than sixty.

Here’s how to catch some of them:

Added sugar may be listed as syrup (examples are corn syrup or rice syrup) or anything with an ingredient that ends in “ose” (such as fructose, sucrose, maltose, dextrose). Other examples of added sugar include fruit nectars, juice concentrates, honey, agave and molasses.

Ideally, the WHO urges an intake of no more than 6 teaspoons (or less than 5 percent) of sugars per day to “provide additional health benefits.” This is an ambitious goal for Americans who have become literally addicted to sugar.

In a study of lab rats who were provided with a diet of food and intermittent supplies of sugar water, the results showed indications of addiction and symptoms of withdrawal. https://www.sciencedirect.com/science/article/abs/pii/S0149763407000589?via%3Dihub

The study spurned on a succession of additional studies. In one, it was noted that sugar “lights up” the same area of the brain as cocaine.

https://www.businessinsider.com/sugar-has-a-similar-effect-on-the-brain-as-cocaine-2016-4

As a periodontist, I’m especially concerned about sugar intake to the detriment of oral health. Sugar lowers the natural pH levels in saliva and triggers a process that is the beginning of tooth demineralization. Demineralization describes the process where the enamel and tooth structures are dissolved.

Although sugar is not a healthy food choice for any part of the body, it is important to remember that it is the mouth that is the entry point for what we eat or drink. Thus, the destructive nature of sugar begins by causing an imbalance in the mouth through altering the healthy formulation of saliva.

For a minute, think of the foods you consumed yesterday. Coffee with sweetened creamer? Toast with jam? Sweet tea with lunch? A candy bar and cola as a mid-afternoon snack? Catsup over your fries at dinner, followed by a bowl of ice-cream?

When we are conscious of just how much sugar is being consumed over the course of a day, it becomes easier to make better choices. As we taper down little by little, it actually helps us to “wean” off the dependency of sugar so it doesn’t feel like deprivation.

As an Asheville Periodontist, I see patients every day who have periodontal disease, cavities and missing teeth that can be attributed to diet, smoking and insufficient oral hygiene. Many face involved treatment decisions that can be costly and take months to accomplish.

 

Although we pride ourselves on providing our patients with a comfortab

le experience backed by advanced skills and technology, so much of our treatment can be prevented with easy proactive measures. Eating a healthy diet, keeping the mouth moist, brushing and flossing, and seeing a dentist regularly are all practical ways to keep a healthy, confident smile.

Yet, “we don’t know what we don’t know.” Because our population is largely unaware of the extent of sugars in many foods and beverages, it is easy to consume far more than is realized.

Take charge of your oral health by reading food labels, meal planning that limits sugars, and being highly committed to your oral hygiene routine at home. A few tips for a healthy mouth between dental check-ups are:

Brush twice a day (at least) for two minutes each time. Use a fluoride toothpaste with a soft to medium bristle toothbrush.
Floss your teeth every day before your brush to dislodge food particles caught between teeth. If flossing is difficult for you, try one of the water flossers. These are affordable and as effective as manual flossing.
Brush your tongue after your teeth to unroot embedded bacteria, especially reaching the back area of the tongue (where most bacteria are embedded).
• Use an oral rinse that replenishes moisture twice a day (or as directed). These are available at most drug stores.
• Chew sugarless gum, preferably a brand that contains Xylitol. Xylitol looks and tastes like sugar, yet has 40 percent fewer calories.
• Drink plenty of water throughout the day. Be aware that beverages such as most coffee, tea and colas contain caffeine are drying to the mouth. Many medications also have the side effect of oral dryness – another good reason to stay hydrated.

Also, be aware of the signs and symptoms of gum disease. Sore, tender, bleeding, swollen or red gums are all warning signs. With prompt measures, we can greatly minimize treatment needs to rid your mouth of this dangerous bacteria that has been associated with a number of serious health problems (including stroke and some cancers).

If you haven’t seen your general dentist on a regular basis, call 828-274-9440. Our Asheville periodontal office can help to restore your mouth to a healthy state with the most conservative, yet effective, treatment possible.

 

Seniors Have Unique Oral Health Challenges


Posted on Aug 19, 2021 by William J. Claiborne, DDS MS

A friend once told me, “Someone who is a senior is always ten years older than I am.” I loved that, especially since, like most ‘older’ adults, I don’t feel like I’m in my senior years.

Like many individuals who are my age, I like being in the over-55 age group. There are definite advantages to being ‘older and wiser.’ I feel more confident, most self-assured, and more health conscious than I have ever been.

Yet, I am no stranger to the challenges that come with age. No matter how well we eat or how fit we try to stay, the body gradually succumbs to the natural process of aging. Hair thins, eyesight wanes, hearing declines, and flexibility decreases.

Not quite as obvious to many aging adults are the increasing challenges to oral health.

It seems seniors assume that having more aches and pains in joints is to be expected. And, when it comes to the need to replace or repair natural teeth on an ever-increasing basis, it just seems to come with the territory.

As an Asheville periodontist, I can confirm that dental needs do increase as we age. What I can also assure, however is that certain measures can greatly decrease the risks for oral health problems. Most of these are simple, proactive steps that can turn the tables on the potential for tooth loss and oral diseases.

One of the most common contributors to ‘oral aging’ is oral dryness.

It is a fact that we “dry up” as we age. Hair and skin become drier, the cushioning discs between spinal vertebrae shrink and the lubricating coating surrounding joints thins. So, it makes perfect sense that the moist coverage of gum tissues in the mouth is affected as well.

Because of this, the gum tissues that wrap the base of each tooth thin and pull away. As the gums shrink, more area of the natural tooth is exposed. This can leave vulnerable segments of the tooth’s root exposed. When oral bacteria are able to penetrate into this area, teeth are more susceptible to decay.

Too, oral bacteria below the gum line can become infectious. The inflammatory reaction that results can damage the structures that support natural teeth, including bone. Gum disease is the leading cause of adult tooth loss.

The good news? It is actually easy to avoid the repercussions that can result from oral dryness. It’s rather inexpensive and takes mere minutes a day.

First, drink plenty of water. I’m referring to plain, unflavored, unsweetened water. This can be tap or filtered, room temp or chilled. But, water is your most hydrating substance and there is no substitute for it. Colas, tea, coffee, sports drinks or juices do not count. As a matter of fact, many work against you.

The acid and caffeine in many of these are very drying and harmful to tooth enamel as well as challenging to the make-up of saliva. Too, even natural juices contain a sugar, even if it is ‘natural.’ (And adding a squeeze of lemon to water makes it too acidic.)

Next, assess the day-to-day add-in’s your mouth endures. Wine and alcoholic drinks are drying to oral tissues, contain sugar and are more acidic than many people realize. If you indulge in a cocktail, keep a glass of water nearby and take occasional gulps that linger in the mouth before swallowing. This will help dilute the acids and wash out some of the components that are problematic to oral health.

If you have a sweet tooth, don’t think I’m going to tell you to avoid your Snickers bar or bowl of ice-cream. (I’m in your court!) However, think about indulging in your sweet treat just after a meal as a dessert rather than a snack.

The reason is, every time you eat, an acid flows into the mouth through saliva. This is a normal part of early digestion and helps begin the breakdown of food before swallowing. However, this is a potent acid that can actually soften tooth enamel for 20-30 minutes. Thus, if you add your Rocky Road to the end of your dinner as dessert (rather than have it two hours later), you merely extend the acid’s longevity rather than trigger a new acid flow. As with cocktails, try to drink some water following your sweets or swish a couple of times.

Another challenge to oral health for older adults is that they take more medications. It is estimated that 39 percent of seniors take five or more prescriptions each day. (https://www.agingcare.com/articles/polypharmacy-dangerous-drug-interactions-119947.htm) Surprisingly, many have a side effect of oral dryness. Those most commonly associated with oral dryness include antidepressants, decongestants, antihistamines, muscle relaxants and those prescribed for blood pressure. However, there is a long list of meds (both prescriptive and OTC) with a drying side effect. If you take meds that seem to be causing you to have a drier mouth, there are several things you can do.

If your doctor has no medication substitute that has less drying side effects, up your daily water intake. Be sure to brush thoroughly at least twice a day and floss daily. Use an oral rinse that is specially formulated for oral dryness at least once a day. Try to limit your caffeine and alcohol intake. And, chew sugarless gum occasionally during the day, which will help to activate saliva flow.

Keep in mind that teeth are not rocks. Although they seem rock hard, years of use can leave teeth with fractures and cracks. Teeth that are over-filled by cavity repair can finally give way and break. Be conscious of things that can add undue pressure on teeth, such as chewing ice. Remember, too, that teeth are not meant to be tools. Biting down on hard things that are not meant to be chewed is a sure way to fracture or break teeth.

For post-menopausal females, changes to hormonal levels add further to the risks for periodontal disease and tooth loss. Thus, older females have a particular need to maintain excellent oral health. This may be a good reason to have dental check-ups and cleanings every 4 months versus every six. Speak to your general dentist about the best dental hygiene schedule and at-home routine for your individual needs.

The good news is that tooth loss doesn’t have to be a ‘symptom’ of aging. With proper measures, the majority of your natural teeth can last for your lifetime. If you are missing one or more, however, the best option for replacement is dental implants. These help to preserve supporting bone structure and do not rely on neighboring teeth for support. Too, dental implants, properly selected, placed and maintained are an investment designed to last your lifetime.

For optimal oral health and replacement of teeth via dental implants, it is advised to see a periodontal specialist. This is an expert in the care of gum health and a specialist with advanced skills in dental implants. Begin with a consultation with a periodontist to learn what may be advisable to keep your smile in great shape as you age.

Keep in mind that research has shown that having good oral health has a direct impact on your ability to have a healthier you. Your oral health is intricately connected to your body’s immune system and digestive ‘checks and balances’, which is an especially important asset during this time of viral vulnerability.

When your mouth is healthy, you’ll smile more (another benefit to overall health!), your breath will be fresher, your body will have a ‘leg up’ in maintaining good, overall health, and the time and costs for repairs and tooth replacement will be minimized.

Begin with a thorough periodontal examination by a Board Certified Periodontal Specialist. In my speciality, we are able to treat all stages of periodontal (gum) disease and are the experts in the selection and placement of all types of dental implants (including the All On 4 implant system).

Call 828-274-9440 to schedule or to request additional information.

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